Wiltse入路在腰椎疾病中的研究进展

Research Progress of Wiltse Approach in Lumbar Spine Disorders

摘要: 本文旨在综述Wiltse入路的历史发展、解剖基础、临床应用、技术革新及研究进展。重点探讨Wiltse入路的临床研究、解剖学研究，关注其手术技术细节与围手术期指标及临床疗效。据现有证据表明，Wiltse入路在腰椎后路手术中能有效完成螺钉置入、减压及植骨融合，与传统入路相比，其临床优势显著，能通过对椎旁肌的保护实现更少的组织损伤、减少术中出血、术后腰背痛、缩短住院时间。该入路已从传统的开放技术通过联合可扩张通道、内镜及导航系统辅助等转变为多元化的微创平台。Wiltse入路已成为腰椎疾病外科治疗的重要微创技术。其核心理念——通过天然解剖入路工作以最大限度地保护椎旁肌功能从而减少术中损伤而获得了强有力的循证医学支持。未来的研究方向应聚焦于复杂病例的适用性、更精细的解剖变异研究，以及不同技术变体间成本效益的比较。

Abstract: This article aims to systematically review the historical development, anatomical basis, clinical applications, technical innovations, and research advancements of the Wiltse approach. The focus is placed on clinical and anatomical studies related to the Wiltse approach, emphasizing its surgical techniques, perioperative indicators, and clinical efficacy. Existing evidence indicates that the Wiltse approach can effectively accomplish screw placement, decompression, and bone graft fusion in posterior lumbar surgeries. Compared to traditional approaches, it demonstrates significant clinical advantages, including reduced tissue trauma through the preservation of paraspinal muscles, decreased intraoperative bleeding, less postoperative back pain, and shorter hospital stays. This approach has evolved from traditional open techniques into a diversified minimally invasive platform, incorporating expandable channels, endoscopic assistance, and navigation systems. The Wiltse approach has become an important minimally invasive technique in the surgical treatment of lumbar spine disorders. Its core principle—working through a natural anatomical pathway to maximize the protection of paraspinal muscle function and minimize intraoperative damage—is strongly supported by evidence-based medicine. Future research should focus on its applicability in complex cases, more detailed studies of anatomical variations, and cost-effectiveness comparisons among different technical variants.