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目的探讨 Wiltse 入路与后正中入路 TLIF 手术治疗腰椎间盘突出症临床疗效及术后相邻节段退变是否存在差异。方法2014年6月至2015年6月，我科对100例腰椎间盘突出症患者采用 TLIF 手术治疗，按入院顺序编号利用 SPSS 软件随机采用 Wiltse 入路和后正中手术入路两种方法进行。90例获随访，其中Wiltse入路46例，后正中入路44例。比较两组术前、术后1天肌酸激酶值( creatine kinase，CK )，术前、术后3个月及终末随访的疼痛视觉模拟评分( visual analogue scale，VAS )和 Oswestry 功能障碍指数( oswestry disability index，ODI )，术前、终末随访多裂肌脂肪浸润评分和融合节段相邻上位椎间盘修正 MRI指数。结果所有患者均无定位错误、神经损伤、脑脊液漏、椎间隙感染等严重并发症，随访时间11～23个月，平均(15.8±3.7)个月，Wiltse入路组术前、术后1天CK分别为(83.84±24.79) U/L，(164.26±23.74) U/L；后正中手术入路组术前、术后1天CK分别为(79.93±23.50) U/L，(419.27±40.94) U/L。Wiltse 入路组术前、术后3个月和终末随访 VAS 评分分别为(7.00±1.23)分，(1.52±0.67)分，(1.48±0.51)分；后正中手术入路组术前、术后3个月和终末随访 VAS 评分分别为(7.27±1.24)分，(2.09±0.61)分，(2.18±0.66)分。Wiltse入路组术前、术后3个月和终末随访ODI评分分别为68.26±8.97，22.78±4.30，22.96±3.95；后正中手术入路组术前、术后3个月和终末随访 ODI 评分分别为69.18±9.83，27.55±2.82，27.82±3.54。Wiltse 入路组术前、终末随访多裂肌脂肪浸润评分分别为(1.26±0.45)分，(1.35±0.57)分；后正中手术入路术前、终末随访多裂肌脂肪浸润评分分别为(1.36±0.49)分，(2.05±0.58)分；Wiltse入路组术前、终末随访融合节段相邻上位椎间盘修正MRI指数分别为69.98±16.68，68.85±12.38；后正中手术入路术前、终末随访融合节段相邻上位椎间盘修正 MRI 指数分别为67.98±14.84，55.19±11.99。两组术前CK、VAS、ODI、多裂肌脂肪浸润评分、融合节段相邻上位椎间盘修正MRI指数的差异无统计学意义，两组术后1天CK、术后3个月VAS、终末随访VAS、术后3个月ODI、终末随访ODI、终末随访多裂肌脂肪浸润评分、终末访融合节段相邻上位椎间盘修正MRI指数差异有统计学意义。Wiltse手入路组在术后疼痛、疗效、多裂肌损伤和融合节段相邻上位椎间盘退变情况比后正中入路组具有优势。结论在腰椎间盘突出患者行TLIF手术的治疗过程中，Wiltse手术入路比后正中入路具有优势，延缓融合相邻节段退变，提高患者的生活质量。“,”Objective To investigate the clinical effects and the differences of adjacent segment degeneration between Wiltse approach and posterior midline approach in the treatment of lumbar disc herniation by transforaminal lumbar interbody fusion ( TLIF ). Methods A total of 100 patients with lumbar disc herniation were treated with TLIF between June 2014 and June 2015. Each patient had a serial number according to admission order and were treated by Wiltse approach or posterior midline approach at random by the SPSS software. Ninety patients were followed up, including 46 patients treated by Wiltse approach and 44 patients treated by posterior midline approach. The 2 groups were compared in creatine kinase ( CK ) value, visual analogue scale ( VAS ) score, Oswestry disability index( ODI ) score, fatty inifltration score of the multiifdus muscle and modiifed MRI index of the upper adjacent segment preoperatively, postoperatively and at the ifnal follow-up. Results All the patients had no positioning errors, nerve injury, cerebrospinal lfuid leak, disc space infection or other serious complications. The average time of follow-up was ( 15.8 ± 3.7 ) months ( range:11-23 months ). The CK values preoperatively and at 1 day after the operation were ( 83.84 ± 24.79 ) U/L and ( 164.26 ± 23.74 ) U/L respectively in Wiltse approach group, which were ( 79.93 ± 23.50 ) U / L and ( 419.27 ± 40.94 ) U / L respectively in posterior midline approach group. The VAS scores preoperatively, at 3 months after the operation and at the ifnal follow-up were 7.00 ± 1.23, 1.52 ± 0.67 and 1.48 ± 0.51 respectively in Wiltse approach group, which were 7.27 ± 1.24, 2.09 ± 0.61 and 2.18 ± 0.66 in posterior midline approach group. The ODI scores preoperatively, at 3 months after the operation and at the ifnal follow-up were 68.26 ± 8.97, 22.78 ± 4.30 and 22.96 ± 3.95 respectively in Wiltse approach group, which were 69.18 ± 9.83, 27.55 ± 2.82 and 27.82 ± 3.54 respectively in posterior midline approach group. The fatty inifltration scores of the multiifdus muscle preoperatively and at the ifnal follow-up were 1.26 ± 0.45 and 1.35 ± 0.57 respectively in Wiltse approach group, which were 1.36 ± 0.49 and 2.05 ± 0.58 respectively in posterior midline approach group. The modiifed MRI index of the upper adjacent segment preoperatively and at the ifnal follow-up were 69.98 ± 16.68 and 68.85 ± 12.38 respectively in Wiltse approach group, which were 67.98 ± 14.84 and 55.19 ± 11.99 respectively in posterior midline approach group. No statistically significant differences were found between the 2 groups in CK value, VAS, ODI, fatty infiltration score of the multiifdus muscle and modiifed MRI index of the upper adjacent segment preoperatively, but there were statistically signiifcant differences between the 2 groups in CK value at 1 day after the operation, VAS and ODI at 3 months after the operation and at the ifnal follow-up and fatty inifltration score of the multiifdus muscle and modiifed MRI index of the upper adjacent segment at the ifnal follow-up. Wiltse approach was superior to posterior midline approach in postoperative pain, curative effects, multifidus muscle injury and degeneration of the upper adjacent segment. Conclusions Compared with posterior midline approach, the treatment of lumbar disc herniation by TLIF through Wiltse approach has more advantages, which can delay adjacent segment degeneration and promote the quality of patients’ life.