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[目的]比较肌间隙加传统入路的混合手术入路和双侧传统入路对腰椎内固定术中腰背肌损伤及术后患者恢复情况的影响.[方法]回顾性队列研究,混合入路组为肌间隙+传统入路,双侧传统组为匹配的双侧传统入路组.减压和融合均在单侧进行.测量术前肌酸激酶(CK)、谷草转氨酶(AST)、VAS和ODI评分.记录手术时间、术中出血量,术后第1和第3d的CK、AST,术后48 h内引流量、术后3d经B超测定的伤口积液量,术后5d、3个月、1年的VAS和ODI评分,术前和术后1年在MRI上测量双侧多裂肌面积,并比较肌肉的萎缩率.[结果]2012年1月～2013年12月,共有32例患者接受了混合入路手术,同期匹配的双侧传统组患者有43例.两组术前各项指标无显著差异,包括年龄、CK、AST、VAS和ODI评分等.两组的手术时间、术中出血量相似.术后48 h融合侧的引流量无显著差异,但融合对侧差异有统计学意义(P＜0.05).术后第1d的CK差异有统计学意义(P＜0.05),而第3d无显著差异.术后第5d的VAS和ODI评分差异有统计学意义(P＜0.05),术后3个月和1年的VAS和ODI评分差异无统计学意义(P＞0.05).两组术后1年经MRI测量的多裂肌面积的萎缩率,在融合对侧差异有统计学意义(P＜0.05).[结论]无需特殊手术器械可经肌间隙加传统入路手术治疗腰椎退行性疾病,且能减轻手术对多裂肌的损伤,有利于患者术后恢复.“,”[Objective] To investigate the clinical outcome of combined Wiltse approach and conventional approach for the treatment of lumbar degenerative disease,as well as its influence on postoperative recovery and muscle injury.[Methods] From Jan 2011 to Dec 2013,32 patients with lumbar degenerative diseases received combined Wiltse and conventional approach surgery as the trial group,other 43 patients were given bilateral conventional approach surgery as the control group.Decompression and fusion was performed unilaterally.Operation time,blood loss,drainage volume within 48 hours,creatine kinase (CK),aspartate aminotransferase (AST),visual analog scale (VAS),Oswetry disability index (ODI) were measured for evaluation of the outcome.In addition,the area of bilateral multifundi was measured in MRI,and the shrink rates of multifundus were compared between two groups.[Results] Before surgery,there were no significant difference between two groups in age,CK,AST,VAS and ODI (P＞0.05).Intraoperatively,the operation time and blood loss were also similar in the both groups.The drainage volume on fusion side within 48 hours after operation showed no significant difference,but the contralateral drainage volume proved significant difference (P＜0.05).CK was significantly different at 1 day postoperatively,however the difference was diminished at 3 days after operation between the two groups.VAS and ODI also indicated significant differences between the two groups at 5 days postoperatively,but they become unremarkable at 3 month and 1 year after operation.Compared to the control group,the shrink rate of multifundus at fusion-contralateral sides was significantly decreased in the trial group (P＜0.05).[Conclusion] The combined Wiltse approach and conventional approach is feasible for the treatment of lumbar degenerative diseases with advantages of minimizing muscle injury during operation and facilitating postoperative recovery.