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目的:比较经Wiltse入路选择性减压及短节段融合与传统后正中入路全节段减压及长节段融合治疗多节段腰椎管狭窄并腰椎失稳的临床疗效。方法:协和江南医院脊柱骨科自2017年12月至2020年2月共收治多节段腰椎管狭窄并腰椎失稳66例，其中男36例，女30例，年龄范围54～79岁，平均年龄61.8岁，病程8个月～4.5年，平均病程2.5年，随访时间12～39个月，经Wiltse入路31例，行选择性减压及短节段融合术(A组)，传统后正中入路35例，行全狭窄节段减压及长节段融合术(B组)，比较两组患者手术时间、术中出血量、术后引流量、术后卧床时间、住院天数，采用疼痛视觉模拟评分(VAS)和日本矫形外科学会评分(JOA)、Oswestry功能障碍指数(ODI)等标准评价其临床疗效。所有数据均采用SPSS 26.0统计软件统计分析，组间比较采用n t检验，计数资料采用n χ2检验，以n P<0.05为差异有统计学意义。n 结果:66例病例都获得随访，随访时间12～39个月，平均27.8个月，A组与B组手术时间[(158.5±57.2) min比(261.3±47.6) min]、术中出血量[(250.8±50.7) ml比(468.5±60.2) ml]、术后引流量[(105.4±48.2) ml比(205.2±50.7) ml]、下床活动时间[(2.5±0.5) d比(5.5±1.5) d]、住院时间[(7.5±1.8) d比(10.5±1.3) d]方面比较，A组明显优于B组，差异有统计学意义(n t＝7.967、15.777、8.167、10.617、7.825，n P<0.05)，融合节段占比分别为45.3%(34/75)、100.0%(87/87)，两组患者的VAS、JOA及ODI评分均较术前改善明显(A组n t＝27.529、28.112、17.608，B组n t＝30.815、23.342、16.722，n P<0.05)，差异有统计学意义，两组间比较，A组明显优于B组(n t＝6.696、10.491、4.251，n P<0.05)，差异有统计学意义，截止末次随访，两组间病例椎间植骨均融合，无严重并发症。n 结论:经Wiltse入路行选择性减压及短节段融合术治疗多节段腰椎管狭窄并腰椎失稳，具有创伤小，失血少，早下床，恢复快等特点。“,”Objective:To compare the clinical efficacy of selective decompression and short-level fusion by Wiltse approach via the full-level decompression and long-level fusion by the traditional posterior median approach in the treatment of multilevel lumbar spinal stenosis with lumbar instability.Methods:From December, 2017 to February, 2020, A total of 66 cases of multilevel lumbar spinal stenosis complicated with lumbar instability were admitted to our department, including 36 males and 30 females (aged 54-79 years, average age 61.8 years, course of disease 8 months-4.5 years, average course of disease 2.5 years, follow-up time 12-39 months). Group of Selective decompression and short segment fusion by the Wiltse approach included 31 patients (Group A). group of full-level decompression and long-level fusion by the traditional posterior median approach included 35 patients (Group B). Two groups were compared by operation time, blood loss, Postoperative drainage, Postoperative bed time, Hospitalization days, fusion rate, visual analogue score (VAS), Japanese orthopedic association (JOA), oswestry disability index (ODI) and other standards to evaluate the clinical efficacy.All data were analyzed using SPSS 26.0 statistical software.Results:All 66 patients were followed up for 12 to 39 months, with an average of 27.8 months. Group A between Group B: operation time (158.5±57.2) minutes vs. (261.3±47.6) minutes, blood loss (250.8±50.7) ml vs. (468.5±60.2) ml, Postoperative drainage (105.4±48.2) ml vs. (205.2±50.7) ml, Postoperative bed time (2.5±0.5) d vs. (5.5±1.5) d, Hospitalization (7.5±1.8) d vs. (10.5±1.3) d, n t values were 7.967, 15.777, 8.167, 10.617, 7.825, respectively, and the difference was statistically significant (n P<0.05). Fusion segment proportion in group A and group B was 45.3% (34/75) and 100% (87/87), respectively .Group A was superior to group B in the scores (VAS, JOA and ODI) after operation (n t values of 6.696, 10.491 and 4.251, respectively: n P<0.05). By the last follow-up, intervertebral bone grafts were all fused in group A and goup B without serious complications.VAS, JOA and ODI scores in two groups were significantly improved compared with those before operation,n t values of group A were 27.529, 28.112, 17.608, and group B were 30.815, 23.342, 16.722, respectively, the difference was statistically significant (n P<0.05). The comparison between the two groups showed that group A was significantly better than group B, withn t value of 6.696, 10.491 and 4.251, respectively, and the difference was statistically significant (n P<0.05). By the last follow-up, intervertebral bone grafts were fused between the two groups without serious complications.n Conclusion:Selective decompression and short segment fusion by the Wiltse approach in the treatment of multilevel lumbar spinal stenosis with lumbar instability is a better treatment method, which has the characteristics of less trauma, less blood loss, early getting out of bed and quick recovery.