经肌间隙入路或后正中入路行腰椎融合术的效果及其对椎旁肌损伤的影响

Impact of intrasacrospinal muscular approach or midline approach on paraspinal muscle during lumbar interbody fusion

中文关键词:  肌间隙入路  腰椎融合术  肌酸磷酸激酶  椎旁肌

英文关键词:Intrasacrospinal muscular approach  Lumbar interbody fusion  Creatine phosphokinase  Paraspinal muscle

中文摘要:

  【摘要】 目的：比较经后正中入路与经肌间隙入路行腰椎融合术的效果及其对椎旁肌损伤的影响程度。方法：选择2010年6月～2011年8月收治的行单节段腰椎融合术患者40例，根据手术入路不同分为肌间隙入路组（A组）和后正中入路组（B组），每组20例。测量两组患者术前、术后24h外周血中肌酸磷酸激酶（CK）浓度，在肌肉暴露后即刻、术后（松开牵开器后）提取肌肉标本，测定组织内CK浓度，记录术中肌肉牵拉时长、手术时间、手术出血量、术后引流量，采用视觉模拟评分（VAS）评价术前、术后1个月及术后6个月腰痛及腿痛评分。术后进行1年以上的随访，观测椎间隙植骨融合情况。结果：两组患者全部完成术后1个月、6个月的定期随访，随访时间为14～25个月，平均18个月。末次随访时所有患者均达到骨性融合。A组与B组比较，术中出血量、术后引流量少（P<0.01）， 患者手术时间、术中肌肉牵拉时间无明显差异（P>0.05）。两组患者椎旁肌及外周血CK水平术前无明显差异（P>0.05）；术前与术后比较，均有显著性差异（P<0.01）；术后A组椎旁肌组织内CK降低幅度小于B组（P<0.05）， 术后外周血CK升高幅度A组与B组比较无明显差异（P>0.05）。两组患者腰痛及腿痛VAS评分术后1个月、6个月较术前比较均有显著性差异（P<0.01），A组腰痛VAS评分术后1个月、6个月较术前缓解程度大于B组（P<0.01），腿痛VAS评分术后1个月、6个月较术前缓解程度与B组比较无明显差异（P>0.05）。结论：经肌间隙入路行腰椎融合术有着对椎旁肌损伤小、术中及术后出血少、术后恢复快的优点，较经后正中入路手术有着明显的优势。

英文摘要:

  【Abstract】 Objectives: To compare the impact of paraspinal muscle through intrasacrospinal muscular approach vs midline approach for lumbar interbody fusion. Methods: 40 cases undergoing single level lumbar spine fusion from June 2010 to August 2011 were reviewed retrospectively. All cases were divided into intrasacrospinal muscular approach group(n=20) and midline approach group(n=20). The creatine phosphokinase(CK) levels of peripheral blood preoperatively and 24 hours after operation and the CK levels in paraspinal muscles were measured when the muscles were immediately exposed and the retractor was just loosened in two groups. The muscle strain time, operation time, the amount of blood loss and post-operative drainage and the VAS score of low back and leg pain preoperatively, 1 month and 6 months after operation were recorded. All case were followed up for more than one year to evaluate fusion status. Results: All cases were followed up for 14-25 months, with an average of 18 months. All patients had bony fusion. For intrasacrospinal muscular approach group, there were less blood loss and post-operative drainage and less change of the muscle CK level(P<0.01), VAS of back pain at both 1 month and 6 months after operation showed better results for intrascrospinal approach(P<0.01) but no difference for leg pain VAS between two groups(P>0.05). There was no significant difference in peripheral blood CK changes in two groups(P>0.05). Conclusions: The intrasacrospinal muscular approach for lumbar interbody fusion is better in less injury to paraspinal muscle, less blood loss and less post-operative drainage, which contributes a rapid recovery.