摘要
目的比较腰椎后路不同显露方式及棘突重建方式对多裂肌的影响。方法40只健康成年山羊随机分为棘突正中劈开（A组）、棘突切除（B组）、单侧进入棘突切断（C组）及双侧椎旁肌剥离（D组）四组，每组10只。其中C组又分为剥离侧（C1组）和未剥离侧（C2组）两组。以术前腰椎MR扫描图像及另1只山羊L6多裂肌标本作为正常对照。术后10个月行腰椎MR及手术区多裂肌组织学检查。测量双侧多裂肌面积及肌肉面积萎缩比。结果四组均出现不同程度的肌肉萎缩，组织学及MRI评分均低于正常对照，面积萎缩比高于一常对照。A组组织学、MRI评分高于B、C1及D组，面积萎缩比较低。B组组织学、MRI评分低于A、C及D组，而研积萎缩比较高。肌肉未剥离组（A组及C2组）各项评分均优于肌肉剥离组（B组、C1组及D组）。棘突重建组（C1组及D组）各项评分均优于棘突切除组（B组）。术后组织学评分与MRI评分呈正相关，而与面积萎缩比无相关性。结论棘突切除会导致术后严重肌萎缩。减少肌肉剥离范围及重建后路骨-韧带结构可有效减少术中肌肉损伤、预防术后多裂肌萎缩。棘突正中劈开方式肌肉剥离范围小，在预防多裂肌萎缩方面优于剥离肌肉后单纯重建棘突的手术方式。
Objective To assess the effect of different surgical approaches on atrophy of muhifidus muscle occurring after lumbar surgery. Methods Forty aduh goats were randomly divided four groups. Group A underwent a spinous process-splitting procedure to expose the lamina; Group B did the bilateral muhifidus muscles stripped and the spinous process excised： Group C underwent the cutting of the spinous process at the bottom, with unilateral muhifidus muscle stripped （Group C1）, and without stripped （Group C2）; and Group D did the bilateral multifidus muscles stripped. Ten mouths after surgery, the atrophy rates of the cross-sectional areas, the subjective scores of fibrosis and fatty tissue infiltration of the bilateral multifidus muscles on MRI, and the histological assessment were evaluated. Normal multifidus muscles taken from healthy goats at L6 level and the preoperative data of MRI in experimental animals provided control data. Results MRI and histological scores of multifidus muscles from Groups A, B, C1, C2, and D were significantly decreased, and the atrophy rate were significantly higher in comparison to control data. The postoper- ative MRI and histological scores of Group A and C2 were highest and the atrophy rate was lowest, while animals from Group B had highest atrophy rate and lowest MRI and histological scores among all experimental groups （P〈0.05）. The Groups A and C2 achieved lower atrophy rate, higher MRI and histological scores than those from Groups C1 and D which did have muscles stripped （P〈0.05）. The Groups C1 and D which reconstructed spinous process after detachment of muscles represented lower atrophy rate, higher MRI and histological scores than Group B （P〈0.05）. The postoperative histological scores were positively correlated with MRI scores, but it had no correlation with atrophy rate of muhifidus. Conclusion Muhifidus muscle can be effectively protected by reducing the extent of muscle detachment and reconstructing the posterior bone-ligament complex. The spinous process-splitting procedure is an effective method to avoid postoperative muscle atrophy.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2010年第2期203-208,共6页
Chinese Journal of Orthopaedics
关键词
腰椎
病理学
磁共振成像
山羊
Lumbar vertebrae
Pathology
Magnetic Resonance Imaging
Goats
