摘要
背景:微创与传统开放手术效果的比较,目前仅涉及患者症状、体征、切口大小及手术出血量、术后影像学等方面的变化,无法确切表达微创优点。目的:以竖脊肌组织病理学变化为量化标准,比较经皮微创与传统开放腰椎后路手术的效果。方法:24只兔随机分为3组,开放手术组自髂棘平面起沿棘突向头侧端做7cm皮肤切口,沿棘突两旁剥离竖脊肌,牵开竖脊肌,维持0.5h和一定压力;微创组在第5,7腰椎棘突中线旁两侧0.5～1.0cm分别插入导针至腰椎板位置,沿导针置入逐级扩张和工作通道,器械到位后维持0.5h;正常对照组不进行任何干预。分别于术后3d、1,2,3周及1,3,6个月,取手术区域椎板附近深部竖脊肌肌肉标本进行病理组织学检测及透射电镜观察。结果与结论:开放手术组早期呈现不同程度的横纹肌细胞间水肿、炎细胞浸润、蜡样变性及液化性坏死,肌组织的坏死逐渐明显,并出现片状的小群状肌萎缩或肌纤维同型化,后期主要是肌纤维同型性成群、萎缩、大小变异以及少量中央核肌纤维再生,明显的脂肪浸润、单核增生、间质浸润以及瘢痕形成;电镜下超微结构改变与光镜结果一致,可见肌纤维排列紊乱,部分溶解,线粒体肿胀,脂肪变性,大量的胶原纤维和成纤维细胞增生。微创组早期呈现轻度炎细胞浸润,肌组织坏死不明显,后期肌纤维大小及构成比例接近正常对照组,瘢痕化、脂肪化也不明显。提示手术创伤程度与竖脊肌的组织学改变密切相关,经皮微创手术可以明显降低腰椎后路手术对于竖脊肌肉的损伤。
BACKGROUND：Minimally invasive surgery displays differences in symptoms,signs,incision size,bleeding,and postoperative imaging from conventional open approach. However,these do not exhibit advantages of minimally invasive surgery. OBJECTIVE：With erector muscle of spine histopathological changes as quantification standard to compare effects of percutaneous and conventional open approach for posterior lumbar surgery. METHODS：A total of 24 rabbits were randomly assigned to three groups. In conventional group,a 7-cm incision was made from spina iliace plane to rostral end along spinous process,and erector muscle of spine was tracted for 0.5 hours under certain pressure. In the percutaneous group,the guide pin was inserted into lumbar vertebral lamina,0.5-1.0 cm from midline of 5th and 7th spinous process,expansion and working channels were implanted through the guide pin,and device was implanted and maintained for 0.5 hours. The control group was not treated. Morphological change of the erector spinae was observed by light microscope and transmission electron microscope at 3 days,1,2,3 weeks,and 1,3,6 months after surgery. RESULTS AND CONCLUSION：For conventional group,the pathological changes of muscle fiber included the intercellular edema,inflammatory cell infiltration,even cerosis,colliquative necrosis in the early stage. By one week postoperatively the muscle fiber necrosis was gradually obvious,regeneration of muscle fibers and neuromuscular junction began at the presence of fiber atrophy and fiber type grouping. The late pathohistological examinations showed fiber atrophy and type grouping,centronucleus fiber regeneration,severe adipose infiltration,monocyte hyperplasy,mesenchyme infiltration and fibrosis,muscle fibers almost replaced by connective tissues or scar. The ultrastructure examinations showed a parallelism with histological examinations. Muscle fiber derangement,myofibril dissolution,swollen mitochondrial,adipose degeneration,numerous collagen fibers and fibroblast proliferation were presented in conventional group. For percutaneous group,the erector spinae presented gently inflammatory cell infiltration and not severe fiber necrosis in the early stage. Late morphological change did not show severe adipose infiltration or fibrosis,the constituent ratio and cross-sectional area of muscle fiber were similar to control group. The morphological change of erector spinae has close relationship with the degree of surgical trauma,and the percutaneous surgery can reduce the injury of erector spinae.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2010年第39期7307-7310,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
