摘要
目的：对比研究Wiltse肌间隙入路与经多裂肌入路术式,在单节段小切口经椎间孔腰椎椎体间融合（TLIF）术中,对脊旁多裂肌损伤程度的差别,为肌间隙入路术式的临床应用提供理论支持.方法：自2009年8月至2011年2月,应用小切口TLIF术治疗一组连续的单侧下肢症状腰椎退行性病变患者共46例.减压侧统一通过经多裂肌肌内入路,非减压侧随机分组,住院日奇数患者实施肌间隙入路,住院日偶数患者实施肌内入路.肌间隙入路组22例,男13例,女9例;年龄36～74岁,平均（52.7±9.2）岁;L3,4病变1例,L4,5病变12例,L5S1病变9例.肌内入路组24例,男11例,女13例;年龄32～72岁,平均（51.8±8.7）岁;L3,4病变2例,L4,5病变14例,L5S1病变8例.记录两组病例的非减压侧手术时间,术中出血,术前及术后1、6、12个月VAS疼痛评分,比较两组差异.所有患者术后12个月进行MRI复查,并进行手术节段水平多裂肌净横截面积和T2信号强度比率测量,组内和组间比较两种术式多裂肌萎缩及脂肪化退变差异.结果：两组病例的年龄、性别、原始病变、切口缝合时间无显着差别,而肌间隙入路组术中出血、皮肤切口至置钉完毕时间明显低于肌内入路组（P〈0.01）.两组非减压侧,术前VAS分值无明显差别;而术后1、6、12个月,肌间隙入路组VAS分值明显低于肌内入路组（P〈0.01）.组内配对比较和组间比较,肌间隙入路术后多裂肌净横截面积减小百分率和T2信号强度比率增加百分率均明显小于肌内入路术式（P〈0.01）.结论：与肌内入路术式相比,肌间隙入路术式具有出血少、入路简单、置钉容易、对脊旁肌多裂肌损伤小和临床疗效好等优点.
Objective：To study differences of multifidus muscle injury between Wiltse intermuscular approach and intra-muscular stripping approach in one-level small incision transforaminal lumbar interbody fusion （TLIF） surgery.Methods：A total of 46 patients with unilateral lumbar degenerative disease underwent small incision TLIF from August 2009 to February 2011 by one group of surgeons at a single institution.The decompression side of all patients adopted intra-muscular stripping approach;for the non-decompression s ide,22 patients adopted Wiltse intermuscular approach（group A）,and 24 patients adopted intra-muscular striping approach（group B）.In group A,there were 13 males and 9 females,ranging in age from 36 to 74 years old,averaged 52.7±9.2;1 patient had disease in L3,4,12 in L4,5 and 9 in L5S1.In group B,there were 11 males a nd 13 females,ranging in age from 32 tio 72 years old,averaged 51.8±8.7;two patients had disease in L3,4,14 in L4,5,and 8 in L5S1.The following data were compared between the 2 groups：surgical time from skin inci sion to completion of pedicle screw placement,suturation time,blood loss.Clinical effects were evaluated by VAS score pre-operatively,as well as 1,6 and 12 months post-operatively.At the latest follow-up,all the patients were evaluated by MRI.This enabled the cross-sectional area （CSA） of lean multifidus muscle, and the T2 signal intensity ratio of multifidus to psoas muscle,to be compared at the operative level.Results：There was no obvious difference in suturation time,but less surgical time from skin incision to completion of pedicle screw placement,less blood loss,less postoperative back pain in Wiltse intermuscular appr oach group.For the comparison between the two groups or paired comparison between sides in the Wiltse group,the reduction of lean CSA and increase in the multifidus：psoas T2 signal intensity ratio were all significant lower in Wiltse intermuscular approach group or side.Conclusion：The Wiltse intermuscular approach is an easy way for pedicle screw placement,and caused less paraspinal muscle damage than intra-muscular stripping approach,and had positive effects on less back pain.
出处
《中国骨伤》
CAS
2013年第9期735-740,共6页
China Journal of Orthopaedics and Traumatology
关键词
脊柱融合术
腰椎
外科手术
病例对照研究
Spinal fusion
Lumbar vertebrae
Surgical procedures,operative
Case-control studies
