多裂肌间隙与传统入路治疗腰椎间盘突出症对多裂肌影响的对比研究

发布时间：2019-05-12 11:03

【摘要】：目的:对比研究经多裂肌肌间隙入路与传统后正中入路术式在腰椎间盘突出症(TLIF)手术中对脊椎旁多裂肌损伤程度的差别,为多裂肌间隙入路术式的临床应用提供理论依据。方法:1,采用前瞻性对比研究,选取2013年3月~2014年6月40例在郴州市第一人民医院住院并接受手术治疗的腰椎间盘突出症患者,入选患者随机分A、B两组,A组20例采用经多裂肌间隙入路,B组20例采用传统后正中入路,观察指标:1术前、术后1周、术后1年行腰椎MRI检查,取手术节段腰椎轴位像,测量手术节段多裂肌横截面积并对其进行比较。2术后(1个月,3个月,12个月)随访行手术节段多裂肌肌内肌电图检查,对其结果进行比较。3收集两组患者手术时间、术中出血量、术后引流量进行比较。4收集术前和术后当天、1周、1年视觉模拟疼痛评分(VAS评分)进行比较。结果:1、A组在手术时间、术中出血量、术后引流量、及术后VAS评分低于B组,两组比较差异具有统计学(P0.05)。2、术后手术节段多裂肌肌电图检查,A组出现失神经纤颤电位少于传统正中手术入路组,多裂肌间隙组术后1个月、3个月、12个月出现异常肌电图波形分别为10例、6例、6例。而传统组20例术后1个月、3个月、12个月均出现异常波形。差异具有统计学意义。(P0.05)。3、两组患者术前、术后1周、术后12个月手术节段多裂肌横截面积比较,多裂肌间隙组(A组)术前1074.85±54.39 mm2,术后1周1086.85±54.70mm2,术后1年976.69±9.61mm2。传统组(B组):术前1115.83±67.98mm2,术后1周1420.25±2.91 mm2,术后1年714.66±6.24mm2。术前无统计学意义(P0.05),术后1周两组手术节段多裂肌横截面积大于正常值(术前值),但多裂肌间隙组多裂肌增大程度小于传统组,1年后传统组多裂肌明显萎缩,而多裂肌间隙组萎缩不明显,多裂肌组多裂肌横截的变化率不大,而传统后正中入路组多裂肌横截面积的变化率明显增大,两组变化率比较差异有统计学意义(P0.05)。结论:多裂肌间隙入路(A组)与传统入路(B组)手术治疗腰椎间盘突出症对多裂肌均有损伤,手术疗效相似。但多裂肌间隙入路手术方式避免了对椎旁多裂肌的剥离,减少了术中出血量及电刀的使用,明显降低了手术早期多裂肌的损伤程度及远期多裂肌的萎缩程度以及腰背痛的发生率,与传统入路相比具有优势。
[Abstract]:Aim: to study the difference of the injury degree of paraspinal polycleft muscle between the intermuscular approach and the traditional posterior median approach in (TLIF) operation for lumbar disc herniation, so as to provide the theoretical basis for the clinical application of the intermuscular approach for the treatment of lumbar disc herniation. Methods: 1. From March 2013 to June 2014, 40 patients with lumbar disc protrusion who were hospitalized and treated surgically in Chenzhou first people's Hospital were randomly divided into two groups. Group A (n = 20) was treated with posterior median approach, and group B (n = 20) was treated by posterior median approach. The outcome indexes were as follows: (1) preoperative, 1 week and 1 year after operation, MRI of lumbar spine was performed, and axial images of operative segments were obtained. After operation (1 month, 3 months, 12 months), the intramuscular electromyography (EMG) of the operation segment was followed up and the results were compared. (3) the operation time of the two groups was collected, the operation time of the two groups was collected, the operation time of the two groups was collected, and the operative time of the two groups was collected. 4 the visual analogue pain score (VAS) was collected before and on the day of operation, 1 week and 1 year. Results: 1 the operation time, intraoperative bleeding volume, postoperative drainage volume and postoperative VAS score in group A were lower than those in group B, and there was significant difference between the two groups (P 0.05). The potential of denervated fibrillar in group A was lower than that in the traditional median approach group. The abnormal electromyography waveforms were found in 10 cases, 6 cases and 6 cases respectively at 1 month, 3 months and 12 months after operation in the multi-fissure muscle space group. In the traditional group, abnormal waveforms appeared 1 month, 3 months and 12 months after operation. There was significant difference between the two groups (P 0.05). 3. The cross section area of multilobed muscles in the two groups was 1074.85 卤54.39 mm2, before operation, 1 week after operation and 12 months after operation, and 1074.85 卤54.39 min before operation in group A. 1086.85 卤54.70mm 2 1 week after operation and 976.69 卤9.61 mm 2 1 year after operation. Traditional group (group B): 1115.83 卤67.98mm2 before operation, 1420.25 卤2.91mm ~ 2 1 year after operation, 714.66 卤6.24mm ~ 2. 1 year after operation, 1420.25 卤2.91mm ~ (- 1) mm2,. There was no significant difference before operation (P 0.05). One week after operation, the cross section area of multi-split muscle in the two groups was larger than the normal value (pre-operation value), but the enlargement degree of multi-split muscle in the multi-split muscle space group was smaller than that in the traditional group, and one year later, the multi-split muscle in the traditional group was significantly atrophied. However, the atrophy was not obvious in the multi-fissure muscle space group, and the change rate of the multi-split muscle cross section was not significant in the multi-lobar muscle space group, but the change rate of the multi-split muscle cross section area in the traditional median approach group was significantly increased, and there was significant difference between the two groups (P 0.05). Conclusion: the surgical treatment of prolapse of lumbar intervertebral disc by the interspace approach (group A) and the traditional approach (group B) is similar to that of the other two approaches (group A) and the traditional approach (group B) in the treatment of prolapse of lumbar intervertebral disc. However, the method of operation through the interspace approach avoids the stripping of the paravertebral muscle, reduces the amount of bleeding during the operation and the use of the electric knife. It significantly reduced the degree of multi-split muscle injury in the early stage of operation, the degree of long-term atrophy of multi-split muscle and the incidence of low back pain, which was superior to the traditional approach.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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