CAJ | 학술논문

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L_6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,面积萎缩比高于正常对照.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,而面积萎缩比较高.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一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.
목적 비교요추후로불동현로방식급극돌중건방식대다렬기적영향.방법 40지건강성년산양수궤분위극돌정중벽개(A조)、극돌절제(B조)、단측진입극돌절단(C조)급쌍측추방기박리(D조)사조,매조10지.기중C조우분위박리측(C1조)화미박리측(C2조)량조.이술전요추MR소묘도상급령1지산양L_6다렬기표본작위정상대조.술후10개월행요추MR급수술구다렬기조직학검사.측량쌍측다렬기면적급기육면적위축비.결과 사조균출현불동정도적기육위축,조직학급MRI평분균저우정상대조,면적위축비고우정상대조.A조조직학、MRI평분고우B、C1급D조,면적위축비교저.B조조직학、MRI평분저우A、C급D조,이면적위축비교고.기육미박리조(A조급C2조)각항평분균우우기육박리조(B조、C1조급D조).극돌중건조(C1조급D조)각항평분균우우극돌절제조(B조).술후조직학평분여MRI평분정정상관,이여면적위축비무상관성.결론 극돌절제회도치술후엄중기위축.감소기육박리범위급중건후로골일인대결구가유효감소술중기육손상、예방술후다렬기위축.극돌정중벽개방식기육박리범위소,재예방다렬기위축방면우우박리기육후단순중건극돌적수술방식.
Objective To assess the effect of different surgical approaches on atrophy of multifidus muscle occurring after lumbar surgery. Methods Forty adult goats were randomly divided four groups.Group A underwent a spinous process-splitting procedure to expose the lamina; Group B did the bilateral multifidus muscles stripped and the spinous process excised; Group C underwent the cutting of the spinous process at the bottom, with unilateral multifidus muscle stripped (Group C1), and without stripped (Group C2); and Group D did the bilateral multifidus muscles stripped. Ten months after surgery, the atrophy rates of the cross-sectional areas, the subjective scores of fibrosis and fatty tissue infiltration of the bilateral multi-fidus muscles on MRI, and the histological assessment were evaluated. Normal multifidus muscles taken from healthy goats at L_6 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 signifi-cantly 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 an-imals 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 recon-structed spinous process after detachment of muscles represented lower atrophy rate, higher MRI and histo-logical 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 multifidus. Conclusion Multifidus muscle can be ef-fectively 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.