脊髓空洞源性脊柱侧凸椎旁肌肌纤维分型及群化的对比研究  

Comparative study on fiber transformation and type grouping of paravertebral muscles in scoliosis associated with syringomyelia

作　　者：邱勇[1] 朱泽章[1] 吴亮[1] 王斌[1] 俞杨[1] 钱邦平[1] 马薇薇[1] 

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华骨科杂志》2006年第5期317-322,共6页Chinese Journal of Orthopaedics

基　　金：南京市科技局人才培养基金资助项目(200306066)

摘　　要：目的分析脊髓空洞源性脊柱侧凸患者椎旁肌肌纤维分型及群化的特征,探讨其与脊柱侧凸发病的关系。方法病例分为三组:脊髓空洞源性脊柱侧凸(SS)组20例,青少年特发性脊柱侧凸(AIS)组16例,非脊柱侧凸(NS)组10例。术中切取两侧椎旁肌组织,统计三组的椎旁肌肌纤维分型及群化,并进行对比。结果SS组凸侧Ⅰ型肌纤维比例和横截面积均小于凹侧,差异无统计学意义;AIS组凸侧Ⅰ型肌纤维比例和横截面积均显著高于凹侧;NS组左、右侧之间差异无统计学意义。各组间比较显示:(1)凸侧Ⅰ型肌纤维所占比例,SS组和AIS组均高于NS组;凹侧Ⅰ型肌纤维所占比例,SS组高于AIS组和NS组。(2)凸侧Ⅰ型肌纤维横截面积,SS组低于AIS组;凹侧Ⅰ型肌纤维横截面积,AIS组低于NS组。(3)凸侧Ⅱ型肌纤维横截面积,SS组<AIS组<NS组;凹侧Ⅱ型肌纤维横截面积,SS组和AIS组均低于NS组。SS组中11例观察到椎旁肌Ⅰ型肌纤维群化,凹侧群化程度大于凸侧,但差异无统计学意义。AIS组中8例观察到凸侧Ⅰ型肌纤维群化,无凹侧肌纤维群化和Ⅱ型肌纤维群化。NS组左、右两侧均未见肌纤维群化。结论SS组患者椎旁肌肌纤维分型及群化的特征与AIS组明显不同,提示椎旁肌存在原发性失神经支配,可能与脊柱侧凸的发生、发展有一定相关性。Objective To study the features of fiber transformation and type grouping of paravertebral muscles and analyze their relationship with the aetiology of scoliosis associated with syringomyelia as compared with AIS and non-scoliotic patients. Methods All the enrolled patients were divided into three groups： SS group consisted of 20 patients with syringomyelia and scoliosis, AIS group included 16 adolescents with idiopathic scoliosis, and NS group was 10 patients without scoliosis. Bilateral biopsy of paravertebral muscles was performed during scheduled spinal surgery. Fiber transformation and type grouping of paravertebral muscles were compared among the three groups. Results The percentage and cross sectional area of type Ⅰ fibers on the convex side were less than those on the concave side in SS group, but without significant difference; and significantly more than those on the concave side in AIS group, respectirely. No significant difference between bilateral type Ⅰ fibers was found in NS group. We also noted that： 1 ）Percentage of type I fibers on the convex side： SS group or AIS group〉NS group; Percentage of type Ⅰ fibers on the concave side： SS group〉AIS group or NS group. 2）Cross sectional area of type Ⅰ fibers on the convex side： SS group〈AIS group; Cross sectional area of type Ⅰ fibers on the concave side： AIS group〈NS group. 3）Cross sectional area of type Ⅱ fibers on the convex side： SS group〈AIS group〈NS group; Cross sectional area of type Ⅱ fibers on the concave side： SS group or AIS group〈NS group. 11 patients in SS group had type Ⅰ fiber grouping. The degree of fiber type grouping on the concave side was more severe than that on the convex side, although without statistical significance. Type Ⅰ fiber grouping was demonstrated in 8 patients of AIS group, all of which happened on the convex side of the curve. Conclusion The features of fiber transformation and type grouping of paravertebral muscles in SS group are different from those in AIS group. I

关 键 词：脊柱侧凸 脊髓空洞症 去神经支配 

分 类 号：R682[医药卫生—骨科学] R744.4[医药卫生—外科学]