经皮与开放手术治疗胸腰椎骨折术中椎旁肌细胞应激反应的比较研究  

A comparative study of stress reaction in paraspinal muscle cells during the open and percutaneous operation for thoracolumbar fractures respectively

作　　者：倪文飞[1] 尹丽慧[1] 池永龙[1] 徐华梓[1] 林焱[1] 李驰[1] 

机构地区：[1]温州医学院附属第二医院

出　　处：《浙江创伤外科》2008年第1期6-8,共3页Zhejiang Journal of Traumatic Surgery

摘　　要：目的比较传统开放手术与经皮微创手术治疗胸腰椎骨折对椎旁肌细胞的急性损伤程度。方法经皮手术组与开放手术组患者各15例,分别在肌肉暴露后即刻、肌肉牵开后0.5、1、1.5小时及松开牵开器后,共5个时段提取肌肉标本,免疫组化方法测定细胞HSP70表达,比色法测定细胞MDA含量,分析两种术式对椎旁肌细胞造成的应激反应。结果开放手术组椎旁肌细胞MDA含量在肌肉牵开后0.5小时无明显变化,1.0小时组有显著升高,1.5小时组达到高峰,松开牵开器后仍维持在较高的水平。经皮手术组椎旁肌细胞MDA含量在手术各个时间段均没有显著升高。开放手术组椎旁肌HSP70阳性细胞数在肌肉牵开后0.5小时即明显增多,1.5小时组达到高峰,而松开牵开器后出现明显减少趋势。经皮手术组椎旁HSP70阳性细胞数在手术各个时间段均没有显著变化。结论与经皮微创手术相比,传统开放手术造成椎旁肌细胞严重应激反应,提示其对椎旁肌产生严重急性损伤。Objective To compare acute injury of paraspinal muscle cells initiated by open operation and percutaneous operation for thoracolumbar fractures. Methods 15 cases with thoracolumbar spine fracture underwent open operation and the other 15 cases underwent percutaneous operation,paraspinal muscle samples were collected instantly after muscle exposure ,0.5 hour after retraction, 1.0 hour after retraction, 1.5 hours after retraction and reperfusion respectively.The intrinsic HSP70 expression was determined through immunohistochemical evaluation,and the content of MDA was determined through colourimetry. The stress reaction of paraspinal muscle cells was compared between two operations. Results In the group of open operation,the content of MDA has no marked change during 0.5 hour after retraction,marked change and peak were found during 1.0 and 1.5 hours after retraction respectively,a high level was still apparent during reperfusion. The HSP70 expression has marked change during 0.5 hour after retraction, more marked change and peak were found during 1.0 and 1.5 hours after retraction respectively,an apparent decreased level was found during reperfusion. In contrast, both the content of MDA and HSP70 expression have no marked change in the percutaneous group throughout the operation. Conclusion The open operation bring severe stress reaction in the paraspinal muscle cells,indicating severe acute injury of paraspinal muscles.

关 键 词：胸腰椎骨折 手术 微创 椎旁肌 

分 类 号：R692.4[医药卫生—泌尿科学] R574.5[医药卫生—外科学]