椎间盘镜与椎板开窗手术治疗腰椎间盘突出症对椎旁肌损伤的比较  

Comparison of Paraspinal Muscle Injury Between Open Discectomy and Microendoscopic Discectomy for Lumbar Disc Herniation

作　　者：汤朝晖[1] 杨维权[1] 孙荣华[1] 植致敏[1] 朱海云[2] 卫杰[3] 刘大雄[1] 

机构地区：[1]解放军第85医院骨科,上海市200052 [2]解放军第85医院放射科,上海市200052 [3]解放军第85医院肌电图室,上海市200052

出　　处：《中国骨与关节损伤杂志》2011年第9期784-786,共3页Chinese Journal of Bone and Joint Injury

基　　金：南京军区"十一五"课题(06MA01)

摘　　要：目的比较椎板开窗(OLD)与经椎间盘镜(MED)治疗腰椎间盘突出症对椎旁肌的损伤。方法对60例单节段腰椎间盘突出症,30例采用OLD(OLD组),30例采用MED(MED组),术中不同时间段切取受牵拉的椎旁肌标本,切片观察肌肉的病理改变和透射电镜观察超微结构改变,并对术前和术后1个月椎旁肌的肌电图(EMG)和MRI检查进行比较。结果光镜下,两组肌肉损伤无明显差异,电镜下,OLD组肌肉损伤明显比MED组严重,肌原纤维紊乱、断裂、溶解,线粒体和内质网肿胀、空泡状;EMG显示OLD组椎旁肌收缩动作电位波幅降低,出现多相电位,MED组手术前后无明显差异。MRI检查,在同一平面比较手术前后椎旁肌横截面积,OLD组椎旁肌明显萎缩,MED组手术前后椎旁肌面积无显著差异。结论 OLD对椎旁肌损伤明显比MED严重,而且术后椎旁肌恢复较慢。MED对肌肉损伤轻,对于腰椎间盘突出症术后的恢复具有优势。Objective To compare the damage on the paraspinal muscle in open lumbar discectomy （OLD） and microendoscopic discectomy （MED） for lumbar disc herniation. Methods Sixty cases of single lumbar disc herniation, 30 patients by OLD, 30 cases by MED, the paraspinal muscle specimens harvested at different times in surgery, muscle pathological changes were observed by light microscope and transmission electron microscopy. Preoperative and postoperative 1 month, the electromyography （EMG） and magnetic resonance imaging （MRI） examination of paraspinal muscle were evaluated. Results In the light microscope, the two groups had no significant difference in muscle damage, in the electron microscope, OLD group paraspinal muscle injury was significantly more serious than MED group, myofibril disorder, fracture, mitochondria and endoplasmic reticulum swelling observed in OLD group. EMG examination revealed that in OLD group the paraspinal muscle motor unit potential （MUP） amplitude decreased, the average time was shortened. By MR/, before and after operation, significant atrophy of paraspinal muscles in OLD group was found. In MED group there was no significant difference before and after surgery with EMG and MRI. Conclusion OLD injury to the paraspinal muscle is significantly more serious than MED and paraspinal muscle recovery more slow, MED for lumbar disc herniation is less injury and could achieve satisfactory clinical results.

关 键 词：腰椎间盘突出 椎旁肌损伤 组织病理学 肌电图 核磁共振 

分 类 号：R681.53[医药卫生—骨科学]