腰椎间盘突出症微创及开放手术中骶棘肌损伤的病理学比较研究  

Comparasion of histopathology on sacrospinalis injury with microendoscopic discectomy and open discectomy in treating lumbar disc herniation

作　　者：汤朝晖[1] 杨维权[1] 孙荣华[1] 植致敏[1] 朱礼传[1] 刘大雄[1] 

机构地区：[1]解放军第85医院骨科,上海200052

出　　处：《颈腰痛杂志》2012年第2期95-97,共3页The Journal of Cervicodynia and Lumbodynia

基　　金：南京军区"十一五"课题(06MA01)

摘　　要：目的比较传统开放手术与经椎间盘镜微创治疗腰椎间盘突出症对骶棘肌损伤的病理变化。方法椎间盘镜(microendoscopic discectomy,MED)组与开放手术(open lumbar discectomy,OLD)组患者各30例,分别在术中骶棘肌牵开前、牵开后30、45、60、75min取肌肉标本,光镜观察肌肉损伤情况,透射电镜观察肌肉细胞的超微结构改变。结果光镜下,两组肌肉细胞病理改变无明显差异。透射电镜下,MED组肌原纤维排列整齐,Z带清晰,线粒体、内质网轻度肿胀。OLD组在手术45min出现肌原纤维排列紊乱,线粒体、内质网肿胀,60 min见肌原纤维断裂,Z带模糊,线粒体和内质网结构紊乱,空泡状,严重者细胞核出现DNA聚集。结论开放手术对骶棘肌的损伤随手术时间延长而加重,MED可以明显减轻对骶棘肌的损伤;施行开放手术者,建议间歇放松椎板拉钩,可以减轻对骶棘肌的损伤。Objective To compare the histopathology of sacrospinalis injury in treating lumbar disc herniated by microendoscopic discectomy（MED）and open lumbar discectomy（OLD）.Methods 60 cases of mono-segment discectomy analyzed,30 cases operated with MED and 30 cases with OLD.The deep sacrospinalis sections in surgery were examined with lightmicroscopy and transmission electron microscope at various time.Results In lightmicroscopy,the muscle cells injury of two groups were no significant difference,in transmission electron microscope,myofibrils aligned,mitochondria and endoplasmic reticulum swelling were observed in the MED group.In the OLD group,myofibrils disordered,mitochondria and endoplasmic reticulum swelling at 30 minutes,myofibril fracture,the structure of mitochondria and endoplasmic reticulum disorder,vacuolization at 45 minutes,in nuclear DNA gathered there.Conclusion The injury of the sacrospinalis increased with the operation time in open surgery,intermittent relaxation of laminectomy retractors can reduce damage.MED can significantly reduce the damage of the sacrospinalis.

关 键 词：腰椎间盘突出 微创 骶棘肌 组织病理学 

分 类 号：R681.53[医药卫生—骨科学]