Wiltse入路椎弓根钉内固定术对脊柱结构和多裂肌功能的影响  

Effect of Wiltse Approach for Pedicle Screw Fixation on the Function of Spinal Structure and Electrophysiological Condition of Multifidus in Patients with Lumbar Disc Herniation

作　　者：侯正轩 刘宁波 袁文杰 李建波 Hou Zhengxuan;Liu Ningbo;Yuan Wenjie(Orthopedic Department,Central Hospital of Liaocheng City,Shandong Province,Liaocheng 252000,China)

机构地区：[1]聊城市中心医院骨科,山东聊城252000

出　　处：《实用骨科杂志》2018年第3期205-210,共6页Journal of Practical Orthopaedics

摘　　要：目的探究Wiltse入路椎弓根钉内固定术对腰椎间盘突出患者脊柱结构和多裂肌的影响。方法回顾性研究我院2014年10月至2015年8月收治的74例手术治疗的单节段腰椎间盘突出症患者,随机分为观察组(37例)及对照组(37例),分别行Wiltse入路和后正中入路非融合钉棒系统内固定术,比较两组患者的手术治疗情况、脊柱结构及功能的恢复情况、多裂肌的组织形态、电生理情况及不良反应的发生情况。结果随访过程中两组患者各脱落2例,两组患者手术时间的差异并没有统计学意义(P>0.05),观察组患者的术中出血量、术后引流量显著低于对照组(P<0.05),住院时间显著短于对照组(P<0.05)。术后12个月,术后24个月,观察组腰背部视觉模拟评分(visual analogue scale,VAS)较对照组低,脊椎节段活动范围(range of motion,ROM)较对照组小(P<0.05),而两组患者日本矫形外科学会(Japanese orthopedic association,JOA)评分、Oswestry功能障碍指数(oswestry dability index,ODI)、椎间盘后缘高度(posterior disk height,PDH)、椎间孔高度(intervertebral foramina height,FH)的比较差异无统计学意义(P>0.05)。治疗后,与对照组相比,观察组多裂肌横截面面积较大,脂肪浸润分级较低,多裂肌中位频率及平均振幅均较高,且差异具有统计学意义(P<0.05)。两组患者治疗期间不良反应发生率的差异无统计学意义(P>0.05)。结论 Wiltse入路椎弓根钉内固定术同后正中入路椎弓根钉内固定术相比,患者手术治疗情况好,脊柱的结构及功能恢复迅速,且对多裂肌的影响较小,安全性高,值得推广应用。Objective To investigate the effect of wiltse approach for pedicle screw fixation on the spinal structure and multifidus in patients with lumbar disc herniation.Methods We retrospectively researched 74 cases of patients who were diagnosed with single segmental lumbar disc herniation and underwent surgical treatments in our hospital from October 2014 to August 2015.The patients were randomly divided into the observation group(37 cases)and control group(37 cases).They received non fusion internal fixation through Wiltse approach and posterior midline approach respectively.The surgical treatment,the recovery of spinal structure and function,the morphology and electrophysiological condition of the multiple muscles,the incidence of adverse reactions were compared between the two groups.Results Both of the two groups had 2 cases of patients lost in the follow-up.The operation time of the two groups had no significant difference(P>0.05),the intraoperative blood loss and postoperative drainage of the observation group was less than the control group,and its length of stay was shorter.The differences were statistically significant(P<0.05).12 and 24 months after the surgery,lumbar VAS score in the observation group was lower than the control group,and the ROM in the observation group was smaller than the control group,and the difference was statistically significant(P<0.05),while there was no statistical difference on JOA score,ODI score,PDH and FH between the two groups(P>0.05).After the treatment,compared with the control group,the observation group had larger multifidus cross-sectional area,lower fatty infiltration classification,higher median frequency and mean amplitude of multifidus,and the difference were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Compared with the posterior midline approach,patients with Wiltse approach for pedicle screw fixation's operation have better condition,the structure and function of

关 键 词：Wiltse入路 椎弓根钉内固定术 腰椎间盘突出症 多裂肌 

分 类 号：R681.53[医药卫生—骨科学]