单侧双通道内镜单纯髓核摘除术对椎旁肌肉的影响  

Effects of Unilateral Biportal Endoscopic Discectomy on Lumbar Paravertebral Muscles

作　　者：贾康 王前亮 戴俊 彭煜健 张钱中逸 曹峻胤 陈浩然 严军[1] JIA Kang;WANG Qianliang;DAI Jun;PENG Yujian;ZHANG Qianzhongyi;CAO Junyin;CHEN Haoran;YAN Jun(Department of Orthopedic Surgery,The Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院骨外科,江苏苏州215004

出　　处：《骨科》2023年第4期311-315,共5页ORTHOPAEDICS

基　　金：国家自然科学基金(81971036);江苏省自然科学基金(BK20191169)。

摘　　要：目的研究单侧双通道内镜单纯髓核摘除术(unilateral biportal endoscopic discectomy,UBED)对于椎旁肌肉的影响,并评估椎旁肌肉改变与随访时间的相关性。方法回顾性分析2020年3月至2021年12月就诊于我院脊柱外科并接受UBED手术治疗的42例病人的临床资料。所有病人在术前、术后、末次随访时均行MRI检查。收集病人基本信息、末次随访时间、MRI图像、腰部和腿部的疼痛视觉模拟量表(visual analogue scale,VAS)评分及Oswestry功能障碍指数(Oswestry disability index,ODI)。结果与术前相比,手术侧多裂肌术后信号强度、水肿面积均明显上升[41.02±14.40 vs.19.14±10.11,(26.95±14.70)cm^(2)vs.(10.17±5.41)cm^(2)];与非手术侧相比,术后手术侧多裂肌信号强度、横截面积、水肿面积占比明显升高[41.02±14.40 vs.21.92±11.07,(39.27±12.82)cm^(2)vs.(33.66±11.79)cm^(2),26.95%±14.70%vs.11.53%±7.06%];上述指标比较,差异有统计学意义(P<0.05)。手术对于竖脊肌上述指标的改变未见统计学意义(P>0.05)。手术侧多裂肌信号强度、水肿面积占比均与随访时间存在显著负相关(r=-0.53、r=-0.47)。结论UBED对于椎旁肌肉的影响集中于手术侧多裂肌,但其损伤是可逆的。Objective To evaluate the changes in lumbar paravertebral muscles following unilateral biportal endoscopic discectomy(UBED),and to assess the correlations between the changes in lumbar paravertebral muscles and the duration of follow⁃up after UBED.Methods The clinical data of 42 patients who underwent UBED for lumbar disc herniation at our institution between March 2020 and December 2021 were retrospectively analyzed.All patients underwent preoperative,postoperative,and final follow⁃up MRI examination.Relevant data,including basic patient information,last follow⁃up time,MRI images,visual analogue scale(VAS)scores for back and leg pain,and Oswestry Disability Index(ODI)scores,were recorded.Results The signal strength and proportion of edema area of the operated lumbar multifidus significantly increased after operation[41.02±14.40 vs.19.14±10.11,(26.95±14.70)cm^(2)vs.(10.17±5.41)cm^(2)].Compared with the non⁃operated lumbar multifidus,the signal strength,cross sectional area and proportion of edema area of the operated lumbar multifidus significantly increased[41.02±14.40 vs.21.92±11.07,(39.27±12.82)cm^(2)vs.(33.66±11.79)cm^(2),26.95%±14.70%vs.11.53%±7.06%)].The signal strength and proportion of edema area of the operated lumbar multifidus had a negative correlation with follow⁃up time(r=-0.53,r=-0.47).Conclusion The muscle most directly affected by UBED is the operated lumbar multifidus,but the injury is reversible.

关 键 词：微创手术 单侧双通道内镜技术 单纯髓核摘除术 腰椎间盘突出症 腰椎旁肌肉 腰椎多裂肌 

分 类 号：R687.3[医药卫生—骨科学]