单侧双通道内镜下腰椎椎体间融合对椎旁肌肉的影响  

Effects of unilateral biportal endoscopic transforaminal lumbar interbody fusion on paraspinal muscles

作　　者：王前亮 张钱中逸 彭煜健 严军[1] Wang Qianliang;Zhang Qianzhongyi;Peng Yujian;Yan Jun(Department of Orthopedics,Second Affiliated Hospital of Soochow University,Suzhou 215004,Jiangsu Province,China)

机构地区：[1]苏州大学附属第二医院骨外科,江苏省苏州市215004

出　　处：《中国组织工程研究》2025年第27期5862-5868,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金(81971036),项目负责人:严军。

摘　　要：背景:随着单侧双通道内镜技术的发展,内镜下进行腰椎融合手术越发成为脊柱外科的发展趋势。单侧双通道内镜下经椎间孔腰椎融合在腰椎管狭窄、腰椎滑脱等腰椎退行性疾病中可能具有更好的保护椎旁肌肉、减少术中出血量等优势,有待进一步研究。目的:比较单侧双通道内镜下经椎间孔腰椎椎体间融合与传统开放性经椎间孔腰椎椎体间融合治疗对于椎旁肌肉的影响。方法:回顾性分析2019年10月至2022年11月就诊于苏州大学附属第二医院脊柱外科并接受单节段单侧减压融合治疗的60例患者的临床资料,按照术式分为2组,A组进行单侧双通道内镜下经椎间孔腰椎椎体间融合治疗,B组进行传统开放性经椎间孔腰椎椎体间融合治疗。所有患者在术前、术后3个月均行MRI检查;收集患者基本信息、末次随访时间、MRI图像、腰部和腿部疼痛目测类比评分及Oswestry功能障碍指数。结果与结论:①A组术后3个月双侧多裂肌横截面积显著大于B组(P<0.05),且脂肪浸润程度更低(P<0.01);②两组术后3个月双侧竖脊肌横截面积及脂肪浸润程度均无明显差异(P>0.05);③提示单侧双通道内镜下经椎间孔腰椎椎体间融合组较开放性经椎间孔腰椎椎体间融合组可更有效地起到多裂肌保护作用,减少多裂肌肌肉萎缩及脂肪浸润;两种术式对竖脊肌均未产生明显影响。BACKGROUND:With the development of unilateral biportal endoscopic technology,endoscopic lumbar fusion surgery has become an increasingly popular development trend in spinal surgery.Unilateral biportal endoscopic transforaminal lumbar interbody fusion shows significant advantages for preserving paravertebral muscle and reducing intraoperative bleeding in spinal stenosis and lumbar spondylolisthesis in the lumbar spine with degenerative changes.OBJECTIVE:To compare the effects of unilateral biportal endoscopic lumbar interbody fusion and traditional open transluminal lumbar interbody fusion on paraspinal muscles.METHODS:A retrospective analysis was conducted on the clinical data of 60 patients who visited the Department of Spine Surgery,Second Affiliated Hospital of Soochow University from October 2019 to November 2022 and underwent single segment unilateral decompression fusion.They were divided into two groups according to different surgical procedures.Group A received unilateral biportal endoscopic lumbar interbody fusion.Group B received traditional open transluminal lumbar interbody fusion.All patients underwent magnetic resonance imaging examination before and 3 months after surgery.Basic patient information,last follow-up time,magnetic resonance imaging images,visual analog scale scores for lower back and leg pain,and Oswestry Disability Index were collected.RESULTS AND CONCLUSION:(1)Three months after surgery,the cross-sectional area of the bilateral multifidus muscle in group A was significantly larger than that of group B(P<0.05),and the degree of fat infiltration was lower(P<0.01).(2)There was no significant difference in the cross-sectional area and degree of fat infiltration of bilateral erector spinae muscles between the two groups 3 months after surgery(P>0.05).(3)It is concluded that unilateral biportal endoscopic lumbar interbody fusion is more effective than traditional open transluminal lumbar interbody fusion in protecting multifidus muscle,reducing multifidus muscle atrophy and fat infiltration

关 键 词：单侧双通道内镜 经椎间孔腰椎椎体间融合 腰椎间盘突出症 椎旁肌肉损伤 多裂肌 MRI 疼痛 骨科植入物 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R681.5