【摘要】：目的:對(duì)比研究經(jīng)多裂肌肌間隙入路與傳統(tǒng)后正中入路術(shù)式在腰椎間盤(pán)突出癥(TLIF)手術(shù)中對(duì)脊椎旁多裂肌損傷程度的差別,為多裂肌間隙入路術(shù)式的臨床應(yīng)用提供理論依據(jù)。方法:1,采用前瞻性對(duì)比研究,選取2013年3月~2014年6月40例在郴州市第一人民醫(yī)院住院并接受手術(shù)治療的腰椎間盤(pán)突出癥患者,入選患者隨機(jī)分A、B兩組,A組20例采用經(jīng)多裂肌間隙入路,B組20例采用傳統(tǒng)后正中入路,觀察指標(biāo):1術(shù)前、術(shù)后1周、術(shù)后1年行腰椎MRI檢查,取手術(shù)節(jié)段腰椎軸位像,測(cè)量手術(shù)節(jié)段多裂肌橫截面積并對(duì)其進(jìn)行比較。2術(shù)后(1個(gè)月,3個(gè)月,12個(gè)月)隨訪行手術(shù)節(jié)段多裂肌肌內(nèi)肌電圖檢查,對(duì)其結(jié)果進(jìn)行比較。3收集兩組患者手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量進(jìn)行比較。4收集術(shù)前和術(shù)后當(dāng)天、1周、1年視覺(jué)模擬疼痛評(píng)分(VAS評(píng)分)進(jìn)行比較。結(jié)果:1、A組在手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量、及術(shù)后VAS評(píng)分低于B組,兩組比較差異具有統(tǒng)計(jì)學(xué)(P0.05)。2、術(shù)后手術(shù)節(jié)段多裂肌肌電圖檢查,A組出現(xiàn)失神經(jīng)纖顫電位少于傳統(tǒng)正中手術(shù)入路組,多裂肌間隙組術(shù)后1個(gè)月、3個(gè)月、12個(gè)月出現(xiàn)異常肌電圖波形分別為10例、6例、6例。而傳統(tǒng)組20例術(shù)后1個(gè)月、3個(gè)月、12個(gè)月均出現(xiàn)異常波形。差異具有統(tǒng)計(jì)學(xué)意義。(P0.05)。3、兩組患者術(shù)前、術(shù)后1周、術(shù)后12個(gè)月手術(shù)節(jié)段多裂肌橫截面積比較,多裂肌間隙組(A組)術(shù)前1074.85±54.39 mm2,術(shù)后1周1086.85±54.70mm2,術(shù)后1年976.69±9.61mm2。傳統(tǒng)組(B組):術(shù)前1115.83±67.98mm2,術(shù)后1周1420.25±2.91 mm2,術(shù)后1年714.66±6.24mm2。術(shù)前無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后1周兩組手術(shù)節(jié)段多裂肌橫截面積大于正常值(術(shù)前值),但多裂肌間隙組多裂肌增大程度小于傳統(tǒng)組,1年后傳統(tǒng)組多裂肌明顯萎縮,而多裂肌間隙組萎縮不明顯,多裂肌組多裂肌橫截的變化率不大,而傳統(tǒng)后正中入路組多裂肌橫截面積的變化率明顯增大,兩組變化率比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:多裂肌間隙入路(A組)與傳統(tǒng)入路(B組)手術(shù)治療腰椎間盤(pán)突出癥對(duì)多裂肌均有損傷,手術(shù)療效相似。但多裂肌間隙入路手術(shù)方式避免了對(duì)椎旁多裂肌的剝離,減少了術(shù)中出血量及電刀的使用,明顯降低了手術(shù)早期多裂肌的損傷程度及遠(yuǎn)期多裂肌的萎縮程度以及腰背痛的發(fā)生率,與傳統(tǒng)入路相比具有優(yōu)勢(shì)。
[Abstract]:Aim: to study the difference of the injury degree of paraspinal polycleft muscle between the intermuscular approach and the traditional posterior median approach in (TLIF) operation for lumbar disc herniation, so as to provide the theoretical basis for the clinical application of the intermuscular approach for the treatment of lumbar disc herniation. Methods: 1. From March 2013 to June 2014, 40 patients with lumbar disc protrusion who were hospitalized and treated surgically in Chenzhou first people's Hospital were randomly divided into two groups. Group A (n = 20) was treated with posterior median approach, and group B (n = 20) was treated by posterior median approach. The outcome indexes were as follows: (1) preoperative, 1 week and 1 year after operation, MRI of lumbar spine was performed, and axial images of operative segments were obtained. After operation (1 month, 3 months, 12 months), the intramuscular electromyography (EMG) of the operation segment was followed up and the results were compared. (3) the operation time of the two groups was collected, the operation time of the two groups was collected, the operation time of the two groups was collected, and the operative time of the two groups was collected. 4 the visual analogue pain score (VAS) was collected before and on the day of operation, 1 week and 1 year. Results: 1 the operation time, intraoperative bleeding volume, postoperative drainage volume and postoperative VAS score in group A were lower than those in group B, and there was significant difference between the two groups (P 0.05). The potential of denervated fibrillar in group A was lower than that in the traditional median approach group. The abnormal electromyography waveforms were found in 10 cases, 6 cases and 6 cases respectively at 1 month, 3 months and 12 months after operation in the multi-fissure muscle space group. In the traditional group, abnormal waveforms appeared 1 month, 3 months and 12 months after operation. There was significant difference between the two groups (P 0.05). 3. The cross section area of multilobed muscles in the two groups was 1074.85 鹵54.39 mm2, before operation, 1 week after operation and 12 months after operation, and 1074.85 鹵54.39 min before operation in group A. 1086.85 鹵54.70mm 2 1 week after operation and 976.69 鹵9.61 mm 2 1 year after operation. Traditional group (group B): 1115.83 鹵67.98mm2 before operation, 1420.25 鹵2.91mm ~ 2 1 year after operation, 714.66 鹵6.24mm ~ 2. 1 year after operation, 1420.25 鹵2.91mm ~ (- 1) mm2,. There was no significant difference before operation (P 0.05). One week after operation, the cross section area of multi-split muscle in the two groups was larger than the normal value (pre-operation value), but the enlargement degree of multi-split muscle in the multi-split muscle space group was smaller than that in the traditional group, and one year later, the multi-split muscle in the traditional group was significantly atrophied. However, the atrophy was not obvious in the multi-fissure muscle space group, and the change rate of the multi-split muscle cross section was not significant in the multi-lobar muscle space group, but the change rate of the multi-split muscle cross section area in the traditional median approach group was significantly increased, and there was significant difference between the two groups (P 0.05). Conclusion: the surgical treatment of prolapse of lumbar intervertebral disc by the interspace approach (group A) and the traditional approach (group B) is similar to that of the other two approaches (group A) and the traditional approach (group B) in the treatment of prolapse of lumbar intervertebral disc. However, the method of operation through the interspace approach avoids the stripping of the paravertebral muscle, reduces the amount of bleeding during the operation and the use of the electric knife. It significantly reduced the degree of multi-split muscle injury in the early stage of operation, the degree of long-term atrophy of multi-split muscle and the incidence of low back pain, which was superior to the traditional approach.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3

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