脊柱后路小切口与椎间盘镜入路对椎旁肌影响的实验研究

Effect of mini-incision and microendoscopic discectomy(MED) on paraspinal muscles

目的:比较小切口入路与椎间盘镜入路对椎旁肌的影响。方法:选取日本大耳兔12只,随机将其分成6组,每组2只。模拟腰椎间盘突出症手术,一侧采用小切口手术入路,另一侧采用椎间盘镜手术入路。暴露椎板间隙,然后分别于术后即时、术后1周、2周、4周、8周、12周取以切口为中心的椎旁肌1块,大小约1.0 cm×1.0 cm×0.5 cm,福尔马林液浸泡,标本封蜡固定和制片,并常规行HE染色。镜下观察疤痕组织及正常的椎旁肌,并计算疤痕的体积。结果:①术后当时2种手术入路椎旁肌损伤周边水肿带不明显;术后1周小切口入路疤痕周边水肿带更明显;术后8周、12周时小切口入路的椎旁肌肌纤维有萎缩,椎间盘镜入路无明显的椎旁肌肌纤维萎缩。②小切口入路手术疤痕面积较小、体积较大,椎间盘镜入路手术疤痕面积较大、体积较小,差异有统计学意义(t=2.693,P=0.021;t=4.034,P=0.002)。结论:小切口入路、椎间盘镜入路均会造成椎旁肌损伤,但椎间盘镜入路对椎旁肌损伤较小。

Objective：To investigate and compare the effect of mini-incision and microendoscopic discectomy（MED）on paraspinal muscles.Methods：Twelve Japanese rabbits were randomly divided into 6 groups with 2 rabbits in each group.Mini-incision and MED were operated respectively on two sides in the rabbits.Intervertebral spaces were exposed,area of 1.0 cm×1.0 cm×0.5 cm paraspinal muscle around the incision was harvested immediately,1 week,2 weeks,4 weeks,8 weeks and 12 weeks after operation respectively.The specimens underwent histologcal analysis and the area and volume of scars were measured.Results：（1）Both of the two methods had no edematus belt around the injured paraspinal muscles after surgery immediately.But 1 week later,the edematus belt around scar of mini-incision was more obvious than that of MED.8 weeks and 12 weeks after operation,the paraspinal muscles of mini-incision showed atrophy,while no atrophy appeared in the paraspinal muscles of MED.（2）The scars of mini-incision shown smaller area and larger volume than that of MED,the difference was significant（t=2.693,P=0.021;t=4.034,P=0.002）.Conclusion：Both mini-incision and microendoscopic discectomy in the treatment for the lumbar disc herniation damage paraspinal muscle,however,less injury was found after microendoscopic discectomy.