微创与传统开放腰椎后路术对竖脊肌影响的实验对比研究

Comparison study of erector spinae injury between the minimally invasive and conventional open approach for posterior lumbar surgery

目的对比研究腰椎后路传统开放手术与经皮微创手术对竖脊肌损伤程度的差别。方法将成年新西兰大白兔24只随机分为正常对照组(n=8)不行手术,开放手术组(n=8)行传统开放后路手术,微创手术组(n=8)行微创后路手术。每组分别于术后3 d,1、2周,1、2、3、6个月取手术区域竖脊肌肌肉,分别石蜡切片行HE、Masson染色,冷冻切片行ATP、AChE、NADH染色,以及透射电镜检查。结果开放手术组早期即呈现出明显的肌纤维的萎缩、坏死,肌组织内微观结构的改变,肌纤维的萎缩改变在后期仍恢复较差,而微创手术组虽然仍有肌纤维的轻度萎缩、构成改变、脂肪浸润及瘢痕形成,但在整个过程中表现出极佳的恢复效果。结论手术创伤程度与竖脊肌的组织学改变密切相关,经皮微创手术可以明显降低腰椎后路手术对于竖脊肌的损伤。

Objective To investigate the differences of erector spinae injury between the minimally invasive and conventional open approach for posterior lumbar surgery.Methods Twenty four rabbits were randomly divided into control group,conventional group,minimally invasive group,8 for each group.Morphological change of the erector spinae was observed by light microscope（Hematoxylin Eosin Staining,Masson trichrism staining,myosin ATPase staining and tetrazolium staining）and transmission electron microscope at various times：three days,one week,two weeks,one month,two months,three months,six months after surgery.Results The pathological change of conventional group showed obvious muscle fiber atrophy,necrosis and the change of microstructure in early stage;the recovery of muscle fiber atrophy was poor even in later stage;for minimally invasive group,the erector spinae presented gently inflammatory cell infiltration,fiber necrosis and adipose infiltration in whole time,showed better recovery.Conclusion The morphological change of erector spinae has close relationship with the degree of surgical trauma,the minimally invasive surgery can reduce the injury of erector spinae.