单节段腰椎间盘突出继发腰椎侧凸患者间盘摘除后椎旁肌的表面肌电分析

Surface electromyographic analysis of paraspinal musculature in patients with single-level lumbar disc herniation with secondary lumbar scoliosis after disc removal

背景:先天性及特发性脊柱侧凸患者椎旁肌肌电图改变已被广泛研究,而对腰椎间盘突出继发腰椎侧凸患者椎旁肌肌力肌电图的研究较少。目的:通过应用表面肌电图技术分析腰椎间盘突出继发腰椎侧凸患者两侧椎旁肌的肌电活动,评估两侧肌力,揭示腰椎侧凸的特殊临床特点并探讨其产生的机制。方法:回顾性分析2012年7月至2014年7月收治的单节段腰椎间盘突出继发腰椎侧凸的成人患者26例,均行腰椎侧路椎间孔镜下间盘摘除。治疗前后摄站立位全脊柱正侧位片,测量腰椎侧凸Cobb角及躯干偏移距离,行表面肌电图检查,测量两侧椎旁肌大力收缩募集电位值,评估腰椎间盘突出水平两侧椎旁肌肌力。结果与结论:治疗后所有患者腰椎侧凸明显减少,脊柱冠状面平衡恢复。患者治疗前腰椎侧凸Cobb角为(11.81±3.50)°,治疗后为(2.65±3.10)°,腰椎侧凸明显减少,平均差值为(9.15±2.84)°,差异有显著性意义(P<0.05)。治疗前躯干偏移距离为(5.92±3.20)cm,治疗后为(0.32±0.26)cm,平均差值为(5.59±3.08)cm,差异有显著性意义(P<0.05)。治疗后疼痛明显缓解(P<0.05)。治疗前Oswestry功能障碍指数平均为78%,治疗后平均为4%。突出节段水平治疗前凹侧屈曲时凹侧大力收缩募集电位为(0.21±0.12)m V,治疗后为(0.88±0.26)m V,平均差值为(0.59±0.27)m V;治疗前凸侧屈曲时凸侧大力收缩募集电位为(0.29±0.12)m V,治疗后为(0.88±0.25)m V,平均差值为(0.67±0.27)m V,差异均有显著性意义(P<0.05);治疗后两侧大力收缩募集电位平均差值为(0.003±0.020)m V,差异无显著性意义(P>0.05)。随访至少1年,所有患者均无并发症发生,无腰椎间盘突出复发。以上结果说明腰椎间盘突出症引起的腰椎侧凸为代偿性侧凸,早期行腰椎侧路椎间孔镜下间盘摘除可以纠正腰椎侧凸。椎旁肌肌力在维持腰椎冠状面平衡中具有重要作用。

BACKGROUND： Electromyographic analysis of the paraspinal musculature in patients with congenital and idiopathic scoliosis has been widely studied. Electromyographic analysis of paraspinal musculature strength has rarely been researched in patients with lumbar disc herniation and secondary lumbar scoliosis. OBJECTIVE： To analyze electromyographic activity using surface-electromyogram technology and assess the strength of paraspinal musculature in patients with lumbar disc herniation and secondary lumbar scoliosis so as to reveal their unique clinical features, and to explore the pathogenetic mechanism of lumbar socliosis. METHODS： A total of 26 adult patients with single-level lumbar disc herniation presenting secondary lumbar scoliosis were retrospectively analyzed from July 2012 to July 2014. Patients were subjected to percutaneous transforaminal endoscopic lumbar disc decompression surgery. Before and after treatment, patients accepted full spine anterior-posterior X-ray to measure lumbar Cobb angle and trunk shift distance. Special surface-electromyogram test was conducted to measure recruitment order so as to access the strength of paraspinal musculature, RESULTS AND CONCLUSION： After treatment, lumbar scoliosis apparently reduced in all patients, and the balance of spine in coronal plane was restored. The average of lumbar Cobb angle was （11.81±3.50）° and （2.65±3.10）° before and after surgery, which was significantly improved （9.15±2.84）° （P 〈 0.05）. The average of trunk shift distance was （5.92±3.20） and （0.32±0.26） cm before and after surgery, which was significantly different （5.59±3.08） cm （P 〈 0.05）. Pain was significantly lessened after surgery （P 〈 0.05）. The mean Oswestry Disability Index improved from 78% before surgery to 4% after surgery. On the level of the herniated disc, when bending to the concave side, the mean recruitment order of spinal musculature in the concave side of lumbar scoliosis was （0.21±0.12） mV and （0.88±0.26） mV after treatment; the improvement was （0.59±0.27） inV. In the convex side, when bending to the opposite side, the mean increase of recruitment order was （0.67±0.27） mV from （0.29±0.12） mV before surgery to （0.88±0.25） mV after surgery （P 〈 0.05）. However, there was no significant difference between concave and convex sides of the recruitment order postoperatively （0.003±0.02） mV （P 〉 0.05）. All patients were followed up more than one year. No severe complication was observed after percutaneous transforaminal endoscopic lumbar disc decompression. Above results suggest that lumbar scoliosis secondary to the lumbar disc herniation was a compensated presentation. Early decompression helps to spontaneously correct scoliosis. Spinal musculature plays an important role in keeping the spinal coronal balance.