脊柱椎旁肌松解术治疗早期强直性脊柱炎的临床效果观察

The treatment of early stage of ankylosing spondylitis by release of spinal paravertebral muscles

目的探讨脊柱椎旁肌松解术治疗早期强直性脊柱炎的临床效果。方法对240例符合强直性脊柱炎(ankylosing spondylitis,AS)诊断标准的活动期患者,手术剥离腰2、3椎体后方的多裂肌在棘突、乳突及横突上的止点,达到松解胸腰段及腰骶段椎旁肌的目的。分别于术前、术后2、6、12、24周、1年、2年,观察C反应蛋白(CRP)、红细胞沉降率(ESR)炎症指标,同时对AS病情活动性指数(BASDAI)、AS功能指数(BASFI)、AS测量指数(BASMI)、AS健康综合指数(BAS-G)进行评估,最终评价患者满意率。结果所有患者手术顺利,无并发症发生。术后随访2年,CRP、ESR、BASDAI、BASFI和BAS-G一直维持在平稳水平,患者评价优良率86.3%。结论脊柱椎旁肌松解术治疗早期强直性脊柱炎效果显著,可有效降低炎症指标,缓解腰背疼痛、晨僵等症状,值得临床推广应用。

Objective The surgery of releasing the hypertonicity of spine paravertebral muscle was performed to treating AS patients and then the clinical efficacy was observed by follow-up. Methods Two hundred and forty patients with active stage of AS, whom undergoing the surgery treatment, were analyzed. Among those patients, the attaching sides of lumbar multifidus on lumbar 2 and 3 levels were striped and the dorsal rami of the spinal nerves around the lumbar facet were cut off. Preoperative and postoperative follow- up （2,6,12 and 24 weeks, 1 year,2 years） investigations, including CRP, ESR, BASDAI, BASF1, BASMI, BAS-G and VAS of patient~ satisfy, were obtained to evaluate clinical outcomes. Results No any complications and consequences occurred. The CRP and ESR sig- nificantly decreased from 2 weeks after operation as well as by the improving of BASDAI, BASFI and BAS-G questionnaires scores com- pared to preoperative, and maintained with a stable level lasting more than 2 years. But the BASMI scores showed no statistically signifi- cant difference. Conclusion Releasing lumbar muhifidus on lumbar 2 and 3 levels results a safe procedure in AS patients. The clinical symptoms such as back pain and morning stiff had a long-term remission and there was no recurrence after more than 2 years follow- up. This simple procedure was able to stop the spread of stiff up along the spine and prevent AS patients from developing deformity. Moreover, by this clinical practice,it was conformed that a synergy occurs between altered biomechanical and immunological activation pathways that may conjointly be needed to induce enthesopathy in AS patients.