椎旁肌退变对退变性腰椎侧凸短节段减压融合病人术后临床疗效的影响

Effect of the degeneration of paraspinal muscles on postoperative clinical efficacy of degenerative lumbar scoliosis treated by short decompression and fusion

目的分析椎旁肌退变程度对退变性腰椎侧凸短节段减压融合病人术后临床疗效的影响。方法退变性腰椎侧凸行短节段(≤3个节段)椎管减压椎体间融合治疗的病人53例,根据术前核磁共振是否存在椎旁肌退变分为观察组28例,对照组25例。比较两组术前术后腰椎Cob角、椎旁肌(竖脊肌、多裂肌、腰大肌)横截面积、椎旁肌脂肪化率、视觉模拟量表评分、Oswestry功能障碍指数。结果两组病人术前Cob角、VAS、ODI评分比较,差异无统计学意义(P>0.05)。术后6个月两组病人Cob角与术前比较,差异有统计学意义(P<0.05)。术后12个月观察组Cob角大于对照组,对照组VAS、ODI评分优于观察组,差异有统计学意义(P<0.05)。观察组多裂肌和竖脊肌的凹侧横截面积与对照组比较,差异具有统计学意义(P<0.05),观察组中凹侧和凸侧比较,多裂肌及竖脊肌横截面积比较差异有统计学意义(P<0.05)。多裂肌脂肪化率与术后ODI评分存在显著相关性(r=0.462)。结论退变性腰椎侧凸病人术前应重视椎旁肌退变程度的评价,特别是多裂肌的脂肪化率,延长固定节段或注意加强腰背肌的锻炼,有助于缓解病人术后腰背痛。

Objective To the relationship between the degeneration of paraspinal muscles and postoperative clinical efficacy of short decompression and fusion in patients with degenerative lumbar scoliosis.Methods From December 2013 to December 2017,53 patients were treated for DLS with short decompression and intervertebral fusion.According to the preoperative MRI measurement of the paraspinal muscles cross section area(CSA)and the fatty rate,All patients was divided into the observation group(28 cases)and the control group(25 cases).Preoperative measurement of Cob Angle,CSA and fatty rate of paraspinal muscles,visual analog scale(VSA),Oswestry dysfunction index(ODI).Results There was no significant difference in Cob’s angle,VAS and ODI between the two groups(P>0.05).There was a significant difference in Cobb’s angle between the two groups at 6 months after operation and before operation.12 months after operation,the Cobb’s angle in the observation group was higher than that in the control group(P<0.05),while the VAS and ODI scores in the control group were better than those in the observation group(P<0.05).There was significantly difference between the two groups in the CSA of the multifidus and the erector spinalis(P<0.05).In the observation group,there was significantly difference in CSA between the concave side and the convex side(P<0.05).There was significant correlation between the fatty rate and the postoperative ODI score,r=0.462.Conclusion Before operation,we should pay attention to the evaluation of the degree of degenerative paravertebral muscles,especially the fatty rate of the polysplit muscles,lengthen the fixed segment or strengthen the exercise of the lumbodorsal muscles,which is helpful to relieve the postoperative lumbodorsal pain.