单侧旁正中切口TLIF术对手术侧与非手术侧椎旁肌肉的影响

Effects of unilateral paramedian incision TLIF on the paravertebral muscles of surgical side and nonsurgical side

目的观察单侧旁正中切口经椎间孔椎体融合术(TLIF)对手术侧与非手术侧椎旁肌肉的影响。方法回顾性分析38例行单侧旁正中切口TLIF术的退行性腰椎疾病患者临床资料。比较术后手术侧与非手术侧多裂肌、竖脊肌横截面积(CSA)差异。观察术前、术后6个月及末次随访时患者腰椎功能、功能障碍、腰腿疼痛及腰椎前凸角(LL)、手术节段前凸角(SL)改善情况。结果患者术后L5~S1近头侧、L3~L4、L4~L5手术侧与非手术侧多裂肌CSA及各节段手术侧与非手术侧竖脊肌CSA比较差异无统计学意义(P>0.05);L5~S1近尾侧手术侧多裂肌CSA显著小于非手术侧(P<0.05)。术后6个月、末次随访时患者腰椎功能量表(JOA)评分、LL、SL较术前升高,Oswestry功能障碍指数问卷(ODI)、腰腿视觉模拟评分(VAS)则均较术前降低(P<0.05);患者术后6个月、末次随访时JOA、ODI、腰腿VAS评分及LL、SL比较差异无统计学意义(P>0.05)。结论单侧旁正中切口TLIF术对术侧椎旁肌影响较小,可有效改善退行性腰椎疾病患者腰椎功能和功能障碍,减轻其术后腰腿疼痛,增加其LL、SL并维持稳定,对促进患者术后恢复有利。

Aim To observe the effects of unilateral paramedian incision of transforaminal lumbar interbody fusion(TLIF)on the paravertebral muscles of surgical side and nonsurgical side.Methods The clinical data of 38 patients with degenerative lumbar disease who underwent unilateral paramedian incision TLIF were retrospectively analyzed.The differences in the cross-sectional area(CSA)of the multifidus and erector spinae of surgical side and nonsurgical side were compared after operation.The lumbar spinal function,low back and leg pain,lumbar lordosis(LL)and segmental lordosis(SL)were observed before operation,at 6 months after operation and at the last follow-up.Results There was no significant difference in multifidus CSA of L5~S1 proximal cephalic side,and L3~4,L4~5 surgical and nonsurgical sides,and the erector spinae CSA of surgical and non-surgical sides of all segments.The CSA of L5~S1 proximal caudal side of surgical side multifidus was significantly less than nonsurgical side(P<0.05).At 6 months after operation and last follow-up,the Japanese orthopaedic association(JOA)score,LL and SL were higher than those before operation,while the oswestry disability index(ODI)and visual analogue scale(VAS)scores were lower than those before operation(P<0.05).At 6 months after operation and last follow-up,there was no significant difference in the JOA,ODI and VAS scores,and LL and SL(P>0.05).Conclusion Unilateral paramedian incision TLIF has small influence on the paravertebral muscles of surgical side,and it can effectively improve lumbar spinal function and dysfunction in patients with degenerative lumbar disease,relieve postoperative low back and leg pain,increase LL and SL and maintain stability,and it helps to promote the postoperative recovery of patients.