脊柱侧凸症与椎旁肌病理的相关因素

Related factors of scoliosis to pathological changes of paravertebral muscles

目的 探讨脊柱侧凸症与其椎旁肌病理变化的相关因素。方法 对特发性脊柱侧凸(IS) 2 0例 ,先天性脊柱侧凸 (CS) 15例 ,进行椎旁肌的肌电测定。并于术中取IS组 2 3例 ,CS组 11例顶椎旁的椎旁肌 ,进行神经镀银染色 ,观察其神经终末支配率及神经终板。并对IS19例、CS15例的椎旁肌进行了 6种元素的含量测定。结果 肌电测定IS组静息电位 ,凸侧肌电波幅大于凹侧 ,最大用力时电位凸侧波幅亦大 ,呈干扰期 ,CS组静息电位凸凹侧均可见到连续电位 ,最大用力凸侧呈混合相 ,凹侧呈单纯相神经终末支配率 (TIR) :IS组凸侧TIR值大 ,凹侧小 ,神经终板凸侧T0 少 ,T1型多 ,病变终板少 ,凹侧TIR值小 ,病变终板多。椎旁肌元素含量与Cobb角呈正相关 ,其中Ca、Mg、Fe、Zn凸侧含量多于凹侧。结论 脊柱侧凸与椎旁肌病理变化程度呈正相关 ,变化为不可逆 ,椎旁肌病理改变是继发性改变 ,故早期制止侧凸进展是防止椎旁肌病变的关键 ,因此实验结果为早期治疗提供了依据。

Objective To study the related factors of scoliosis to pathological changes of paravertebral muscles. Methods The electromyography of paravertebral muscles of 20 cases of idiopathic scoliosis (IS) and 15 with congenital scoliosis (CS) were determined. The nerve innervations, terminal innervation ratio (TIR) and axonal terminal branch of motor end plates in paravertebral muscle biopsy specimens from 23 patients of IS and 11 of CS were compared .The content of six chemical elements in the paravertebral muscles of 19 IS cases and 15 CS cases were estimated.Results The resting potential in IS groups showed the muscle electric waves in the convex side were higher than those of the concave when rest or over load. Continuous electric potential was observed on the paravertebral muscles of convex and concave side in SC groups. The resting potential demonstrated mixed period in convex side and simple period in concave side. The values of TIR in the convex side were significantly higher than those of concave in both IS and CS groups. The motor end plates in convex was mainly consist of T 1 type, whereas the concave side were of T 0 type. The chemical elements content in paravertebral muscles had positive correlation with Cobb's Angle, and the content of Ca?Mg?Fe?Zn elements were higher in convex side than in the concave. Conclusions The scoliosis presents a positive correlation with the pathological changes of paravertebral muscles,and it is secondary and irreversible. An early scoliosis progression under control is of great importance to prevent the pathological changes of paravertebral muscles.