椎旁肌横截面测量在评价手术创伤的临床意义

目的　探讨椎旁肌横截面的测量方法，为评价手术对椎旁肌结构与功能的影响提供依据。 方法　将95例胸腰椎骨折患者椎体进行CT扫描，在横截面上标记相关解剖标志，测量椎旁肌最大冠状径、矢状径及椎旁肌面积，分析各参数与椎旁肌损伤的关系及其与术后疼痛、功能障碍相关性。 结果　术前、术后、末次随访时椎旁肌面积差异有统计学意义，术后明显大于术前（P<0.01），而末次随访时小于术前（P<0.05）。术后-术前、末次随访时-术前椎旁肌最大冠状径、最大矢状径之差与术后4 d、末次随访时VAS疼痛评分及术后Oswestry功能障碍指数之间存在相关关系，以最大矢状径的变化最为相关（b'= 　-0.521）。 结论 在CT横截面上可精确识别相关的解剖标志，并能准确地测量椎旁肌最大冠状径、最大矢状径及椎旁肌面积，为评价手术对椎旁肌肉损伤提供客观的依据。

Clinical evaluation of surgical trauma through measurements of the cross-section area of paravertebral muscles

Objective　To assess the paravertebral muscle cross section measurement for evaluation of the impact of surgery on the paravertebral muscle structure and function provided by it.　Method　95 cases of patients with thoracic or lumbar vertebral fracture underwent CT scan, anatomic landmarks were marked on the horizontal sections. Measurements involving the largest coronary diameter, the largest sagittal diameter and the area of paravertebral muscles were carried out, and analysis of the correlations of the abovementioned parameters to paraspinal muscle injury, postoperative residual pain and dysfunction were performed. Results There was statistically significant difference among the preoperative, the postoperative, and the last paravertebral muscle area measured during the following-up; Moreover, the last horizontal section area measured was smaller than the preoperative one(P<0.01), which in turn was smaller than the postoperative one(P<0.05) The difference between postoperative and preoperative largest coronary and sagittal diameter of the paravertebral muscles, and the differnce between the last and preoperative largest coronary and sagittal diameter of the paravertebral muscles were both correlated to the VAS pain score and the postoperative Oswestry dysfunction index evaluated 4 days postoperativelly (b'= -0.521).　Conclusion　Can accurately identify the anatomical landmarks, the largest coronary and sagittal diameter and the horizontal area of the paraspinal muscles can all be accurately identified and measured in CT cross section, which together can provide an objective evaluation of the surgical paraspinal muscle damage.