腰椎后路术后骶棘肌损伤的临床病理学分析

目的：阐明常规腰椎后入路手术导致骶棘肌的功能紊成与后期残留临床症状之间的关系。方法：随访3组人群，包括初次腰椎后路手术患者12例，再次腰椎后路手术患者7例和正常健康人20例，采用EMG、Cybex肌力测试和组织病理学方法评价骶棘肌的功能状态态，临床功能评价采用改良的WHO－OH评分法，结果：肌电图测试结果显示，再次手术组患者的腰背伸肌肌电活动显著低于正常对照组；Cybex等速肌力测试表明，再次手术组患者的腰背伸肌力显著弱于正常对照组和初次手术组；棘肌的组织学检查显示，在各种染色下出现不同程度的变化性，坏死和修复反应以及骶棘肌的失神经支配现象，电镜与光镜表现相呼应，按WHO－－OH评分，初次手术组多属轻或中度损害，而再次手术组则多为中度或较严重病损，结论：由EMG和Cybex等速肌力测试所反映的骶棘肌功能状态与其组织形态学的改变是密切相关的；骶棘肌对于维持脊柱的稳定性起着重要的作用，其功能紊乱可能是引起腰椎后路术后失败综合征的原因之一。

The clinical and pathological analysis of multifidus injury after posterior lumbar spine surgery

Objective:To elucidate the relationship between the functional disturbance of multifidus and the clinical sequelae,caused by routine posterior lumbar operation.Method:The three groups were observised.They included primary posterior lumbar operation(12cases),re-operative patients(7cases)and controls(20cases)respectively.We evaluated the functional state of multifidus with EMG,Cybex isokinetic test and histopathology,forthmore,the modified WHO-OH scores was adopted to evaluate the clinical function.Result:Surface electromyographic findings showed that EMG activities of lumbar extensor in re-operative group of patients are statistically significant lower than that in controls.Cybex isokinetic test showed that lumbar extensor strength in re-operative group of patients was significant lower than that in controls and primary operative group of patients.The histological study of multifidus showed that the extent of degeneration?necrosis and repairment process of muscle fibers by various stains was presented and muscle denervation remained.The significant ultrapathologic results were associated with the microscopic histological reactions.According to the WHO-OH scores,the primary group of patients belonged to mild or moderate,nevertheless the re-operative group of patients belonged to moderate or severe handicap.Conclusion:Multifidus functional state which is demonstrated by EMG and Cybex isokinetical test has close relationship with its histologicomorphology;Multifidus acts mainly on spine stablibity,and its disturbance seems to be the one cause of postoperative failed back syndrome.Author's address Dept.of Orthopaedic,Ruijin Hospital,Shanghai Second Medical University,200025