腰椎后路椎间融合术对椎旁肌损伤的影响研究

doi:10.11958/20221658

天津医药 ›› 2023, Vol. 51 ›› Issue (4): 392-394.doi: 10.11958/20221658

腰椎后路椎间融合术对椎旁肌损伤的影响研究

张晓(), 商亮, 阮智()

石河子大学医学院第一附属医院脊柱外科（邮编832000）

收稿日期:2022-10-17 修回日期:2022-11-24 出版日期:2023-04-15 发布日期:2023-04-20
通讯作者: 阮智 E-mail:zjx01205@163.com;1725660475@qq.com
作者简介:张晓（1992），男，硕士在读，主要从事脊柱椎间盘退变方面研究。E-mail：zjx01205@163.com
基金资助:
国家自然科学基金资助项目(82060410);八师石河子市科技计划项目(2018LY05)

The influence of posterior lumbar interbody fusion on paraspinal muscle injury

ZHANG Xiao(), SHANG Liang, RUAN Zhi()

Department of Spine Surgery, the First Affiliated Hospital of Shihezi University Medical College, Shihezi 832000, China

Received:2022-10-17 Revised:2022-11-24 Published:2023-04-15 Online:2023-04-20
Contact: RUAN Zhi E-mail:zjx01205@163.com;1725660475@qq.com

张晓, 商亮, 阮智. 腰椎后路椎间融合术对椎旁肌损伤的影响研究[J]. 天津医药, 2023, 51(4): 392-394.

ZHANG Xiao, SHANG Liang, RUAN Zhi. The influence of posterior lumbar interbody fusion on paraspinal muscle injury[J]. Tianjin Medical Journal, 2023, 51(4): 392-394.

摘要/Abstract

摘要：

目的评估腰椎后路椎间融合术（PLIF）后椎旁肌肉损伤状况。方法前瞻性纳入接受PLIF治疗的侧隐窝型腰椎管狭窄症患者56例。记录术前、术后3个月疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）；使用表面肌电图（sEMG）测定在抬物动作试验三阶段椎旁肌均方根（RMS）和中位频率（MF）变化；检测术前及术后第1、3、7天血清肌酸激酶（CK）和C-反应蛋白（CRP）水平。结果患者术后3个月的疼痛VAS评分和ODI评分均较术前降低（P<0.05）。在测试阶段一、二中，患者术后3个月椎旁肌RMS水平低于术前，在测试阶段三中患者术后椎旁肌的MF值高于术前（P<0.05）。血清CK术后第1、3天较术前水平升高，且在术后第1天达到峰值（P<0.05），术后第7天血清CK水平基本恢复至术前水平。CRP水平术后各时点均高于术前，于术后第3天达到峰值，术后第7天较前下降（P<0.05）。结论 sEMG显示PLIF对椎旁肌组织造成了一定程度的损伤，这可能是引起患者术后椎旁肌功能下降和术后腰痛仍未完全缓解的主要原因。

关键词: 椎管狭窄, 腰椎, 脊柱融合术, 肌酸激酶, 肌电描记术, 椎旁肌

Abstract:

Objective To evaluate paraspinal muscle injury after posterior midline lumbar interbody fusion. Methods Fifty-six patients with lateral recess lumbar spinal stenosis who received PLIF were prospectively included. Visual analog scale (VAS) and Oswestry Disability Index (ODI) were recorded before surgery and 3 months after surgery. Surface electromyography (sEMG) was used to measure the root mean square (RMS) and median frequency (MF) of paravertebral muscle in the three stages of lift test. Serum levels of creatine kinase (CK) and C-reactive protein (CRP) were detected before surgery and at 1, 3 and 7 days after surgery. Results The VAS score and ODI score were significantly lower in patients 3 months after surgery than those before surgery (P<0.05). In test stage 1 and 2, the level of paraspinal muscle RMS was significantly lower 3 months after surgery than that before surgery, and in test stage 3, the postoperative paraspinal muscle MF value was significantly higher than that before surgery (P<0.05). Serum CK level was significantly higher on the 1st and 3rd day after surgery than that before surgery, and which reached the peak on the 1st day after surgery (P<0.05). Serum CK level basically recovered to the preoperative level on the 7th day after surgery, and CRP level was higher at all time points after surgery than that before surgery, and reached the peak on the 3rd day after surgery, and decreased on the 7th day after surgery (P<0.05). Conclusion sEMG reveals that posterior lumbar interbody fusion causes some paraspinal muscle tissue injury, which may be the primary cause of postoperative paraspinal muscle function decline and postoperative low back pain.

Key words: spinal stenosis, lumbar vertebrae, spinal fusion, creatine kinase, electromyography, paraspinal muscles

中图分类号:

R681.5

图/表 2

参考文献 22

[1]	JENSEN R K, LAURIDSEN H H, ANDRESEN A, et al. Diagnostic screening for lumbar spinal stenosis[J]. Clin Epidemiol, 2020, 12:891-905. doi:10.2147/CLEP.S263646.
[2]	CHO S M, KIM S H, HA S K, et al. Paraspinal muscle changes after single-level posterior lumbar fusion:volumetric analyses and literature review[J]. BMC Musculoskelet Disord, 2020, 21(1):73. doi:10.1186/s12891-020-3104-0.
[3]	FENTON-WHITE H A. Trailblazing:the historical development of the posterior lumbar interbody fusion(PLIF)[J]. Spine J, 2021, 21(9):1528-1541. doi:10.1016/j.spinee.2021.03.016.
[4]	HE W, HE D, SUN Y, et al. Quantitative analysis of paraspinal muscle atrophy after oblique lateral interbody fusion alone vs. combined with percutaneous pedicle screw fixation in patients with spondylolisthesis[J]. BMC Musculoskelet Disord, 2020, 21(1):30. doi:10.1186/s12891-020-3051-9.
[5]	PALPAN FLORES A, GARCíA FEIJOO P, ISLA GUERRERO A. Paraspinal muscle atrophy after posterior lumbar surgery with and without pedicle screw fixation with the classic technique[J]. Neurocirugia(Astur:Engl Ed), 2019, 30(2):69-76. doi:10.1016/j.neucir.2018.11.006.
[6]	MORTKA K, WIERTEL-KRAWCZUK A, LISIńSKI P. Muscle activity detectors-surface electromyography in the evaluation of abductor hallucis muscle[J]. Sensors(Basel), 2020, 20(8):2162. doi:10.3390/s20082162.
[7]	MAEZAWA K, NOZAWA M, GOMI M, et al. Changes in serum creatine kinase and C-reactive protein after posterior and direct anterior approaches in total hip arthroplasty[J]. Hip Int, 2022, 32(5):591-595. doi:10.1177/1120700020978643.
[8]	MARGRAF A, LUDWIG N, ZARBOCK A, et al. Systemic inflammatory response syndrome after surgery:Mechanisms and protection[J]. Anesth Analg, 2020, 131(6):1693-1707. doi:10.1213/ANE.0000000000005175.
[9]	BARTYNSKI W S, LIN L. Lumbar root compression in the lateral recess:MR imaging,conventional myelography,and CT myelography comparison with surgical confirmation[J]. AJNR Am J Neuroradiol, 2003, 24(3):348-360.
[10]	李永忠, 朱一霄, 陈文君, 等. 基于表面肌电信号分析的退行性腰椎后凸患者手术前、后椎旁肌肉功能变化研究[J]. 中华物理医学与康复杂志, 2018, 40(4):290-295.
	LI Y Z, ZHU Y X, CHEN W J, et al. The functional status of the paraspinal muscles among patients with degenerative lumbar kyphosis before and after surgery[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2018, 40(4):290-295. doi:10.3760/cma.j.issn.0254-1424.2018.04.012.
[11]	TANDON R, KIYAWAT V, KUMAR N. Clinical correlation between muscle damage and oswestry disability index score after open lumbar surgery:Does open surgery reduces functional ability?[J]. Asian Spine J, 2018, 12(3):518-523. doi:10.4184/asj.2018.12.3.518.
[12]	CHMIELEWSKA D, STANIA M, KUCAB-KLICH K, et al. Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises[J]. PLoS One, 2019, 14(12):e0225647. doi:10.1371/journal.pone.0225647.
[13]	MERLETTI R, CERONE G L. Tutorial. Surface EMG detection,conditioning and pre-processing:Best practices[J]. J Electromyogr Kinesiol, 2020, 54:102440. doi:10.1016/j.jelekin.2020.102440.
[14]	JERO S E, BHARATHI K D, RAMAKRISHNAN S. A method to differentiate fatiguing conditions in surface electromyography signals using instantaneous spectral centroid[J]. Annu Int Conf IEEE Eng Med Biol Soc, 2020, 2020:690-693. doi:10.1109/EMBC44109.2020.9176599.
[15]	KRAJEWSKA-WęGLEWICZ L, BANACH M, FILIPIAK E, et al. The feasibility of surface electromyography in monitoring orbicularis oculi recovery after anterior approach levator aponeurosis advancement[J]. J Clin Med, 2022, 11(3):731. doi:10.3390/jcm11030731.
[16]	KOUMANTAKIS G A, OLDHAM J A. Paraspinal strength and electromyographic fatigue in patients with sub-acute back pain and controls:Reliability,clinical applicability and between-group differences[J]. World J Orthop, 2021, 12(11):816-832. doi:10.5312/wjo.v12.i11.816.
[17]	LI W, LIU Y C, ZHENG C F, et al. Diagnosis of compressed nerve root in lumbar disc herniation patients by surface electromyography[J]. Orthop Surg, 2018, 10(1):47-55. doi:10.1111/os.12362.
[18]	JUNG G S, CHANG M C, SEO S W, et al. Transcutaneous neuromuscular electrical stimulation applied to optimal points on the lower abdomen and lumbar paraspinal region changes gait parameters in patients with lumbar degenerative kyphosis[J]. J Back Musculoskelet Rehabil, 2018, 31(2):267-274. doi:10.3233/BMR-169638.
[19]	MATěJKA T, ZEMAN J, BELATKA J, et al. Creatine kinase and myoglobin levels as indicators of perioperative muscle damage during open- and mini-invasive stabilization of thoracic and lumbar spine fracture - a prospective randomized study[J]. Acta Chir Orthop Traumatol Cech, 2020, 87(1):9-16.
[20]	AO S, ZHENG W, WU J, et al. Comparison of preliminary clinical outcomes between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in a tertiary hospital: Is percutaneous endoscopic procedure superior to MIS-TLIF? A prospective cohort study[J]. Int J Surg, 2020, 76:136-143. doi:10.1016/j.ijsu.2020.02.043.
[21]	KUMBHARE D, PARKINSON W, DUNLOP B, et al. Biochemical measurement of muscle injury created by lumbar surgery[J]. Clin Invest Med, 2007, 30(1):12-20. doi:10.25011/cim.v30i1.444.
[22]	HOELLER S, ROCH P J, WEISER L, et al. C-reactive protein in spinal surgery: more predictive than prehistoric[J]. Eur Spine J, 2021, 30(5):1261-1269. doi:10.1007/s00586-021-06782-8.

测试阶段	术前	术后3个月	t
阶段一RMS值（μV）	16.44±6.26	9.37±3.34	10.301^*
阶段二RMS值（μV）	43.58±15.39	24.87±7.96	11.122^*
阶段三MF值（Hz）	62.68±23.86	74.82±25.44	3.535^*

测试阶段	术前	术后3个月	t
阶段一RMS值（μV）	16.44±6.26	9.37±3.34	10.301^*
阶段二RMS值（μV）	43.58±15.39	24.87±7.96	11.122^*
阶段三MF值（Hz）	62.68±23.86	74.82±25.44	3.535^*

时间	CK（U/L）	CRP（mg/L）
术前	69.46±18.73	1.73±0.84
术后第1天	284.98±108.18^a	32.17±16.95^a
术后第3天	156.29±56.72^ab	79.06±31.12^ab
术后第7天	76.05±27.36^bc	21.58±12.38^abc
F	89.180^**	145.857^**

时间	CK（U/L）	CRP（mg/L）
术前	69.46±18.73	1.73±0.84
术后第1天	284.98±108.18^a	32.17±16.95^a
术后第3天	156.29±56.72^ab	79.06±31.12^ab
术后第7天	76.05±27.36^bc	21.58±12.38^abc
F	89.180^**	145.857^**

腰椎后路椎间融合术对椎旁肌损伤的影响研究

The influence of posterior lumbar interbody fusion on paraspinal muscle injury

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

图/表 2

参考文献 22

相关文章 15

编辑推荐

Metrics

本文评价

[1]	张春虹, 黄洪超, 刘越, 杜立龙, 许海委, 黎宁, 李勇进. 基于RNA测序和生物信息学分析鉴定椎旁肌退变中关键的铁死亡基因[J]. 天津医药, 2024, 52(9): 991-995.
[2]	王敏, 王龙胜, 陈磊. 骨质疏松症患者腰椎骨折预测模型的构建[J]. 天津医药, 2024, 52(7): 766-769.
[3]	刘越, 姜洪丰, 黄洪超, 黎宁, 徐宝山. 有关退变性腰椎滑脱治疗的争议问题[J]. 天津医药, 2021, 49(8): 883-886.
[4]	李会侠, 赵玉龙, 王祺, 李晓辉, 冯琳, 张永婷. 腰椎管狭窄合并马尾神经冗余患者的手术疗效分析[J]. 天津医药, 2021, 49(10): 1085-1088.
[5]	丁吉, 程招军, 张黎龙, 徐宝山△. 2种固定方式对短节段颈椎前路椎间盘切除融合术后#br# 颈椎矢状位参数变化的影响#br#[J]. 天津医药, 2020, 48(8): 736-740.
[6]	王锟 , 孙晓亮 △, 吴国锋 , 周剑 , 孙晗 , 袁峰 . 腰椎管狭窄合并L3退行性脊柱滑脱的病理机制研究 #br#[J]. 天津医药, 2020, 48(4): 294-297.
[7]	张春虹, 杜立龙, 张凯辉, 徐宝山△. 新冠肺炎疫情下脊柱内镜治疗腰椎间盘突出症日间手术模式及效果分析[J]. 天津医药, 2020, 48(10): 913-916.
[8]	徐宝山，刘阳，姜洪丰，刘越，王涛，黎宁，许海委，黄洪超，吉宁. 自锚式侧路腰椎椎体间融合术的设计与应用[J]. 天津医药, 2019, 47(9): 937-942.
[9]	张春虹 1，闫兵山 1,2，徐宝山 1，马信龙 1，杨强 1，刘越 1. 经颅直流电刺激治疗腰椎融合术后疼痛的疗效观察[J]. 天津医药, 2017, 45(9): 980-983.
[10]	朱何涛 1，2，朱博 1，高天阳 1，张琳 3，邓晓磊 4，张西峰 2△. 经皮微创手术治疗腰椎结核的中远期疗效观察[J]. 天津医药, 2017, 45(6): 614-619.
[11]	徐宝山，马信龙，杨强，刘越，姜洪丰，许海委，吉宁. 可动式椎间盘镜下保留后韧带复合体的颈椎管扩大成形术的设计与临床应用[J]. 天津医药, 2017, 45(4): 409-412.
[12]	刘新宇，原所茂，田永昊，王连雷，阎峻，郑燕平，宫良泰，李建民. 前路小切口病灶清除结合后路微创内固定治疗单节段腰椎结核[J]. 天津医药, 2017, 45(2): 116-120.
[13]	黎宁，徐宝山，刘越，杨强，姜洪丰，吉宁，张春虹，杨涛. 颈前路内镜联合后路单开门治疗多节段椎管狭窄伴巨大椎间盘突出的临床分析[J]. 天津医药, 2017, 45(2): 125-128.
[14]	徐宝山，马信龙，刘越，等.. 可动式椎间盘镜下MED-LIF 手术的设计与临床应用[J]. 天津医药, 2016, 44(8): 1043-1047.
[15]	徐宝山马信龙杨强刘越姜洪丰许海委吉宁. 可动式椎间盘镜下MED-TLIF的设计与临床应用[J]. 天津医药, 2016, 44(7): 910-913.