微創脊椎減壓經骨皮質內固定手術與傳統脊椎手術術後椎旁肌萎縮之研究

Paraspinal muscle change after cortical bone trajectory screw and traditional pedicle screws techniques for lumbar fusion

曾福豪(Fook-How Chan)

指導教授 ： 李宗賢

中山醫學大學/醫學院/醫學研究所/碩士(2021年)

https://doi.org/10.6834/csmu202100208

摘要

研究目的：
傳統脊椎椎間融合手術是一種安全有效的治療方法，但許多文獻證實，傳統脊椎手術對於脊椎兩側椎旁肌有很大程度的損傷。微創脊椎經骨皮質內固定手術由日本學者Santoni於2008年提出，不同於傳統脊椎手術，經骨皮質內固定手術採取由內側至外側的螺釘軌跡。有更小的傷口；更少的脊椎旁肌肉破壞。這次研究通過手術前後的磁振造影成像，探討傳統脊椎手術和脊椎骨皮質內固定手術對腰椎椎旁肌產生的影響。
研究方法及資料：
本回溯性研究於中山醫學大學附設醫院，2018年1月至2020年12月間。48名病人患有退化性脊椎疾病，且接受過單節微創脊椎減壓經骨皮質內固定手術(n=24)或傳統脊椎固定手術(n=24)，並根據不同手術平均配對成兩組納入研究。使用疼痛視覺擬量表評估術後臨床結果。使用椎旁肌椎核磁共振成像以及面積測量軟體，計算脊柱旁肌群肌肉截面積中的實質肌肉量。
研究結果：
傳統脊椎手術組和微創脊椎骨皮質內固定手術組別基本臨床特徵無顯差別，包括分組人數、年紀、身高、體重，BMI值。骨皮質釘組在術中出血量、手術傷口大小、術後平均引流量、住院天數明顯比傳統組來得好。兩組在手術時間、手術前後一年的疼痛視覺擬量表並無差別。研究發現兩組患者的椎旁肌群在手術後均會造成肌群萎縮現象。椎旁肌群中內側多裂肌，在傳統組手術後萎縮剩下61.87±21.93%；骨皮質釘組術後萎縮剩下78.45±17.86％。而外側豎脊肌群中，傳統組手術後萎縮剩下84.06±14.10％；骨皮質釘組術後萎縮剩下89.83±10.19％ (p<0.0001)。傳統組中椎旁肌群萎縮程度比微創脊椎骨皮質內固定手術組更加嚴重。
結論與建議：
微創脊椎減壓經骨皮質內固定手術，有更少兩側椎旁肌的破壞及更小的傷口。與傳統脊椎手術比較，這種技術可以保護兩側椎旁肌在脊椎手術後萎縮的風險。

關鍵字

微創脊椎經骨皮質內固定 ； 手術疼痛視覺擬量表 ； 肌肉截面積

並列摘要

Objective：
Traditional spinal fusion surgery is a safe and effective surgical technique. However, several studies have shown the possibility of bilateral paraspinal muscle injury. Santoni et al. first reported cortical bone trajectory(CBT). Different from traditional spinal fusion surgery, the cortical screw represents an alternative to the pedicle screw track for posterior fixation of the lumbar spine. It can effectively reduce the incision length and paraspinal muscle dissection. This study evaluated paraspinal muscle atrophy subsequent to traditional spinal fusion surgery or cortical bone trajectory technique using magnetic resonance imaging.
Methods and Materials：
This is a retrospective cohort study from January 2018 and December 2020 at Chung Shan Medical University Hospital. A total of 48 patients with diagnosis of degenerative spinal disease. All patients underwent traditional spinal fusion surgery (n=24) or cortical bone trajectory technique (n=24) involving only one level of spine. Perioperative data and clinical characteristics in terms of visual analogue scale (VAS) after surgey were evaluated. Use paraspinal muscle magnetic resonance imaging and area measurement software to calculate the substantial muscle mass in muscle cross sectional area (CSA).
Results：
There was no significant difference in clinical characteristics between the traditional spine surgery group and the CBT group, including the number of groups, age, height, weight, and BMI value. However, CBT group had a less intraoperative blood loss, shorter surgical incision length, less postoperative drainage and shorter hospital stay duration than the patients in the traditional group. The were no differences in operation times, visual analogue scale (VAS) after surgey between the two groups. Both surgical techniques will cause paraspinal muscle atrophy after surgery. However, the atrophy of paraspinal muscle was more severe in traditional group.
Conclusion and Suggestion：
The CBT technique induced less paraspinal muscle damage and incision length than traditional technique. This technique protect the paraspinal muscle from the risk of atrophy after spinal surgery.

並列關鍵字

cortical bone trajectory(CBT) ； visual analogue scale (VAS) ； cross sectional area (CSA).

參考文獻

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