Kim Dong-Yun, Lee Sang-Ho, Chung Sang Ki, Lee Ho-Yeon
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
Spine (Phila Pa 1976). 2005 Jan 1;30(1):123-9.
This study was conducted by retrospective case selection and prospective observation of longitudinal changes of the multifidus muscle cross-sectional area and of trunk extension muscle strength in percutaneous and open pedicle screw fixations.
To compare postoperative multifidus muscle atrophy and trunk muscle performance of percutaneous pedicle screw fixation against those of open pedicle screw fixation.
Recent attempts to combine percutaneous pedicle screw fixation with minimally invasive fusion techniques are based on an anecdotal presupposition that percutaneous pedicle screw fixation is superior to its open counterpart. However, the benefits of percutaneous pedicle screw fixation are currently poorly defined.
Nineteen enrolled patients were divided as follows: 11 in the open pedicle screw fixation group (OPF group) and eight in the percutaneous pedicle screw fixation group (PPF group). The preoperative and postoperative cross-sectional area and T2-weighted signal intensity of multifidus muscle were measured by MRI, and trunk extension muscle strength was measured. In addition, various clinical variables were compared between two groups.
There was significant decrease in the cross-sectional area of multifidus muscle in the OPF group. In contrast, the results in the PPF group showed no statistical difference between preoperative results and that of the follow-up MRI. Although percutaneous pedicle screw fixation had positive effects on postoperative trunk muscle performance, clinical outcomes were not significantly different in areas of pain score, JOA score, and patient's opinion regarding the outcome of the surgery. However, percutaneous pedicle screw fixation caused less blood loss, and the proportion of patients who did not need postoperative oral analgesics was greater in the PPF group.
Percutaneous pedicle screw fixation caused less paraspinal muscle damage than open pediclescrew fixation and had positive effects on postoperative trunk muscle performance.
本研究通过回顾性病例选择和前瞻性观察，对比经皮椎弓根螺钉固定术和开放椎弓根螺钉固定术中多裂肌横截面积及躯干伸展肌力的纵向变化。
比较经皮椎弓根螺钉固定术与开放椎弓根螺钉固定术后多裂肌萎缩情况及躯干肌肉功能。
近期将经皮椎弓根螺钉固定术与微创融合技术相结合的尝试基于一种未经证实的假设，即经皮椎弓根螺钉固定术优于开放手术。然而，目前经皮椎弓根螺钉固定术的优势尚不明确。
19例入选患者分为两组：开放椎弓根螺钉固定组（OPF组）11例，经皮椎弓根螺钉固定组（PPF组）8例。通过MRI测量术前及术后多裂肌的横截面积和T2加权信号强度，并测量躯干伸展肌力。此外，比较两组间的各项临床变量。
OPF组多裂肌横截面积显著减小。相比之下，PPF组术前与术后MRI结果无统计学差异。尽管经皮椎弓根螺钉固定术对术后躯干肌肉功能有积极影响，但在疼痛评分、日本骨科协会（JOA）评分及患者对手术效果的评价方面，临床结果无显著差异。然而，经皮椎弓根螺钉固定术出血量较少，PPF组中无需术后口服镇痛药的患者比例更高。
与开放椎弓根螺钉固定术相比，经皮椎弓根螺钉固定术对椎旁肌损伤较小，且对术后躯干肌肉功能有积极影响。
