Hatakeyama Yuji, Miyakoshi Naohisa, Senma Seietsu, Narita Yuichiro, Sasaki Kana, Sugimura Yusuke, Shimada Yoichi
Department of Orthopedic Surgery, Nakadori General Hospital, Japan.
Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Japan.
J Orthop Sci. 2019 May;24(3):400-403. doi: 10.1016/j.jos.2018.10.018. Epub 2018 Nov 10.
We sought to evaluate the hip abduction strength in patients before and after lumbar surgery.
Eighty-four patients (51 males and 33 females) undergoing surgery for lumbar disc herniation or lumbar canal stenosis were selected. Mean age was 64.7 ± 13.8 years. Seven patients (8.3%) had surgery at multiple levels, including L2-L3 (group A), 27 (32.1%) patients had surgery at multiple levels including L3-L4 (group B), 32 (38.1%) patients had surgery at the L4-L5 level only (group C), and 18 (21.4%) patients had surgery at the L5-S1 level only (group D). Hip abduction strength was measured in the 84 patients preoperatively and in 49 patients postoperatively.
In all patients, preoperative mean hip abduction strength on the symptomatic side and the asymptomatic side was 71.4 ± 34.5 N and 90.7 ± 36.5 N, respectively (p = 0.0008). In groups A and B, there were no significant differences between the mean hip abduction strength on the symptomatic and contralateral side. In group C, those on the symptomatic and contralateral side were 68.0 ± 33.5 N and 89.3 ± 34.8 N, respectively (p = 0.0181). In group D, those on the symptomatic and contralateral side were 74.3 ± 42.4 N and 101.7 ± 44.7 N, respectively (p = 0.0314). In the 49 patients of all groups that could be measured postoperatively, there were no significant differences between the mean hip abduction strength on both sides.
It was confirmed that the gluteus medius, which was main hip abductor, was mainly innervated by L5 and its mean strength significantly improved postoperatively. The possibility of improvement of hip abduction strength, especially with unchanged tibialis anterior strength, could be very useful for operative decisions.
我们试图评估腰椎手术前后患者的髋关节外展力量。
选取84例接受腰椎间盘突出症或腰椎管狭窄症手术的患者（51例男性和33例女性）。平均年龄为64.7±13.8岁。7例（8.3%）患者在多个节段进行手术，包括L2-L3（A组），27例（32.1%）患者在包括L3-L4的多个节段进行手术（B组），32例（38.1%）患者仅在L4-L5节段进行手术（C组），18例（21.4%）患者仅在L5-S1节段进行手术（D组）。对84例患者术前及49例患者术后测量髋关节外展力量。
所有患者中，患侧和健侧术前平均髋关节外展力量分别为71.4±34.5N和90.7±36.5N（p=0.0008）。A组和B组中，患侧与对侧平均髋关节外展力量无显著差异。C组中，患侧与对侧分别为68.0±33.5N和89.3±34.8N（p=0.0181）。D组中，患侧与对侧分别为74.3±42.4N和101.7±44.7N（p=0.0314）。在所有组可进行术后测量的49例患者中，两侧平均髋关节外展力量无显著差异。
证实作为主要髋关节外展肌的臀中肌主要由L5神经支配，且其平均力量在术后显著改善。髋关节外展力量改善的可能性，尤其是在胫前肌力量不变的情况下，对手术决策可能非常有用。
