Lu Meng-Ling, Cheng Chih-Hsiu, Chen Wen-Chien, Fu Chen-Ju, Niu Chi-Chien
Department of Orthopedic Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung.
Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan.
Global Spine J. 2022 Jul;12(6):1192-1198. doi: 10.1177/2192568220979666. Epub 2020 Dec 17.
Prospective study.
Minimally-invasive lumbar fusion surgery (MIS) is a viable alternative to conventional open surgery (COS) for spinal disorders. Although MIS seems to be associated with less para-spinal muscle trauma, the actual back muscle performance after MIS and COS remain controversial. This study investigated post-operative para-spinal muscle performance, and the correlation between muscle dysfunction and clinical outcome.
In this prospective, non-randomized control study, 50 patients were enrolled and split into 2 groups: COS and MIS. We established a biomechanical model of the para-spinal muscle in the lumbar spine using electromyography (EMG) and specific muscle function tests. Functional outcomes were also reviewed and analyzed. All patients underwent EMG pre-operatively, and at 3 months and 1 year post-operatively. The para-spinal muscle performance was investigated by comparing the back muscle co-contraction ratio and the load transmission zone to the pre-operative data.
Twenty-one patients in the COS group and 25 in the MIS group completed the study. Both groups showed a significant improved functional score. The abdominal and back muscle strengths were decreased post-operatively, and were then increased at 12 months post-operatively in both groups. During the perturbed balance task and static task, the MIS group exhibited a trend of recovery in comparison with the COS group. But, the back muscle performance at 12 months was poorer than the pre-op performance in both groups.
There was no significant difference in clinical outcome and para-spinal muscle performance between groups. In both methods, the global muscle function had declined post-operatively.
前瞻性研究。
对于脊柱疾病，微创腰椎融合手术（MIS）是传统开放手术（COS）的一种可行替代方案。尽管MIS似乎与椎旁肌创伤较小相关，但MIS和COS术后的实际背部肌肉功能仍存在争议。本研究调查了术后椎旁肌功能，以及肌肉功能障碍与临床结果之间的相关性。
在这项前瞻性、非随机对照研究中，招募了50名患者并分为两组：COS组和MIS组。我们使用肌电图（EMG）和特定肌肉功能测试建立了腰椎椎旁肌的生物力学模型。还对功能结果进行了回顾和分析。所有患者在术前、术后3个月和1年接受EMG检查。通过将背部肌肉共同收缩率和负荷传递区域与术前数据进行比较，来研究椎旁肌功能。
COS组21名患者和MIS组25名患者完成了研究。两组的功能评分均有显著改善。两组术后腹部和背部肌肉力量均下降，然后在术后12个月时增加。在平衡扰动任务和静态任务期间，与COS组相比，MIS组呈现出恢复趋势。但是，两组术后12个月时的背部肌肉功能均比术前差。
两组之间的临床结果和椎旁肌功能无显著差异。两种方法中，术后整体肌肉功能均有所下降。
