Song Zefeng, Chen Xingda, Zhou Zelin, Chen Wanyan, Zhu Guangye, Jiang Rueishiuan, Zhang Peng, Lin Shaohao, Wang Xiaowen, Yu Xiang, Ren Hui, Liang De, Cui Jianchao, Tang Jingjing, Jiang Xiaobing
First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou 510405, China.
J Clin Med. 2023 Jan 27;12(3):989. doi: 10.3390/jcm12030989.
Oblique lumbar interbody fusion (OLIF) has been driven to the maturity stage in recent years. However, postoperative symptoms such as thigh paresthesia resulting from intraoperative retraction of the psoas major (PM) have sometimes occurred. The aim of this study was to assess the different positions and morphology of PM muscles and their relationship with clinical outcomes after OLIF by introducing the Moro zones. Patients who underwent L4-5 OLIF at our institution between April 2019 and June 2021 were reviewed and all data were recorded. All patients were grouped by Moro zones into a Moro A cohort and a Moro I and II cohort based on the front edges of their left PM muscles. A total of 94 patients were recruited, including 57 in the Moro A group and 37 in the Moro I and II group. Postoperative thigh pain or numbness occurred in 12 (21.1%) and 2 (5.4%) patients in the Moro A group and the Moro I and II group, respectively. There was no difference in the psoas major transverse diameter (PMTD) between groups preoperatively, while longer PMTD was revealed postoperatively in the Moro A group. The operating window (OW) and psoas major sagittal diameter (PMSD) showed significant differences within and between groups. Thirteen patients had teardrop-shaped PM muscles, with 92.3% in the Moro A group showing significantly worse clinical scores at 1-week follow-up. The Moro zones of the PM affected the short-term outcomes after OLIF. Preoperative measurements and analysis of OW, PMSD and PM morphology should be performed as necessary to predict short-term outcomes.
近年来，斜外侧腰椎椎间融合术（OLIF）已发展到成熟阶段。然而，术中腰大肌（PM）牵开导致的术后症状，如大腿感觉异常有时会出现。本研究的目的是通过引入莫罗区来评估PM肌肉的不同位置和形态及其与OLIF术后临床结果的关系。回顾了2019年4月至2021年6月在我院接受L4-5 OLIF手术的患者，并记录了所有数据。根据左PM肌肉的前缘，将所有患者按莫罗区分为莫罗A组和莫罗I和II组。共招募了94例患者，其中莫罗A组57例，莫罗I和II组37例。莫罗A组和莫罗I和II组分别有12例（21.1%）和2例（5.4%）患者术后出现大腿疼痛或麻木。术前两组间腰大肌横径（PMTD）无差异，而术后莫罗A组的PMTD更长。手术窗口（OW）和腰大肌矢状径（PMSD）在组内和组间均存在显著差异。13例患者的PM肌肉呈泪滴状，其中92.3%的莫罗A组患者在1周随访时临床评分明显更差。PM的莫罗区影响OLIF术后的短期结果。必要时应进行术前OW、PMSD和PM形态的测量和分析，以预测短期结果。
