Kawaguchi Y, Matsui H, Tsuji H
Department of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Japan.
Spine (Phila Pa 1976). 1996 Apr 15;21(8):941-4. doi: 10.1097/00007632-199604150-00007.
Back muscle injury after posterior lumbar surgery was studied by muscle histology and serum creatine phosphokinase MM isoenzyme activity.
To investigate intraoperative factors influencing the magnitude of back muscle injury after posterior lumbar surgery.
The authors previously have reported iatrogenic back muscle injury in an animal model and in humans. Serious injury of the back muscle has been shown by short-term and long-term follow-up evaluation.
The retraction pressure was monitored, and the retraction pressure-time products were calculated in 24 patients. Early histologic changes of multifidus muscle, which were taken at completion of surgery, and serum creatine phosphokinase MM isoenzyme activity changes were examined.
The magnitude of back muscle injury was significant as the pressure-time product increased. Creatine phosphokinase MM isoenzyme activity increased after surgery and reached a plateau 1 day after surgery, followed by recovery to the normal value 1 week after surgery. Creatine phosphokinase MM isoenzyme activity tended to be high in cases with multilevel exposure and with high pressure-time product.
Back muscle injury occurs in all patients who underwent posterior lumbar surgery, and these injuries are related to the retraction pressure, time, and extent of exposure.
通过肌肉组织学和血清肌酸磷酸激酶MM同工酶活性对腰椎后路手术后的背部肌肉损伤进行研究。
探讨影响腰椎后路手术后背部肌肉损伤程度的术中因素。
作者此前曾在动物模型和人体中报道过医源性背部肌肉损伤。短期和长期随访评估显示背部肌肉存在严重损伤。
监测24例患者的牵开压力，并计算牵开压力-时间乘积。检查手术结束时获取的多裂肌早期组织学变化以及血清肌酸磷酸激酶MM同工酶活性变化。
随着压力-时间乘积增加，背部肌肉损伤程度显著增加。术后肌酸磷酸激酶MM同工酶活性升高，术后1天达到平台期，随后在术后1周恢复至正常值。在多节段显露和压力-时间乘积高的病例中，肌酸磷酸激酶MM同工酶活性往往较高。
所有接受腰椎后路手术的患者均会发生背部肌肉损伤，且这些损伤与牵开压力、时间和显露范围有关。
