Kawaguchi Y, Matsui H, Gejo R, Tsuji H
Department of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Japan. zenjims.toyama-mpu.ac.jp
Spine (Phila Pa 1976). 1998 Nov 1;23(21):2282-7; discussion 2288. doi: 10.1097/00007632-199811010-00006.
Postoperative back muscle injury was studied in rats. Postoperative findings were compared among three groups: 2-hour continuous back muscle retraction, 5-minute retraction release after 1 hour of retraction, and 5-minute release at every 40 minutes of retraction.
To determine whether intermittent release of the retractor during surgery is effective to prevent severe muscle injury.
In surgery performed on the extremities using a tourniquet, intermittent reperfusion intervals can permit extended tourniquet application when the operation is prolonged. However, there have been no specific studies on the effects of intermittent retraction release for postoperative back muscle injury.
The back muscle of rats was retracted using a self-retaining retractor for 2 hours. The 36 rats were divided equally into the following three groups: Group 1, 2 hours of continuous retraction; Group 2, two 1-hour retractions interposed with a 5-minute retraction release; and Group 3, three 40-minute retractions interposed with a 5-minute retraction release. In each group, the multifidus muscle was histologically analyzed at 48 hours, 1 week, and 6 weeks after surgery. The muscles were stained by a variety of histochemical methods. The level of serum CPK-MM isoenzyme was measured 48 hours after surgery.
Postoperative back muscle degeneration was the most severe in Group 1. The concentration of CPK-MM in Group 1 was significantly higher than that in Groups 2 and 3. One week after surgery, the lesser diameter of regenerated fibers in Group 1 was smaller than that in Groups 2 and 3. The incidence of neurogenic muscle damage was the highest in Group 1.
During posterior lumbar spine surgery, 5-minute retraction release after 1 hour or after 40 minutes of retraction was effective in preventing severe back muscle injury after surgery.
对大鼠术后背部肌肉损伤进行研究。比较三组术后结果：持续2小时的背部肌肉牵拉、牵拉1小时后5分钟的牵拉释放以及每牵拉40分钟进行5分钟的释放。
确定手术期间牵开器的间歇性释放是否能有效预防严重的肌肉损伤。
在使用止血带进行肢体手术时，当手术时间延长时，间歇性再灌注间隔可允许延长止血带的使用时间。然而，对于间歇性牵拉释放对术后背部肌肉损伤的影响尚无具体研究。
使用自动牵开器对大鼠背部肌肉进行2小时的牵拉。36只大鼠平均分为以下三组：第1组，持续牵拉2小时；第2组，两次1小时的牵拉，中间间隔5分钟的牵拉释放；第3组，三次40分钟的牵拉，中间间隔5分钟的牵拉释放。每组在术后48小时、1周和6周对多裂肌进行组织学分析。肌肉用多种组织化学方法染色。术后48小时测量血清CPK-MM同工酶水平。
第1组术后背部肌肉退变最严重。第1组CPK-MM的浓度显著高于第2组和第3组。术后1周，第1组再生纤维的较小直径小于第2组和第3组。第1组神经源性肌肉损伤的发生率最高。
在腰椎后路手术中，牵拉1小时或40分钟后进行5分钟的牵拉释放可有效预防术后严重的背部肌肉损伤。
