Many investigators have reported that persistent low back pain may occur after posterior surgical intervention, and studies have investigated the histologic and histochemical changes in back muscle after posterior lumbar spine surgery. The purpose of the current study is to compare the pre- and postoperative cross-sectional area of the back musculature among 5 surgical groups including anterior lumbar interbody fusion, which has no direct invasion of the back musculature, using magnetic resonance imaging, and to correlate the clinical results with the degree of atrophy. The cross-sectional area of the back musculature was measured before and after surgery in T2-weighted axial magnetic resonance images using a computer-linked digitizer. The degree of atrophy (atrophy ratio) was calculated as a ratio of the postoperative cross-sectional area to the preoperative cross-sectional area. Clinical results were evaluated using the Japanese Orthopaedic Association's scores for the management of low back pain. Atrophy of the back musculature was confirmed in each group. However, no significant difference was seen in the atrophy ratio between the groups. Back musculature atrophy occurred even in anterior lumbar interbody fusion, which does not involve any direct surgery of the back muscle. A positive correlation was noted between the atrophy ratio and operation time only in posterior surgery, especially in nonfusion surgery. In conclusion, the current study suggests that a shorter operation time may minimize back muscle injury, and shows that factors inducing back musculature atrophy include not only direct invasion of the back muscle via a posterior approach, but also postoperative external fixation.

译文

:许多研究人员报告说,后路手术干预可能会导致持续的下背部疼痛,并且研究调查了后路腰椎手术后背部肌肉的组织学和组织化学变化。本研究的目的是使用磁共振成像技术比较包括前腰椎椎间融合术在内的5个手术组的前,后肌肉截面积,其中前腰椎椎间融合术不直接侵犯后肌,并进行相关分析。临床结果与萎缩程度有关。使用计算机链接的数字化仪,在T2加权的轴向磁共振图像中,在手术前后测量背部肌肉的横截面积。萎缩度(萎缩率)以术后截面积与术前截面积之比计算。使用日本骨科协会的腰背痛管理评分对临床结果进行评估。在每个组中都证实了背部肌肉的萎缩。但是,两组之间的萎缩率没有显着差异。甚至在前腰椎椎间融合术中也发生了背部肌肉萎缩,这不涉及对背部肌肉的任何直接手术。仅在后路手术中,尤其是在非融合手术中,发现萎缩率与手术时间之间存在正相关。总而言之,当前的研究表明,较短的手术时间可以最大程度地减少背部肌肉的损伤,并表明引起背部肌肉萎缩的因素不仅包括通过后路直接侵入背部肌肉,还包括术后外固定。

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