THE LUMBAR MULTIFIDUS MUSCLE 5 YEARS AFTER SURGERY FOR A LUMBAR INTERVERTEBRAL DISC HERNIATION
THE LUMBAR MULTIFIDUS MUSCLE 5 YEARS AFTER SURGERY FOR A LUMBAR INTERVERTEBRAL DISC HERNIATION
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DOI：
10.1097/00007632-199304000-00008
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发表时间：
1993-04-01
期刊：
影响因子：
3
通讯作者：
KALIMO, H
中科院分区：
文献类型：
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作者：
RANTANEN, J;HURME, M;KALIMO, H
腰椎多裂肌活检标本取自18例腰椎间盘突出症患者术中及术后5年随访。对肌纤维的结构和形态进行分析，并将这些数据与术中活检结果和手术的临床结果进行比较。主要发现是：1）根据职业障碍评分，10 名患者属于“阳性”结果组，8 名患者属于“阴性”结果组； 2）术中记录的选择性2型肌纤维萎缩和病理性内部结构变化的程度在“阳性”结果组中均有所减少，而在“阴性”结果组中持续存在； 3) 在“阳性”结果组和“阴性”结果组中，仅 2 名患者和 4 名患者中观察到分组作为神经支配的明确标志； 4) 在“阳性”结果组中，肌肉内脂肪组织的相对数量减少得更明显。作者提出，不活动和轴突损伤（主要是神经失用型）都会导致椎间盘患者多裂肌的选择性 2 型萎缩和内部结构变化。这些病理结构变化与临床结果密切相关，最重要的是，它们是可逆的，并且可以通过适当的治疗来减少。
Biopsy specimens of the lumbar multifidus were obtained from 18 patients with lumbar disc herniation at operation and after a postoperative follow-up period of 5 years. The structure and morphometry of the muscle fibers were analyzed and these data were compared with intraoperative biopsy results and the clinical outcome of the operation.The main findings were: 1) on the basis of occupational handicap score 10 patients belonged in the ''positive'' and 8 in the ''negative'' outcome group; 2) the intraoperatively recorded selective type 2 muscle fiber atrophy and the extent of pathologic inner structure changes both decreased in the ''positive'' outcome group, whereas they persisted in the ''negative'' group; 3) grouping as a definite sign of reinnervation was seen in only two versus four patients of the ''positive'' versus ''negative'' outcome group; 4) the relative amount of adipose tissue within the muscle decreased more markedly in the ''positive'' outcome group.The authors propose that both inactivity and axonal injury (mainly of neurapraxia type) contribute to the selective type 2 atrophy and inner structure changes in disc patients' multifidus muscle. These pathologic structural changes correlated well with the clinical outcome, and most importantly they are reversible and can be diminished by adequate therapy.