Contrast Study On The Effects Of Multifidus Muscle Between Multifidus Muscle Gap And Conventional Open Approach In Treatment Of The Lumbar Intervertebral Disc

Objective: to Compare the differences of degree of exposure to musculi multifidi between transmultifidus approach and traditional approach in treating protrusion of the intervertebral disci, and provide academic evidence for clinical application of transmultifidus approach.Methods : Prospective control study was conducted. 40 patients suffered from protrusion of the intervertebral disci, who was hospitalized and accepted operative treatment in the first Chen Zhou people′s affiliated hospital of university of south China from March 2013 to june 2014 were obtained. All cases were divided into Group A and Group B randomly, and 20 patients were included in each group. Patients in Group A were treated by transmultifidus approach, while by traditional posterior median approach in group B. Obvervational index: 1 All the cases were proformed with MRI examination in preoperation、first week after operation、and one year after surgery, and measure and contrast the cross sectional area of musculi multifidi in operative segment. 2 Electromyography of musculi multifidi in operative segment was done one month、three months and 12 months after operation, the result of which was compared with each other. 3 Operative time, intraoperative blood loss o, and postoperative volume of drainage in each group were collected and compared. 4 VAS score of preoperative, first day、one week and one year after operation were collected and compared.Results:Compared with Group B, the Group A had lower o perative time, intraoperative blood loss, postoperative volume o f drainage and VAS score, and the differences were of statistic al significance(P< 0.05).When conducting electromyography of musculi multifidi in operative segment, Group A has less fibril lation potential amplitude, and The number of abnormal wave patterns appearing one month、 three months and 12 months aft er operation in Group A were 10 cases、 6 cases、 6 cases resp ectively, while all the cases in Group B. The differences were of statistical significance(P< 0.05).The cross sectional area of musculi multifidi in operative segment in group A was 1074.85±54.39 mm2(preoperation),1086.8554.70mm2(one week after ope ration), 976.69±9.61mm2(one year after operation),while 1115.83 ±67.98mm2(preoperation), 1420.25±2.91 mm2(one week after op eration),714.66±6.24mm2(one year after operation). There was no statistical significance(P> 0.05),when comparing Group A w ith Group B in preoperative cross sectional area of musculi mult ifidi in operative segment. One week after operation, the cros s sectional area of musculi multifidi was larger than the normal range(preoperative range), however, the enlargement of muscul i multifidi in Group A was less than Group B. One year after operation, when compared with Group A, musculi multifidi in Group B became atrophic obviously. Compared with Group A, the rate of range of the cross sectional area of musculi multifi di in group B increased significantly. The differences were of statistical significance(P< 0.05).Conclusion:Both transmultifidus approach and traditionalappr oach,with the similar effect, could injure the musculi multifid i in treating protrusion of the intervertebral disci surgically. H owever, compared with traditional approach, transmultifidus app roach had advantages, avoiding the peeling of musculi multifid i, reducing the blood loss in operation and the usage of electr otome, decreasing the long-term degree of atrophy and the de gree of exposure of musculi multifidi during early postoperative period, bringing down the morbidity rate of low back pain.