脊柱后路融合术对青少年特发性脊柱侧凸患者早期躯干肌及运动功能的影响

关键词：青少年特发性脊柱侧凸  后路脊柱融合手术  表面肌电  肌肉功能  运动功能

Keywords:adolescent idiopathic scoliosis  posterior spinal fusion  surface electromyography  muscle function  motor function

摘要：

      摘要 目的：探索脊柱后路融合手术（posterior spinal fusion，PSF）对青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者早期躯干肌和运动功能的影响，为临床围手术期AIS患者康复评估和治疗方案的制定提供循证依据。 方法：纳入2023年1—9月昆明医科大学第二附属医院骨科的35例即将行脊柱后路融合手术的AIS患者（Cobb=32°—83°），于术前、术后3、6个月进行躯干肌肌力、肌耐力和椎旁肌表面肌电评估，采用功能性运动筛查（functional movement screen，FMS）进行运动功能评估，以便全面了解手术对患者肌肉和运动功能影响。 结果：AIS患者术后3、6个月时椎旁肌较术前激活下降（P<0.05），但术后3、6个月较术前凸凹侧的对称比更接近1（P<0.05）。术后3个月时躯干屈肌和伸肌的肌力和肌耐力均下降（P<0.01），术后6个月屈肌和伸肌的肌力仍较术前差（P<0.01），而肌耐力虽低于术前但无显著性差异（P>0.05）。患者术后3个月时FMS测试1、5、6、总分都较术前下降（P<0.05），其他测试虽有下降，但无显著性差异（P>0.05）。术后6个月时，除FMS1仍较术前差（P<0.05），其他评分和总分较术前无显著性差异（P>0.05），FMS1、2、3、6、总分较术后3个月评分高（P<0.05）。 结论：AIS患者术前存在的椎旁肌凸凹侧的不平衡在术后早期就可获得改善，但手术会影响椎旁肌的激活。AIS术后3个月时脊柱躯干的肌力和肌耐力，以及运动功能表现并未完全恢复到术前，手术导致早期肌肉和运动功能的总体下降。虽然6个月时肌耐力和FMS运动总分可恢复至术前水平，但患者核心肌力仍较术前差。应关注脊柱融合手术对患者躯干肌和运动功能的影响，在围手术期进行康复治疗。

Abstract:

      Abstract Objective： To explore the effects of posterior spinal fusion （PSF） on early trunk muscle and motor function in adolescent idiopathic scoliosis （AIS） patients and to provide evidence for perioperative rehabilitation assessment and intervention planning. Method： Thirty-five AIS patients （Cobb=32°—83°） scheduled for posterior spinal fusion surgery at the department of orthopedics of the second affiliated hospital of Kunming Medical University from January to September 2023 were enrolled. Truck muscle strength， muscle endurance, and paravertebral muscle were evaluated by surface electromyography preoperatively and at 3 and 6 months postoperatively. Motor function was assessed using the Functional Movement Screen （FMS）to fully evaluate postoperative changes in muscle and movement function. Result： The activation of paravertebral muscle decreased at 3 and 6 months after surgery （P<0.05）; however, the symmetry ratio between the convex and concave side of the paraspinal muscles was closer to 1 （P<0.05）. At 3 months postoperatively, trunk flexor and extensor muscle strength and endurance were decreased（P<0.01）. At 6 months, trunk muscle strength remained significantly lower than preoperative levels（P<0.01）, while muscle endurance, although reduced, showed no significant difference compared with baseline （P>0.05）FMS items 1, 5, 6, and the total score were all decreased at 3 months postoperatively compared with preoperative values （P<0.05）, while other items showed no significant difference（P>0.05）. At 6 months after surgery， all FMS scores except FMS item 1 returned to preoperative levels (P>0.05) , and FMS items 1, 2, 3, 6, and the total score were significantly higher than those at 3 months postoperatively (P<0.05). Conclusion： The preoperative imbalance between the convex and concave sides of the paraspinal muscles in AIS patients can be improved early after PSF; however, the surgery leads to reduced paraspinal muscle activation in the early postoperative period. At 3 months after surgery， the trunk muscle strength, endurance, and motor function did not fully recover to preoperative levels， indicating an overall early decline in muscle and motor performance. Although muscle endurance and the total FMS score recovered to preoperative levels at 6 months, core muscle strength remains impaired. Therefore， these findings highlight the importance of addressing trunk muscle and motor function deficits through targeted perioperative rehabilitation following spinal fusion surgery.