摘要
目的评估不同脊柱-骨盆矢状位形态Roussouly分型下椎旁肌群在腰椎不同节段的分布特点,探讨椎旁肌退变在不同Roussouly分型中的差异。方法回顾性分析2019年1月至2019年12月接受手术治疗的腰椎间盘突出症患者102例。责任节段:L2,33例(2.9%)、L3,414例(13.7%)、L4,558例(56.9%),L_(5)S_(1)27例(23.5%)。依据脊柱-骨盆矢状位形态的Roussouly分型进行分组,Ⅰ型组29例(28.4%),年龄为(57.0±11.7)岁(范围43~72岁);Ⅱ型组31例(30.4%),年龄为(56.9±10.3)岁(范围40~77岁);Ⅲ型组28例(27.5%),年龄为(53.5±12.9)岁(范围42~70岁);Ⅳ型组14例(13.7%),年龄为(59.7±9.5)岁(范围51~70岁)。采用健康调查简表(the MOS 36-item short-form health survey,SF-36)、Oswestry功能障碍指数(Oswestry disability index,ODI)和疼痛视觉模拟评分(visual analog scale,VAS)评估临床疗效。选取L_(1-2)、L_(2-3)、L_(3-4)、L_(4-5)及L_(5)S_(1)正中椎间盘水平的轴位MRI,分别测量椎旁肌群(背伸肌群及腰大肌)和相应节段椎间盘的横截面积(cross-sectional area,CSA),计算肌肉的相对横截面积(relative cross-sectional area,RCSA)。四组患者椎旁肌群RCSA的比较采用单因素ANOVA检验,两两比较采用LSD-t检验。结果四组患者的年龄(F=1.067,P=0.367)、性别(χ^(2)=2.412,P=0.491)和体质指数(F=0.326,P=0.481)的差异均无统计学意义。RoussoulyⅠ型组患者SF-36生理功能为(31.5±6.5)分(F=3.207,P=0.047),心理功能为(33.9±5.7)分(F=3.409,P=0.031),均低于其他三型。各型间腰痛VAS评分(F=0.140,P>0.05)、下肢痛VAS评分(F=0.622,P>0.05)及ODI(F=1.075,P>0.05)的差异均无统计学意义。在L_(1-2)~L_(5)S_(1)椎间盘水平,RoussoulyⅣ型患者的腰大肌RCSA均明显低于其他三型(P<0.05),而Ⅰ、Ⅱ和Ⅲ型间的差异无统计学意义(P>0.05);RoussoulyⅠ型、Ⅱ型患者背伸肌群RCSA在L_(1-2)~L_(5)S_(1)椎间盘水平明显低于Ⅲ型、Ⅳ型(P<0.05),而Ⅰ型与Ⅱ型、Ⅲ型与Ⅳ型间的差异均无统计学意义(P>0.05)。四组患者腰大肌与背伸肌群RCSA在L_(1-2)~L_(5)S_(1)椎间盘水平均呈递增趋势,但Ⅱ型患者比值较高,而Ⅳ型较低。结论不同Roussouly分型患者椎旁肌群RCSA存在明显差异,提示椎旁肌群与脊柱矢状位形态相关,矢状位形态可能在椎旁肌群退变中起一定作用。
Objective To investigate the association of the cross-sectional area of lumbar paraspinal muscle with the spino-pelvic profile based on Roussouly classification.Methods From January 2019 to December 2019,102 patients with lumbar disc herniation were collected,the index level included L_(2,3) in 3 cases(2.9%),L_(3,4) in 14 cases(13.7%),L_(4,5) in 58 cases(56.9%),and L 5S1 in 27 cases(23.5%).According to Roussouly classification,there were 29 cases of type I(28.4%),aged 57.0±11.7 years old(range 43 to 72 years old),31 of type II(30.4%),aged 56.9±10.3 years old(range 40 to 70 years old),28 of type III(27.5%),aged 53.5±12.9 years old(range 42 to 70 years old),and 14 of type IV(13.7%),aged 59.7±9.5 years old(range 51 to 70 years old).The clinical status of the patients were evaluated with the MOS 36-item short-form health survey(SF-36),Oswestry disability index(ODI)and visual analog scale(VAS).Select all patients with L_(1,2),L_(2,3),L_(3,4),L_(4,5) and L 5S1 disc level axial MRI images,to measure the cross-sectional area(CSA)of paraspinal muscles(back extensor muscle and psoas muscle)and the CSA of intervertebral disc at each disc level,and calculate the relative cross-sectional area(RCSA:the ratio of the CSA of muscles to that of the disc at the same level).One-way ANOVA was used to test the RCSA of the paraspinal muscles of the four groups,and then LSD-t test was used for pair wise comparisons to compare the RCSA of the paraspinal muscles in each group.Results There was no significant difference in age(F=1.067,P=0.367),female/male sex ratio(χ^(2)=2.412,P=0.491)and body mass index(F=0.326,P=0.481).Roussouly type I group showed lower SF-36 score in both SF-36 PCS(31.5±6.5,F=3.207,P=0.047)and SF-36 MCS(33.9±5.7,F=3.409,P=0.031)compared with the other three types.In contrast,there were no significant differences in VAS Back Pain(F=0.140,P>0.05),VAS leg pain(F=0.622,P>0.05).and ODI scores(F=1.075,P>0.05)among the types.At each level from L_(1,2) to L 5S1,the RCSA of psoas muscle in Roussouly type IV(19.18±6.98,35.36±10.37,41.25±14.35,61.58±12.03,59.29±11.73)was significantly lower than that in patients with any other Roussouly type(P<0.05),while no significant difference in the psoas RCSA among type I,type II and type III curves(P>0.05).With regards to back extensor muscle,the RCSAs of back extensor muscle in Roussouly types I(135.32±19.86,138.53±22.92,125.06±21.44,122.40±19.69,110.87±18.08)and II(131.30±18.68,136.39±24.87,122.61±22.52,121.10±20.47,107.46±18.29)were significantly lower than those in Roussouly type III and IV at each level(P<0.05),yet no significant difference between type I and II or between type III and IV.The ratio between the RCSA of back extensor muscle and psoas muscle in four types increased gradually from L_(1,2) to L_(5)S_(1),with that being higher in type II(0.20±0.07,0.33±0.09,0.40±0.13,0.58±0.11,0.65±0.08)and lower in type IV(0.13±0.05,0.24±0.07,0.31±0.10,0.47±0.10,0.52±0.11).Conclusion RCSA of paraspinal muscles varied among Roussouly types,suggesting a significant association between paraspinal muscles and the sagittal spino-pelvic alignment.Sagittal spino-pelvic alignment may be involved in the degeneration of paraspinal muscles.
作者
王斯年
邱勇
朱泽章
王斌
徐亮
王牧一
蒲小江
孙旭
Wang Sinian;Qiu Yong;Zhu Zezhang;Wang Bin;Xu Liang;Wang Muyi;Pu Xiaojiang;Sun Xu(Department of Spine Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2021年第22期1614-1622,共9页
Chinese Journal of Orthopaedics
基金
国家自然科学基金面上项目(81772422)
江苏省临床医学中心(YXZXA2016009)。
关键词
腰椎
椎间盘移位
磁共振成像
Lumbar vertebrae
Intervertebral disc displacement
Magnetic resonance imaging
