摘要
目的探讨退行性腰椎侧凸患者椎旁肌的变化,以及其与腰椎后凸的相关性。方法回顾性分析67例退行性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者的临床资料,均为女性;年龄为(65.4±5.6)岁(范围52~83岁)。腰椎侧凸伴后凸畸形(lumbar degenerative kyphoscoliosis,LDK)患者35例(DLS+LDK组),年龄(64.6±5.4)岁(范围52~75岁);单纯腰椎侧凸患者32例(DLS组),年龄(66.2±5.8)岁(范围55~83岁)。应用Image J 1.51k(国立卫生研究院,美国)通过MRI测量L1~S1椎间盘水平竖脊肌和多裂肌的横截面积(cross-sectional area,CSA)和脂肪浸润面积百分比(percentage of fat infiltration area,FIA%)。记录两组患者侧弯方向、侧凸Cobb角、矢状面平衡(sagittal vertical axis,SVA)、胸椎后凸角(thoracic kyphosis,TK)、胸腰椎后凸角(thoracolumbar kyphosis,TLK)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)等情况,分析椎旁肌的变化与这些因素的相关性。结果DLS+LDK组患者TLK、LL、SVA分别为11.85°±7.89°、-9.35°±8.70°和(70.16±76.94)mm,均大于DLS组7.47°±5.06°、-26.46°±10.26°和(39.45±38.18)mm(t=2.73,P=0.008;t=7.38,P<0.001;t=2.10,P=0.041)。DLS+LDK组患者TK、PI、SS分别为16.36°±13.52°、42.49°±11.70°和11.89°±10.03°,均小于DLS组23.60°±10.23°、49.38°±11.92°和21.21°±8.28°(t=2.45,P=0.017;t=2.38,P=0.020;t=4.13,P<0.001)。两组患者侧凸Cobb角和PT差异均无统计学意义。DLS+LDK组L1-2、L2-3和L3-4椎间盘水平竖脊肌CSA分别为(1328.36±339.16)mm^(2)、(1331.98±305.76)mm^(2)和(1253.58±275.86)mm^(2),均小于DLS组(1564.16±312.68)mm^(2)、(1574.80±325.92)mm^(2)和(1427.18±278.82)mm^(2)(t=0.40,P=0.004;t=0.81,P=0.002;t=0.31,P=0.013)。DLS+LDK组L1-2、L2-3、L3-4和L4-5椎间盘水平多裂肌CSA分别为(225.07±59.80)mm^(2)、(228.38±87.44)mm^(2)、(436.40±117.99)mm^(2)和(666.55±184.13)mm^(2),均小于DLS组(264.28±44.27)mm^(2)、(384.85±75.52)mm^(2)、(576.10±109.92)mm^(2)和(801.52±145.83)mm^(2)(t=0.21,P=0.004;t=0.42,P=0.001;t=0.52,P=0.001;t=0.37,P=0.002)。两组患者所有腰椎水平竖脊肌和多裂肌FIA%的差异均无统计学意义。两组患者L_(1-2)、L_(2-3)和L_(3-4)椎间盘水平竖脊肌CSA和L_(1-2)、L_(2-3)、L_(3-4)和L_(4-5)椎间盘水平多裂肌CSA与LL呈负相关(r=-0.37,P=0.002;r=-0.34,P=0.005;r=-0.21,P=0.049;r=-0.34,P=0.005;r=-0.61,P<0.001;r=-0.65,P<0.001;r=-0.55,P<0.001),与SS呈正相关(r=0.42,P<0.001;r=0.37,P=0.002;r=0.27,P=0.027;r=0.38,P=0.001;r=0.53,P<0.001;r=0.46,P=0.001;r=0.42,P<0.001)。两组患者L3-4椎间盘水平竖脊肌CSA和L1-2、L2-3椎间盘水平多裂肌CSA与PI呈正相关(r=0.25,P=0.039;r=0.33,P=0.006;r=0.35,P=0.004)。两组患者所有腰椎水平竖脊肌和多裂肌FIA%与脊柱矢状位及骨盆参数均无相关性。结论退行性腰椎侧凸伴腰椎后凸畸形患者椎旁肌肉萎缩更为明显,可能与腰椎前凸及骶骨倾斜角减小有关。PI较小的腰椎侧凸患者更易导致椎旁肌萎缩,致腰椎前凸丧失加重,最终引发腰椎后凸。
Objective To investigate the changes of paraspinal muscles in patients with degenerative lumbar scoliosis(DLS)and its correlation with lumbar kyphosis.Methods The clinical data of 67 female patients with degenerative lumbar scoliosis,with an average of 65.4±5.6 years old(rang 52-83 years old),were retrospectively analyzed.There were 35 patients of DLS with lumbar degenerative kyphosis(LDK)in the DLS+LDK group,with an average of 64.60±5.40 years old(rang 52-75 years old),and 32 patients of lumbar scoliosis without lumbar kyphosis in the DLS group,with an average of 66.22±5.8 years old(rang 55-83 years old).The cross-sectional area(CSA)and the percentage of fat infiltration area(FIA%)of erector spinae and multifidus muscles of the 5 intervertebral disc levels(from L1-2 to L5S1)were measured by MRI using Image J software(ver.1.51 k,National Institutes of Health,USA).The curve direction,Cobb angle,sagittal vertical axis(SVA),thoracic kyphosis(TK),thoracolumbar kyphosis(TLK),lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT)and sacral slope(SS)were evaluated and recordedin both groups using an anteroposterior radiograph in the standing position,and the correlation between the changes of paraspinal muscles and these factors was analyzed.Results The TLK,LL,and SVA values of the DLS+LDK group(11.85°±7.89°,-9.35°±8.70°and 70.16±76.94 mm)were higher than those of the DLS group(7.47°±5.06°,-26.46°±10.26°and 39.45±38.18mm)(t=2.73,P=0.008;t=7.38,P<0.001;t=2.10,P=0.041).The TK,PI,and SS values of the DLS+LDK group(16.36°±13.52°,42.49°±11.70°and 11.89°±10.03°)were lower than those of the DLS group(23.60°±10.23°,49.38°±11.92°and 21.21°±8.28°)(t=2.45,P=0.017;t=2.38,P=0.020;t=4.13,P<0.001).The differences of Cobb and PT were not statistically significant between the two groups.The cross-sectional areas of L1-2,L2-3,L3-4 intervertebral disc levels of erector spinae of the DLS+LDK group(1328.36±339.16 mm^(2),1331.98±305.76 mm^(2) and 1253.58±275.86 mm^(2))were lower than those of the DLS group(1564.16±312.68 mm^(2),1574.80±325.92 mm^(2) and 1427.18±278.82 mm^(2))(t=0.40,P=0.004;t=0.81,P=0.002;t=0.306,P=0.013).The cross-sectional areas of L1-2,L2-3,L3-4,L4-5 intervertebral disc levels of multifidus muscles of the DLS+LDK group(225.07±59.80 mm^(2),228.38±87.44 mm^(2),436.40±117.99 mm^(2) and 666.55±184.13 mm^(2))were lower than those of the DLS group(264.28±44.27 mm^(2),384.85±75.52 mm^(2),576.10±109.92 mm^(2) and 801.52±145.83 mm^(2))(t=0.21,P=0.004;t=0.42,P<0.001;t=0.52,P<0.001;t=0.37,P=0.002).The differences of FIA%of erector spinae and multifidus muscles at all lumbar spine levels were not statistically significant between the two groups.The cross-sectional areas of L_(1-2),L_(2-3),L_(3-4) intervertebral disc levels of erector spinae and L_(1-2),L_(2-3),L_(3-4),L_(4-5) intervertebral disc levels of multifidus muscles of the two groups were negatively correlated with LL values(r=-0.37,P=0.002;r=-0.34,P=0.005;r=-0.21,P=0.049;r=-0.34,P=0.005;r=-0.61,P<0.001;r=-0.65,P<0.001;r=-0.55,P<0.001),and positively correlated with SS(r=0.42,P<0.001;r=0.37,P=0.002;r=0.27,P=0.027;r=0.38,P=0.001;r=0.53,P<0.001;r=0.46,P<0.001;r=0.42,P<0.001).The cross-sectional areas of L3-4 intervertebral disc levels of erector spinae and L1-2,L2-3 intervertebral disc levels of multifidus muscles of the two groups were positively correlated with PI(r=0.25,P=0.039;r=0.33,P=0.006;r=0.35,P=0.004).There was no correlation between the FIA%of erector spinae and multifidus muscles at all lumbar spine levels and the sagittal and pelvic parameters in both groups.Conclusion Paravertebral muscle atrophy is more obvious in patients with degenerative lumbar scoliosis with lumbar kyphosis,which may be related to the reduce of lumbar lordosis and sacral slope.Patients with lumbar scoliosis with a smaller PI are more likely to experience paravertebral atrophy and increased loss of lumbar lordosis,and ultimately leading to lumbar kyphosis.
作者
钟泽祥
李方财
张宁
应最佳
郑晟
许国萍
Zhong Zexiang;Li Fangcai;Zhang Ning;Ying Zuijia;Zheng Sheng;Xu Guoping(Department of Orthopaedics,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Orthopaedics,Shaoxing Yuecheng People's Hospital,Shaoxing 312000,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2022年第7期445-454,共10页
Chinese Journal of Orthopaedics
基金
浙江省医药卫生科技省部共建重大项目(WKJ-ZJ-1903)。
关键词
腰椎
椎间盘退行性变
脊柱侧凸
腰椎后凸
Lumbar vertebrae
Intervertebral disc degeneration
Scoliosis
Kyphosis
