慢性非特异性腰背痛两个运动系统损伤亚组腰椎旁肌肉形态的比较分析。

IF 2.2 3区医学 Q1 REHABILITATION

Musculoskeletal Science and Practice Pub Date : 2024-11-01 DOI:10.1016/j.msksp.2024.103208

Fereshteh Rezazadeh , Shahin Goharpey , Nahid pirayeh , Mohammad Jafar Shaterzadeh Yazdi , Amin Behdarvandan , Saeed Hesam

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引用次数: 0

摘要

背景：根据运动病理模型，腰椎间盘突出症的运动系统损伤（MSI）分类表明，重复运动可能导致病理组织变化。然而，这些变化尚未在不同的 MSI 分类亚组枸杞痛患者中进行评估：本研究比较了被诊断为 MSI 综合征且运动方向相反的两个亚组患者的下腰椎旁肌和腰大肌中作为肌肉病理变化之一的脂肪浸润程度：观察性横断面研究：45名慢性腰痛患者参加了研究，其中23名患者属于腰部屈曲-旋转（FlexRot）亚组，22名患者属于腰部伸展-旋转（ExtRot）亚组。磁共振成像（MRI）和 Goutallier 分类系统（GCS）用于腰椎旁和腰肌的脂肪分级。在对该分级表的可靠性进行评估后，对两个亚组的结果进行了比较：曼-惠特尼U检验显示，腰椎外展肌亚组的下腰部多裂肌和竖脊肌的脂肪浸润率明显更高，而腰大肌的脂肪浸润率在两亚组间无明显差异（P≤0.05）。GCS的评分者间信度为可接受到优秀，评分者内部信度为良好到优秀：结论：腰椎间盘突出症的两个亚组之间，L4-L5 和 L5-S1 水平腰椎旁肌肉的脂肪浸润等级存在显著差异。在 ExtRot 亚组中，腰椎伸展时腰椎旁肌肉的脂肪等级更高，因为腰椎伸展会加重其症状。

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A comparative analysis of lumbar paraspinal muscle morphology between two movement system impairment subgroups of chronic nonspecific low back pain

Background

Based on the kinesiopathologic model, the Movement System Impairment (MSI) classification of LBP has shown that repetitive movements could contribute to pathoanatomic tissue changes. However, these changes have not been evaluated in different MSI classification subgroups of patients with LBP.

Objective

This study compared the grades of fatty infiltration as one of the muscle's pathologic changes in the lower lumbar paraspinal and psoas muscles between the two subgroups of patients diagnosed with MSI syndromes having opposite movement direction impairments.

Design

Observational cross-sectional study.

Method

Forty-five participants with chronic LBP were enrolled in the study, with 23 patients in the lumbar flexion-rotation (FlexRot) subgroup and 22 in the lumbar extension-rotation (ExtRot) subgroup of MSI. Magnetic resonance imaging (MRI) and the Goutallier Classification System (GCS) were used for fatty grading of lumbar paraspinal and psoas muscles. After the reliability of this grading scale was evaluated, the results were compared between the two subgroups.

Results

The Mann–Whitney U Test showed significantly higher fat infiltration of lower lumbar multifidus and erector spinae muscles in the lumbar ExtRot subgroup, with no significant difference between the two subgroups in terms of psoas muscles (P ≤ 0.05). Inter-rater reliability of GCS was acceptable to excellent, and intra-rater reliability was good to excellent.

Conclusion

The fatty infiltration grade of lumbar paraspinal muscles in L4-L5 and L5-S1 levels are significantly different between the two LBP subgroups of MSI that have two opposite movement direction impairments. The lumbar paraspinal muscles, which contribute to extension, have a higher grade of fat in the ExtRot subgroup, whose symptoms are aggravated by lumbar extension.

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来源期刊

Musculoskeletal Science and Practice Health Professions-Physical Therapy, Sports Therapy and Rehabilitation

CiteScore

4.10

自引率

8.70%

发文量

152

审稿时长

48 days

期刊介绍： Musculoskeletal Science & Practice, international journal of musculoskeletal physiotherapy, is a peer-reviewed international journal (previously Manual Therapy), publishing high quality original research, review and Masterclass articles that contribute to improving the clinical understanding of appropriate care processes for musculoskeletal disorders. The journal publishes articles that influence or add to the body of evidence on diagnostic and therapeutic processes, patient centered care, guidelines for musculoskeletal therapeutics and theoretical models that support developments in assessment, diagnosis, clinical reasoning and interventions.