退行性腰椎侧凸椎旁肌不对称退变及其潜在意义

Q4 Medicine
Junzhe Ding, Shibao Lu, C. Kong
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引用次数: 2

摘要

目的测定退行性腰椎侧弯(DLS)患者椎旁肌的截面积(CSA)和脂肪浸润(FI),分析椎旁肌退行性变的机制和临床意义。方法对我院2016年9月至2017年9月收治的118例DLS患者进行回顾性研究。所有患者术前均有完整的影像资料。在脊柱X线平片上测量术前腰椎前凸(LL)、Cobb角和脊椎旋转。用腰椎MRI测量脊柱侧弯顶椎上下椎间层椎旁肌的CSA和FI,并比较CSA、FI及其与Cobb角的相关性。结果本研究纳入118例DLS患者,其中男性49例,女性69例。患者的平均年龄为65.4±7.2岁,平均BMI为24.7±3.4,腰部症状包括LBP、坐骨神经痛、麻木和间歇性跛行、肌力下降和其他症状。症状持续时间为21个月(3-60个月)。患者的Cobb角平均为18.5°±6.7°。在所有患者中,60名患者左侧脊柱侧弯,58名患者右侧脊柱侧弯。位于L1-L4侧的患者数量为:L1 12例,L2 41例,L3 49例,L4 16例。腰大肌凹侧的CSA显著大于凸侧(上椎间水平,凹侧3.74±2.17 cm2,凸侧3.56±1.91 cm2;下椎间水平,凹陷侧6.54±3.08 cm2,凸侧6.31±3.302 cm2)。凹侧多裂肌和伸肌组的CSA显著小于凸侧多裂肌肉:上椎间水平,凹侧9.47±3.86cm2,凸侧10.25±4.20cm2;椎间水平较低,凹侧9.30±3.61cm2,凸侧10.21±3.81cm2;伸肌组:上椎间水平,凹侧18.35±4.94cm2,凸侧19.37±5.17cm2;椎间水平较低,凹侧18.98±4.73cm2,凸侧19.81±5.16cm2。伸肌组凹侧FI明显大于凸侧,上椎间水平,凹侧30.63±15.09,凸侧23.48±15.00;椎间水平较低,凹侧37.87±19.38,凸侧30.43±16.89。多裂肌、背侧伸展肌、椎旁肌CSA和FI的不对称程度与脊柱侧弯Cobb角之间存在相关性。结论腰椎椎旁肌在DLS的退行性变化中不是一个整体。腰椎屈伸肌群具有不同的解剖学和生理学效应。伸肌在对抗DLS的进展中起着重要作用。改善椎旁肌功能是治疗DLS的重要因素。关键词:脊柱侧弯;肌肉、骨骼;生物力学
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Asymmetric degeneration of paravertebral muscles in degenerative lumbar scoliosis and potential significance
Objective To measure the cross-sectional area (CSA) and fatty infiltration (FI) of lumbar paravertebral muscles in patients with degenerative lumbar scoliosis (DLS), and to analyze the mechanism and clinical significance of paravertebral muscles degeneration. Methods A retrospective study was performed on 118 patients with DLS who were enrolled in our hospital from September 2016 to September 2017. All patients had complete preoperative image data. Preoperative lumbar lordosis (LL), Cobb angle, and vertebral rotation were measured on spinal X-ray plain film. The CSA and FI of the paravertebral muscle on the upper and lower intervertebral level of the scoliosis apical vertebrae were measured by lumbar MRI, and the CSA, FI and their correlation with the Cobb angle were compared. Results This study enrolled 118 DLS patients, including 49 males and 69 females. The mean age of the patients was 65.4 ± 7.2 years, with an average BMI of 24.7 ± 3.4 and lumbar symptoms including LBP, sciatica, numbness and intermittent claudication, decreased myodynamia and other symptoms. The lasting time of symptoms were 21 months (3-60 months). The Cobb angle of the patients averaged 18.5°±6.7°. Of all patients, 60 patients had a scoliosis to the left, and 58 patients had a scoliosis to the right. The number of patients with lateral apical vertebrae located at L1-L4 were: 12 cases of L1, 41 cases of L2, 49 cases of L3, 16 cases of L4. The CSA of the concave side psoas muscle was significantly larger than that of the convex side(upper intervertebral level, concave side 3.74±2.17 cm2, convex side 3.56±1.91 cm2; lower intervertebral level, concave side 6.54±3.08 cm2, convex side 6.31±3.302 cm2. And the CSA of the concave side multifidus muscle and the extensor muscle group was significantly smaller than the convex side, multifidus muscle: upper intervertebral level, concave side 9.47±3.86 cm2, convex side 10.25±4.20 cm2; lower intervertebral level, concave side 9.30±3.61 cm2, convex side 10.21±3.81 cm2; extensor muscle group: upper intervertebral level, concave side 18.35±4.94 cm2, convex side 19.37±5.17 cm2; lower intervertebral level, concave side 18.98±4.73 cm2, convex side 19.81±5.16 cm2. The concave side FI of extensor muscle group is significantly larger than the convex side, upper intervertebral level, concave side 30.63±15.09, convex side 23.48±15.00; lower intervertebral level, concave side 37.87±19.38, convex side 30.43±16.89. There was a correlation between the degree of asymmetry of CSA and FI in the multifidus, dorsal extension muscles, paravertebral muscle and the scoliosis Cobb angle. Conclusion The paravertebral muscles of lumbar vertebrae are not a whole in the degenerative changes of DLS. There are different anatomical and physiological effects of lumbar flexion and extension muscle groups. The extensor muscles play an important role in antagonizing the progression of DLS. Improving paravertebral muscle function is an important element in the treatment of DLS. Key words: Scoliosis; Muscle, skeletal; Biomechanics
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中华骨科杂志
中华骨科杂志 Medicine-Surgery
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