退行性腰椎滑脱症患者多裂肌退行性变与临床症状的相关性
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摘要
目的探讨退行性腰椎滑脱症患者多裂肌退行性变程度与腰椎前凸角、腰腿痛视觉模拟量表(VAS)评分以及Oswestry功能障碍指数(ODI)的相关性。方法回顾性分析51例退行性腰椎滑脱症患者的腰痛VAS评分、下肢痛VAS评分和ODI等临床资料。通过腰椎X线片判断滑脱严重程度并测量腰椎前凸角,其中Ⅰ度滑脱30例(L_4/L_5 20例、L_5/S_1 10例),Ⅱ度滑脱21例(L_4/L_5 15例、L_5/S_1 6例)。通过腰椎MRI测量患者L_4/L_5、L_5/S_1水平双侧多裂肌平均横截面积和脂肪浸润率,用Pearson相关分析评估多裂肌横截面积、脂肪浸润率与腰椎前凸角、腰痛VAS评分、下肢痛VAS评分和ODI的相关性。结果不同滑脱程度患者腰椎前凸角、腰痛VAS评分、下肢痛VAS评分、ODI差异无统计学意义(P>0.05)。在相同节段,不同滑脱程度患者多裂肌横截面积差异无统计学意义(P>0.05);Ⅰ度滑脱者多裂肌脂肪浸润率均低于Ⅱ度滑脱者,差异有统计学意义(P<0.05)。多裂肌横截面积、脂肪浸润率与腰椎前凸角、腰痛VAS评分、下肢痛VAS评分和ODI均无相关性。结论不同严重程度退行性腰椎滑脱症患者多裂肌的退行性变程度存在差异,多裂肌退行性变可能参与了退行性腰椎滑脱的进程,但尚不能证明多裂肌退行性变程度与临床症状存在相关性。
Objective To analyze the correlation between multifidus muscle degeneration and lumbar lordosis angle,low back and leg pain visual analogue scale(VAS)score,and Oswestry disability index(ODI)in degenerative lumbar spondylolisthesis patients.Methods The clinical data of 51 degenerative lumbar spondylolisthesis patients,such as low back pain VAS score,leg pain VAS score and ODI,were retrospectively analyzed.The severity of spondylolisthesis and lumbar lordosis angle were judged by lumbar roentgenograph.Among them,30 had gradeⅠspondylolisthesis(L_4/L_5 20 cases,L_5/S_1 10cases),21 gradeⅡspondylolisthesis(L_4/L_5 15 cases,L_5/S_1 6 cases).The mean cross-sectional area and fat infiltration rate of bilateral multifidus were measured by lumbar MRI in L_4/L_5 and L_5/S_1.The Pearson correlation analysis was used to analyze the correlation between the cross-sectional area of multifidus,fat infiltration rate of multifidus and the lumbar lordosis angle,low back pain VAS score,leg pain VAS score and ODI.Results There were no significant differences in lumbar lordosis angle,low back pain VAS score,leg pain VAS score and ODI between the patients with different grades of spondylolisthesis(P>0.05).At the same level,there was no significant difference in the cross-sectional area of multifidus between the patients with different grades of spondylolisthesis(P>0.05);the fat infiltration rate of multifidus in the patients with gradeⅠspondylolisthesis was lower than that in the patients with gradeⅡspondylolisthesis,with a significant difference(P<0.05).There were no significant correlations between the cross-sectional area of multifidus,fat infiltration rate of multifidus and lumbar lordosis angle,low back pain VAS score,leg pain VAS score and ODI.Conclusion There is difference in multifidus degenerative degree in patients with different severity of degenerative spondylolisthesis.Degenerative grade of the multifidus muscle may be involved in the course of degenerative lumbar spondylolisthesis,but it can not prove the correlation between the grade of multifidus muscle degeneration and clinical symptoms.
Objective To analyze the correlation between multifidus muscle degeneration and lumbar lordosis angle,low back and leg pain visual analogue scale(VAS)score,and Oswestry disability index(ODI)in degenerative lumbar spondylolisthesis patients.Methods The clinical data of 51 degenerative lumbar spondylolisthesis patients,such as low back pain VAS score,leg pain VAS score and ODI,were retrospectively analyzed.The severity of spondylolisthesis and lumbar lordosis angle were judged by lumbar roentgenograph.Among them,30 had gradeⅠspondylolisthesis(L_4/L_5 20 cases,L_5/S_1 10cases),21 gradeⅡspondylolisthesis(L_4/L_5 15 cases,L_5/S_1 6 cases).The mean cross-sectional area and fat infiltration rate of bilateral multifidus were measured by lumbar MRI in L_4/L_5 and L_5/S_1.The Pearson correlation analysis was used to analyze the correlation between the cross-sectional area of multifidus,fat infiltration rate of multifidus and the lumbar lordosis angle,low back pain VAS score,leg pain VAS score and ODI.Results There were no significant differences in lumbar lordosis angle,low back pain VAS score,leg pain VAS score and ODI between the patients with different grades of spondylolisthesis(P>0.05).At the same level,there was no significant difference in the cross-sectional area of multifidus between the patients with different grades of spondylolisthesis(P>0.05);the fat infiltration rate of multifidus in the patients with gradeⅠspondylolisthesis was lower than that in the patients with gradeⅡspondylolisthesis,with a significant difference(P<0.05).There were no significant correlations between the cross-sectional area of multifidus,fat infiltration rate of multifidus and lumbar lordosis angle,low back pain VAS score,leg pain VAS score and ODI.Conclusion There is difference in multifidus degenerative degree in patients with different severity of degenerative spondylolisthesis.Degenerative grade of the multifidus muscle may be involved in the course of degenerative lumbar spondylolisthesis,but it can not prove the correlation between the grade of multifidus muscle degeneration and clinical symptoms.
引文
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[7]Hides JA,Stokes MJ,Saide M,et al.Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain[J].Spine(Phila Pa 1976),1994,19(2):165-172.
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[13]Parkkola R,Kormano M.Lumbar disc and back muscle degeneration on MRI:correlation to age and body mass[J].J Spinal Disord,1992,5(1):86-92.
[14]Kalichman L,Hodges P,Li L,et al.Changes in paraspinal muscles and their association with low back pain and spinal degeneration:CT study[J].Eur Spine J,2010,19(7):1136-1144.
[15]Kalichman L,Carmeli E,Been E.The association between imaging parameters of the paraspinal muscles,spinal degeneration,and low back pain[J].Biomed Res Int,2017,2017:2562957.
[16]Yu B,Jiang K,Li X,et al.Correlation of the features of the lumbar multifidus muscle with facet joint osteoarthritis[J].Orthopedics,2017,40(5):e793-e800.
[17]Wilke HJ,Wolf S,Claes LE,et al.Stability increase of the lumbar spine with different muscle groups.Abiomechanical in vitro study[J].Spine(Phila Pa1976),1995,20(2):192-198.
[18]Silfies SP,Mehta R,Smith SS,et al.Differences in feedforward trunk muscle activity in subgroups of patients with mechanical low back pain[J].Arch Phys Med Rehabil,2009,90(7):1159-1169.
[19]Kjaer P,Bendix T,Sorensen JS,et al.Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain?[J].BMC Med,2007,5:2.
[20]Wang G,Karki SB,Xu S,et al.Quantitative MRI and X-ray analysis of disc degeneration and paraspinal muscle changes in degenerative spondylolisthesis[J].J Back Musculoskelet Rehabil,2015,28(2):277-285.
[21]Hodges P,Holm AK,Hansson T,et al.Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury[J].Spine(Phila Pa 1976),2006,31(25):2926-2933.
[22]Dulor JP,Cambon B,Vigneron P,et al.Expression of specific white adipose tissue genes in denervationinduced skeletal muscle fatty degeneration[J].FEBSLett,1998,439(1/2):89-92.
[23]Hyun JK,Lee JY,Lee SJ,et al.Asymmetric atrophy of multifidus muscle in patients with unilateral lumbosacral radiculopathy[J].Spine(Phila Pa 1976),2007,32(21):E598-E602.
[24]Morel E,Ilharreborde B,Lenoir T,et al.Sagittal balance of the spine and degenerative spondylolisthesis[J].Rev Chir Orthop Reparatrice Appar Mot,2005,91(7):615-626.
[25]Jun HS,Kim JH,Ahn JH,et al.The effect of lumbar spinal muscle on spinal sagittal alignment:evaluating muscle quantity and quality[J].Neurosurgery,2016,79(6):847-855.
[26]郭旭朝,张旭,丁文元,等.退变性腰椎不稳椎旁肌退变的影像学研究[J].中华外科杂志,2014,52(8):571-575.
[27]Nava-Bringas TI,Ramírez-Mora I,Coronado-Zarco R,et al.Association of strength,muscle balance,and atrophy with pain and function in patients with degenerative spondylolisthesis[J].J Back Musculoskelet Rehabil,2014,27(3):371-376.
[28]Teichtahl AJ,Urquhart DM,Wang Y,et al.Fat infiltration of paraspinal muscles is associated with low back pain,disability,and structural abnormalities in community-based adults[J].Spine J,2015,15(7):1593-15601.
[29]王鑫强,贾瑞钢,陈彦影,等.退变性腰椎滑脱患者腰部多裂肌退变与腰背痛的相关性研究[J].实用骨科杂志,2017,23(9):777-780.
[2]Nachemson A.The possible importance of the psoas muscle for stabilization of the lumbar spine[J].Acta Orthop Scand,1968,39(1):47-57.
[3]Panjabi MM.The stabilizing system of the spine.PartⅠ.Function,dysfunction,adaptation,and enhancement[J].J Spinal Disord,1992,5(4):383-389,397.
[4]Panjabi MM.The stabilizing system of the spine.PartⅡ.Neutral zone and instability hypothesis[J].J Spinal Disord,1992,5(4):390-397.
[5]Ward SR,Kim CW,Eng CM,et al.Architectural analysis and intraoperative measurements demonstrate the unique design of the multifidus muscle for lumbar spine stability[J].J Bone Joint Surg Am,2009,91(1):176-185.
[6]Barker KL,Shamley DR,Jackson D.Changes in the cross-sectional area of multifidus and psoas in patients with unilateral back pain:the relationship to pain and disability[J].Spine(Phila Pa 1976),2004,29(22):E515-E519.
[7]Hides JA,Stokes MJ,Saide M,et al.Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain[J].Spine(Phila Pa 1976),1994,19(2):165-172.
[8]Huskisson EC.Measurement of pain[J].Lancet,1974,2(7889):1127-1131.
[9]Fairbank JC,Couper J,Davies JB,et al.The Oswestry low back pain disability questionnaire[J].Physiotherapy,1980,66(8):271-273.
[10]Meyerding HW.Low backache and sciatic pain associated with spondylolisthesis and protruded intervertebral disc:incidence,significance and treatment[J].J Bone Joint Surg Am,1941,23(2):461-470.
[11]Crawford RJ,Cornwall J,Abbott R,et al.Manually defining regions of interest when quantifying paravertebral muscles fatty infiltration from axial magnetic resonance imaging:a proposed method for the lumbar spine with anatomical cross-reference[J].BMC Musculoskelet Disord,2017,18(1):25.
[12]Nizard RS,Wybier M,Laredo JD.Radiologic assessment of lumbar intervertebral instability and degenerative spondylolisthesis[J].Radiol Clin North Am,2001,39(1):55-71.
[13]Parkkola R,Kormano M.Lumbar disc and back muscle degeneration on MRI:correlation to age and body mass[J].J Spinal Disord,1992,5(1):86-92.
[14]Kalichman L,Hodges P,Li L,et al.Changes in paraspinal muscles and their association with low back pain and spinal degeneration:CT study[J].Eur Spine J,2010,19(7):1136-1144.
[15]Kalichman L,Carmeli E,Been E.The association between imaging parameters of the paraspinal muscles,spinal degeneration,and low back pain[J].Biomed Res Int,2017,2017:2562957.
[16]Yu B,Jiang K,Li X,et al.Correlation of the features of the lumbar multifidus muscle with facet joint osteoarthritis[J].Orthopedics,2017,40(5):e793-e800.
[17]Wilke HJ,Wolf S,Claes LE,et al.Stability increase of the lumbar spine with different muscle groups.Abiomechanical in vitro study[J].Spine(Phila Pa1976),1995,20(2):192-198.
[18]Silfies SP,Mehta R,Smith SS,et al.Differences in feedforward trunk muscle activity in subgroups of patients with mechanical low back pain[J].Arch Phys Med Rehabil,2009,90(7):1159-1169.
[19]Kjaer P,Bendix T,Sorensen JS,et al.Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain?[J].BMC Med,2007,5:2.
[20]Wang G,Karki SB,Xu S,et al.Quantitative MRI and X-ray analysis of disc degeneration and paraspinal muscle changes in degenerative spondylolisthesis[J].J Back Musculoskelet Rehabil,2015,28(2):277-285.
[21]Hodges P,Holm AK,Hansson T,et al.Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury[J].Spine(Phila Pa 1976),2006,31(25):2926-2933.
[22]Dulor JP,Cambon B,Vigneron P,et al.Expression of specific white adipose tissue genes in denervationinduced skeletal muscle fatty degeneration[J].FEBSLett,1998,439(1/2):89-92.
[23]Hyun JK,Lee JY,Lee SJ,et al.Asymmetric atrophy of multifidus muscle in patients with unilateral lumbosacral radiculopathy[J].Spine(Phila Pa 1976),2007,32(21):E598-E602.
[24]Morel E,Ilharreborde B,Lenoir T,et al.Sagittal balance of the spine and degenerative spondylolisthesis[J].Rev Chir Orthop Reparatrice Appar Mot,2005,91(7):615-626.
[25]Jun HS,Kim JH,Ahn JH,et al.The effect of lumbar spinal muscle on spinal sagittal alignment:evaluating muscle quantity and quality[J].Neurosurgery,2016,79(6):847-855.
[26]郭旭朝,张旭,丁文元,等.退变性腰椎不稳椎旁肌退变的影像学研究[J].中华外科杂志,2014,52(8):571-575.
[27]Nava-Bringas TI,Ramírez-Mora I,Coronado-Zarco R,et al.Association of strength,muscle balance,and atrophy with pain and function in patients with degenerative spondylolisthesis[J].J Back Musculoskelet Rehabil,2014,27(3):371-376.
[28]Teichtahl AJ,Urquhart DM,Wang Y,et al.Fat infiltration of paraspinal muscles is associated with low back pain,disability,and structural abnormalities in community-based adults[J].Spine J,2015,15(7):1593-15601.
[29]王鑫强,贾瑞钢,陈彦影,等.退变性腰椎滑脱患者腰部多裂肌退变与腰背痛的相关性研究[J].实用骨科杂志,2017,23(9):777-780.