腰椎间盘突出症与多裂肌退变相关性的定量影像学研究
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摘要
目的:探讨多裂肌退变与腰椎间盘突出症的相关性,进一步了解椎旁肌对腰椎稳定性的影响,为腰椎间盘突出症治疗与预防提供依据。方法:选取60例腰椎间盘突出症患者为研究对象(患者组),男、女各30例,以同期行健康体检、无腰椎间盘突出的60例志愿者为对照组,男、女各30例;2组性别、年龄、身高、体质量指数相匹配。应用MRS分析,Image J软件测量2组MRI T_2WI上L_(4～5)椎间隙神经根出口水平两侧多裂肌、竖脊肌、腰大肌横截面积和MRS脂肪峰波峰下面积,并行独立样本t检验。结果:在L_(4～5)水平,多裂肌横截面积及肌肉波谱脂肪峰波峰下面积,男性患者组与男性对照组相比差异均有统计学意义(均P<0.05),女性患者组与女性对照组相比差异亦均有统计学意义(均P<0.05)。竖脊肌及腰大肌横截面积,男性患者组与男性对照组相比差异均无统计学意义(均P>0.05),女性患者组与女性对照组相比差异均无统计学意义(均P>0.05)。结论:腰椎间盘突出症患者与对照组相比多裂肌有不同程度退变,且退变与腰椎间盘突出症有一定相关性,MRI在腰椎椎旁肌形态与功能定量分析中具有重要价值。
Objective:To study the correlation between multifidus muscle degeneration and lumbar disc herniation(LDH)by MRI.To further realize the effect of paravertebral muscles on lumbar stability.To provide the evidence for the treatment and prevention of LDH.Methods:Sixty patients with LDH were retrospectively enrolled as LDH group,meanwhile 60 healthy persons without LDH were selected as control group(both divided into two groups as male and female).No significant differences were found in the gender,age and body mass index between the two groups.The cross-sectional area(CSA)and fat infiltration area(FIA)of the paravertebral muscles,such as multifidus muscle,erector spinae and psoas muscle at the L_(4～5)were measured using Image J software and proton MRS.The measured data were analyzed with independent samples t-test.Results:For the different gender,the difference of CSA and FIA of multifidus muscles at the L_(4～5)level in the patients of LDH,compared with the control group,were statistically significant(P<0.05).And the CSA of erector spinae and the psoas muscle between the two groups was not statistically significant(P>0.05).Conclusions:Compared with the control group,patients with lumbar disc herniation have varying degrees of degeneration of the multifidus.There is a certain correlation between the multifidus degeneration and lumbar disc herniation.MRI is valuable in the quantitative analysis of the morphology and function of the paraspinal muscle.
Objective:To study the correlation between multifidus muscle degeneration and lumbar disc herniation(LDH)by MRI.To further realize the effect of paravertebral muscles on lumbar stability.To provide the evidence for the treatment and prevention of LDH.Methods:Sixty patients with LDH were retrospectively enrolled as LDH group,meanwhile 60 healthy persons without LDH were selected as control group(both divided into two groups as male and female).No significant differences were found in the gender,age and body mass index between the two groups.The cross-sectional area(CSA)and fat infiltration area(FIA)of the paravertebral muscles,such as multifidus muscle,erector spinae and psoas muscle at the L_(4～5)were measured using Image J software and proton MRS.The measured data were analyzed with independent samples t-test.Results:For the different gender,the difference of CSA and FIA of multifidus muscles at the L_(4～5)level in the patients of LDH,compared with the control group,were statistically significant(P<0.05).And the CSA of erector spinae and the psoas muscle between the two groups was not statistically significant(P>0.05).Conclusions:Compared with the control group,patients with lumbar disc herniation have varying degrees of degeneration of the multifidus.There is a certain correlation between the multifidus degeneration and lumbar disc herniation.MRI is valuable in the quantitative analysis of the morphology and function of the paraspinal muscle.
引文
[1]王国基,王国军,彭健民,等.腰椎间盘突出症致病因素的流行病学研究[J].现代预防医学,2009,36(13):2041-2043.
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[7] Bhadresha A,Lawrence OJ,McCarthy MJ. A comparison of magnetic resonance imaging muscle Fat content in the lumbar paraspinal muscles with patient-reported outcome measures in patients with lumbar degenerative disk disease and focal disk prolapse[J]. Global Spine J,2016,6:401-410.
[8] Hodges P,Holm AK,Hansson T,et al. Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury[J].Spine,2006,31:2926-2933.
[9] Rebecca J,Crawford,Jon Cornwall,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,2017,18:25-26.
[10] Fischer MA,Nanz D,Shimakawa A,et al. Quantification of muscle fat in patients with low back pain:comparison multi-echo MR imaging with single-voxel MR spectroscopy[J]. Radiology,2013,266:555-563.
[2]欧阳林,徐玉琴,郏潜新,等.应用MRI研究腰背肌退变规律和特征[J].中华临床医师杂志,2009,3(9):69-73.
[3] Freeman MD,Woodham MA,Woodham AW. The role of the lumbar multifidus in chronic low back pain:a review[J]. PMR,2010,2:142-146.
[4] MacDonald D,Moseley GL,Hodges PW. The lumbar multifidus muscle:does the evidence support the clinical beliefs[J]. Man Ther,2006,11:254-263.
[5] MacDonald DA,Moseley GL,Hodges PW. Why do some patients keep hurting their back Evidence of ongoing back muscle dysfunction during remission from recurrent back pain[J]. Pain,2009,142:183-188.
[6] Zhao WP,Kawaguchi Y,Matsui H,et al. Histochemistry and morphology of the multifidus muscle in lumbar disc herniation:comparative study between diseased and normal sides[J]. Spine,2000,25:2191-2199.
[7] Bhadresha A,Lawrence OJ,McCarthy MJ. A comparison of magnetic resonance imaging muscle Fat content in the lumbar paraspinal muscles with patient-reported outcome measures in patients with lumbar degenerative disk disease and focal disk prolapse[J]. Global Spine J,2016,6:401-410.
[8] Hodges P,Holm AK,Hansson T,et al. Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury[J].Spine,2006,31:2926-2933.
[9] Rebecca J,Crawford,Jon Cornwall,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,2017,18:25-26.
[10] Fischer MA,Nanz D,Shimakawa A,et al. Quantification of muscle fat in patients with low back pain:comparison multi-echo MR imaging with single-voxel MR spectroscopy[J]. Radiology,2013,266:555-563.