摘要
目的 对年轻初发腰椎间盘突出症(LDH)的人群进行MRI检查,分析椎旁肌退变情况及其与椎间盘退变程度的相关性.方法 以2021年1月～2023年1月因腰腿痛就诊、被该院首次诊断为LDH的35例年轻初发LDH患者作为观察对象,纳入LDH组.按照1:1的比例,随机选择同一时期在该院接受体检的年轻人群作为健康对照组.对两组研究对象进行腰椎MRI检查,测量L2-3、L3-4、L4-5和L5-S,节段的最长肌(LS)、多裂肌(MF)和腰大肌(PS)的椎旁肌横截面积/椎体横截面积的比值(MVr),并采用半定量分级来评价椎旁肌群的脂肪浸润程度,对椎间盘退变程度进行Pfirrmann分级.对两组研究对象的上述指标进行比较,并针对LDH组患者的椎旁肌退变情况与椎间盘退变程度进行Spearman相关性分析.结果 LDH患者LS、PS的MVr值略低于健康对照人群,但差异并不显著(tLS=0.263,PLS=0.793;tPS=0.374,PPS=0.709);LDH患者MF的MVr值显著低于健康对照人群(tMF=2.567,PMF=0.013).LDH组的椎旁肌脂肪浸润程度分级显著高于对照组(Z=5.309;P＜0.05).Spearman 相关性分析可见:MF MVr(r=0.298)、LS MVr(r=0.293)和 PS MVr(r=0.315)与椎旁肌脂肪浸润分级之间均存在轻度的相关性,椎旁肌脂肪浸润分级与椎间盘退变Pfirrmann分级之间不存在明确的相关性(r=-0.106);MF MVr(r=0.659)、LS MVr(r=0.507)和PS MVr(r=0.542)与椎间盘退变Pfirrmann分级之间均存在中度的相关性,其中以MF MVr与椎间盘退变Pfirrmann分级之间的相关性最强.结论 初发LDH的年轻人群有较明显的椎旁肌退变,尤其以MF退变更为明显;此类患者的多裂肌MVr与椎间盘退变程度之间存在中等程度的相关性,但椎旁肌脂肪浸润与椎间盘退变之间不存在相关性.
Abstract
Objective To investigate the paravertebral muscle degeneration and its correlation with the degree of lumbar interver-tebral disc degeneration in young patients with initial lumbar disc herniation(LDH)through MRI examination.Methods Thirty-five young patients with initial LDH diagnosed for the first time in our hospital due to low back and leg pain from January 2021 to January 2023 were included in the LDH group.A healthy control group was randomly selected from young individuals who underwent physical examination in our hospital during the same period,with a ratio of 1:1.Lumbar MRI was performed on both groups to measure the ratio of paravertebral muscle cross-sectional area to vertebral body cross-sectional area(MVr)for the Longissimus muscle(LS),Multifidus muscle(MF),and Psoas muscle(PS)at the L2-3,L3-4,L4-5,and L5-S,segments.Semiquantitative grading was used to evaluate the degree of fat infiltration in the paravertebral muscles,and the Pfirrmann grading system was used to assess the degree of interverte-bral disc degeneration.The above-mentioned indicators were compared between the two groups,and a Spearman correlation analysis was conducted to investigate the relationship between paravertebral muscle degeneration and the degree of intervertebral disc degenera-tion in the LDH group.Results The MVr values of LS and PS in patients with LDH were slightly lower than those in the healthy con-trol group,but the differences were not significant(tLS=0.263,PLS=0.793;tPS=0.374,PPS=0.709).However,the MVr value of MF in patients with LDH was significantly lower than that in the healthy control group(tMF=2.567,PMF=0.013).The grade of fat infiltration in paravertebral muscles in the LDH group was significantly higher than that in the control group(Z=5.309;P＜0.05).Spearman correlation analysis revealed a mild correlation between MF MVr(r=0.298),LS MVr(r=0.293),PS MVr(r=0.315),and the grade of fat infiltration in paravertebral muscles.No clear correla-tion was observed between the grade of fat infiltration in paravertebral muscles and the Pfirrmann grade of intervertebral disc degenera-tion(r=-0.106).However,there was a moderate correlation between MF MVr(r=0.659),LS MVr(r=0.507),PS MVr(r=0.542),and the Pfirrmann grade of intervertebral disc degeneration,with the strongest correlation observed between MF MVr and the Pfirrmann grade.Conclusion Young patients with initial LDH exhibited significant paravertebral muscle degeneration,particularly in the MF.There was a moderate correlation between the MVr of multifidus muscle and the degree of intervertebral disc degeneration in these patients,but no correlation was found between paravertebral muscle fat infiltration and intervertebral disc degeneration.
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