中华骨科杂志2019，Vol.39Issue(18) ：1133-1141.

退变性腰椎侧凸椎旁肌群不对称退变临床意义

Asymmetric degeneration of paravertebral muscles in degenerative lumbar scoliosis and potential significance

丁浚哲 鲁世保 孔超 孙祥耀
中华骨科杂志2019，Vol.39Issue(18) ：1133-1141.
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退变性腰椎侧凸椎旁肌群不对称退变临床意义

Asymmetric degeneration of paravertebral muscles in degenerative lumbar scoliosis and potential significance

丁浚哲 1鲁世保 1孔超 1孙祥耀1
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作者信息

  • 1. 首都医科大学宣武医院骨科 北京,100032
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摘要

目的 测量退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者腰椎椎旁肌横截面积(cross⁃sectional ar⁃ea,CSA)及脂肪化程度(fatty infiltration,FI),并分析椎旁肌不对称退变的可能机制及临床意义.方法 采用回顾性研究方法,收集自2016年9月至2017年9月在首都医科大学宣武医院骨科就诊的118例DLS患者资料,男49例,女69例,年龄为(65.4±7.2)岁,BMI为24.7±3.4.患者腰椎症状包括腰痛,下肢放射痛或麻木,间歇性跛行,肌力减退等,症状状持续时间3~60个月,平均为21个月.所有患者均具备完整术前影像学资料,通过脊柱X线片测量术前腰椎前凸角(lumbar lordosis, LL),腰椎冠状位侧凸Cobb角,顶椎旋转畸形分级;通过腰椎MRI测量术前腰椎侧凸顶椎上下间盘平面各椎旁肌CSA,腰椎侧凸顶椎上下间盘平面椎旁肌FI.比较患者椎旁肌CSA、FI及其与侧凸Cobb角的相关性.结果 118例侧凸冠状面Cobb角为18.5°±6.7°;60例侧凸方向为左侧,58例为右侧.侧凸顶椎位置:L1 12例,L2 41例,L3 49例,L4 16例.凹侧腰大肌CSA显著大于凸侧,顶椎上椎间盘平面凹侧(3.74±2.17)cm2,凸侧(3.56±1.91);顶椎下椎间盘平面凹侧(6.54±3.08)cm2,凸侧(6.31±3.30);凹侧多裂肌、背伸肌群CSA显著小于凸侧,多裂肌顶椎上椎间盘平面凹侧(9.47±3.86)cm2,凸侧(10.25±4.20);顶椎下椎间盘平面凹侧(9.30±3.61)cm2,凸侧(10.21±3.81);背伸肌群:顶椎上椎间盘平面凹侧(18.35±4.94)cm2,凸侧(19.37±5.17) ;顶椎下椎间盘平面凹侧(18.98±4.73)cm2,凸侧(19.81±5.16).凹侧背伸肌群FI显著大于凸侧,顶椎上椎间盘平面凹侧30.63±15.09,凸侧23.48±15.00(t=4.851,P=0.000);顶椎下椎间盘平面凹侧37.87±19.38,凸侧30.43±16.89(t=6.475,P=0.000).多裂肌、背伸肌群、椎旁肌群CSA及FI不对称程度与侧凸Cobb角大小存在相关性.结论 腰椎各椎旁肌在DLS的退行性改变中,腰椎前屈和背伸肌群存在不同的解剖结构和生理效应,背伸肌群在拮抗DLS进展中具有重要作用,保护和改善椎旁肌功能是DLS治疗中重要的考虑因素.

Abstract

To measure the cross⁃sectional area (CSA) and fatty infiltration (FI) of lumbar paravertebral mus⁃cles 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 hospi⁃tal 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 fe⁃males. 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 lev⁃el, 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 mus⁃cles of lumbar vertebrae are not a whole in the degenerative changes of DLS. There are different anatomical and physiological ef⁃fects 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.

关键词

脊柱侧凸/肌,骨骼/生物力学

Key words

Scoliosis/Muscle,skeletal/Biomechanics

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出版年

2019
中华骨科杂志
中华医学会

中华骨科杂志

CSTPCDCSCD北大核心
影响因子：2.137
ISSN：0253-2352
被引量13
参考文献量8
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