摘要
目的 分析椎旁肌参数与退行性胸腰段后凸角度的相关性.方法 回顾性分析2021年11月至2023年4月于北京积水潭医院脊柱外科接受手术治疗的腰椎退行性疾病的女性患者90例,年龄(67.62±4.98)岁(范围60～80岁),身高(1.58±0.05)m(范围 1.48～1.70)m,体重(63.79±9.13)kg(范围47～90 kg),体质指数(25.48±3.35)kg/m2(范围 18.37～36.05 kg/m2).胸腰段后凸角为6.65°±10.38°(范围-17.34°～9.34°).疾病诊断:腰间盘突出症32例、腰椎管狭窄症58例.摄站立位胸腰段正侧位X线片测量胸腰段后凸角度;摄胸腰段定量CT并采用Osirix软件测量T12、L3、L5水平椎旁肌参数,包括椎旁肌横截面积、骨骼肌面积和组织密度、脂肪浸润比例和身高矫正的骨骼肌面积指数.分析椎旁肌参数与胸腰段后凸角度之间的相关性,采用多重线性回归分析影响胸腰段后凸角度的因素.结果 相关性分析结果显示胸腰段后凸角与T12骨骼肌组织密度(r=-0.303,P=0.004)和L5骨骼肌组织密度(r=-0.219,P=0.038)呈负相关.年龄与T12骨骼肌组织密度(r=-0.263,P=0.012)、T12 身高矫正的骨骼肌面积指数(r=-0.221,P=0.036)、T12椎 旁肌横截面积(r=-0.280,P=0.007)、L3骨骼肌组织密度(r=-0.266,P=0.011)和L5骨骼肌组织密度(r=-0.290,P=0.006)呈负相关.骨密度与椎旁肌参数无相关性(P＞0.05).多重线性回归显示T12骨骼肌组织密度(β=-1.125,P＜0.001)、T12脂肪浸润比例(β=-0.849,P=0.001)、L3骨骼肌组织密度(β=0.996,P＜0.001)和L3脂肪浸润比例(β=0.496,P=0.020)是影响胸腰段后凸角的独立因素.结论 T12和L3椎旁肌密度和脂肪浸润比例是影响胸腰段后凸角的独立因素.T12椎旁肌密度和脂肪浸润比例越小、L3椎旁肌密度和椎旁肌脂肪浸润比例越大,胸腰段后凸角度越大.
Abstract
Objective To analyze the correlation between paraspinal muscle parameters and the angle of degenerative thoracolumbar segmental kyphosis.Methods From November 2021 to April 2023,a total of 90 female patients with lumbar de-generative disease who underwent surgical treatment in the Department of Spine Surgery,Beijing Jishuitan Hospital were retro-spectively analyzed.The average age was 67.62±4.98 years(range,60-80 years),and the average height was 1.58±0.05 m(range,1.48-1.70 m).Weight 63.79±9.13 kg(range,47-90 kg),body mass index 25.48±3.35 kg/m2(range,18.37-36.05 kg/m2).The an-gle of kyphosis of the thoracolumbar segments was 6.65°±10.38°(range,-17.34° to 9.34°).Disease diagnosis:32 cases of lumbar disc herniation and 58 cases of lumbar spinal stenosis.Frontal and lateral radiographs of the thoracolumbar segments in the stand-ing position were taken to measure the angle of kyphosis of the thoracolumbar segments;quantitative CT of the thoracolumbar seg-ments and Osirix software were used to measure the parameters of the paravertebral muscles at the levels of T12,L3,and L5,includ-ing paravertebral muscle cross-sectional area,skeletal muscle area,and tissue density,the proportion of fat infiltration,and the height-corrected skeletal muscle area index.The correlation between paraspinal muscle parameters and the angle of thoracolum-bar segmental kyphosis was analyzed,and the factors affecting the angle of thoracolumbar segmental kyphosis were analyzed using multiple linear regression.Results Correlation analysis showed a negative correlation between the angle of thoracolumbar seg-mental kyphosis and the tissue density of T12 skeletal muscle(r=-0.303,P=0.004)and L5 skeletal muscle(r=-0.219,P=0.038).Age was negatively correlated with Ti2 skeletal muscle tissue density(r=-0.263,P=0.012),T12 height-corrected skeletal muscle ar-ea index(r=-0.221,P=0.036),T12 paravertebral muscle cross-sectional area(r=-0.280,P=0.007),L3 skeletal muscle tissue density(r=-0.266,P=0.011)and L skeletal muscle tissue density(r=-0.290,P=0.006).There was no correlation between bone mineral density and paravertebral muscle parameters(P＞0.05).Multiple linear regression showed that T12 skeletal muscle tissue density(β=-1.125,P＜0.001),T12 fat-infiltrated proportion(β=-0.849,P=0.001),L3 skeletal muscle tissue density(β=0.996,P＜0.001),and L3 fat-infiltrated proportion(β=0.496,P=0.020)were independent factors influencing the angle of thoracolumbar segmental ky-phosis.Conclusion T12 and L3 paraspinal muscle density and fat-infiltrated proportion are independent factors affecting the an-gle of thoracolumbar kyphosis.The smaller the density and fat-infiltrated proportion of T12 paraspinal muscle,and the larger the density and fat-infiltrated proportion of L3 paraspinal muscle,the larger the angle of thoracolumbar kyphosis.
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