2020 年第 8 期 第 15 卷

老年单节段退行性腰椎管狭窄症患者椎旁肌形态改变与腰椎功能障碍的相关性分析

Correlation analysis of paraspinal muscle morphology changes and lumbar dysfunction in elderly patients with single-segment degenerative lumbar spinal stenosis

作者：杨波1杨晋才2梁智林1王健1杜骁1高茂龙3

英文作者：Yang Bo1 Yang Jincai2 Liang Zhilin1 Wang Jian1 Du Xiao1 Gao Maolong3

单位：1北京老年医院骨科100095；2首都医科大学附属北京朝阳医院骨科100020；3北京老年医院老年病临床与康复研究所100095 

英文单位：1Department of Orthopedics Beijing Geriatric Hospital Beijing 100095 China; 2Department of Orthopedics Beijing Chaoyang Hospital Capital Medical University，Beijing 100020 China; 3the Geriatric Institute for Clinic and Rehabilitation Beijing Geriatric Hispital Beijing 100095 China

关键词：退行性腰椎管狭窄症；椎旁肌；功能障碍

英文关键词：Degenerativelumbarspinalstenosis;Paravertebralmuscle;Dysfunction 

• 摘要：

• 目的 探讨老年单节段退行性腰椎管狭窄症（DLSS）患者椎旁肌形态改变与腰椎功能障碍的相关性。方法 收集2014年1月至2019年7月在北京老年医院就诊的97例老年单节段DLSS患者的临床资料。根据磁共振成像32位Osirix多平面重建后应用Image J软件从轴向T2加权图像中定量测量的多裂肌、竖脊肌和腰大肌参数，总结椎旁肌的形态改变情况，应用Oswestry功能障碍指数(ODI)评估患者腰背部功能障碍情况，根据ODI将入组患者分为轻中度功能丧失组（ODI≤24分，51例）和重度功能丧失组（ODI＞24分，46例）。应用Pearson相关性分析方法 评价椎旁肌形态与腰椎ODI评分的相关性。结果 2组患者性别构成、年龄、体重指数、腰痛时间、腿痛时间差异均无统计学意义（均P＞0.05）。重度功能丧失组L4椎体下终板水平多裂肌总截面积、相对截面积、功能截面积/总截面积，腰大肌总截面积、相对截面积小于轻中度功能丧失组［（10.91±1.06）cm2比（12.65±1.34）cm2、（0.55±0.10）比（0.61±0.11）、（0.36±0.15）比（0.47±0.13）、（12.96±1.92）cm2比（13.73±1.77）cm2、（0.59±0.24）比（0.72±0.15）］，差异均有统计学意义（均P＜0.05）。L4下终板平面水平多裂肌总截面积、相对截面积、功能截面积/总截面积和腰大肌总截面积、相对截面积与腰椎ODI均呈明显负相关（r=-0.752、-0.766、-0.818、-0.622、-0.614，均P＜0.001）。结论 多裂肌的萎缩和脂肪浸润、腰大肌的萎缩与DLSS患者的腰椎功能障碍之间存在明显的相关性，而竖脊肌的形态改变与DLSS患者的腰椎功能障碍之间无明显的相关性。

• Objective To investigate the correlation between the changes of paraspinal muscle morphology and lumbar dysfunction in elderly patients with single-segment degenerative lumbar spinal stenosis(DLSS). Methods The clinical data of 97 elderly single-segment DLSS patients admitted to Beijing Geriatric Hospital from January 2014 to July 2019 were collected. According to the quantitative measurement parameter of multislice muscle, erector spinalis muscle and psoas major muscle parameters from axial T2-weighted images using image J software after magnetic resonance imaging 32-bit Osirix multiplanar reconstruction, the morphological changes of paravertebral muscles were summarized, and the oswestry dysfunction index(ODI) score was used to assessment of patients′ lumbar and back dysfunction. According to the scores of ODI, the patients were divided into mild to moderate loss of function group(ODI≤24, 51 cases) and severe loss of function group(ODI>24, 46 cases). Pearson correlation analysis was used to evaluate the correlation between the shape of paravertebral muscles and the lumbar ODI score. Results There was no significant difference in gender composition, age, body mass index, waist and leg pain time between the two groups(all P>0.05). In the lower endplate of the L4 vertebral body level, the total cross-sectional area, relative cross-sectional area, functional cross-sectional area/total cross-sectional area of the flat multifidus muscle and the total cross-sectional area, relative cross-sectional area of psoas major muscle in severe loss of function group were less than those in mild to moderate loss of function group［（10.91±1.06）cm2 vs （12.65±1.34）cm2, （0.55±0.10） vs （0.61±0.11）, （0.36±0.15） vs （0.47±0.13）, （12.96±1.92）cm2 vs （13.73±1.77）cm2, （0.59±0.24） vs （0.72±0.15）］(all P<0.05). There was a significant negative correlation between the above parameters of paravertebral muscles and the ODI index of lumbar vertebra（r=-0.752, -0.766, -0.818, -0.622, -0.614; all P＜0.001）. Conclusion There is a clear correlation between the atrophy and fat infiltration of the multifidus muscle and the atrophy of the psoas major muscle and lumbar spine dysfunction in DLSS patients, but there is no obvious correlation between the morphological changes of the erector spinae and the lumbar spine dysfunction in DLSS patients.