退变性腰椎不稳椎旁肌退变的影像学研究  

Imaging study of paravertebral muscle degeneration in degenerative lumbar instability

作　　者：郭旭朝[1] 张旭[1] 丁文元[1] 杨大龙[1] 马雷[1] 谢东晓[1] 王辉[1] 王海莹[1] 路宽[1] 

机构地区：[1]河北医科大学第三医院脊柱外科河北省骨科生物力学重点实验室,石家庄050051

出　　处：《中华外科杂志》2014年第8期571-575,共5页Chinese Journal of Surgery

摘　　要：目的 以MRI为评估手段,对比在退变性腰椎不稳患者和正常人两组人群中椎旁肌（多裂肌、竖脊肌、腰大肌）的改变,观察椎旁肌退变情况并分析椎旁肌退变与退变性腰椎不稳腰椎曲度的关系.方法 选取2011年12月至2013年7月60例退变性腰椎不稳患者为研究对象（退变组）,以同期进行健康体检、无腰椎不稳者60例为对照组;两组间性别、年龄、体重指数相匹配.应用ImageJ软件测量两组MRI T2WI上L4-S1椎间盘水平两侧椎旁肌横截面积和脂肪浸润百分比,同时测量腰椎正侧位X线上两组患者的腰椎生理曲度以腰椎前凸角表示,所测数据应用两独立样本t检验进行统计学分析.结果 退变组患者多裂肌横截面积及脂肪浸润百分比在L4-L5、L5-S1水平与对照组相比差异有统计学意义（t=2.768、6.216,P＜0.05）.两组间竖脊肌脂肪浸润百分比差异有统计学意义（t=5.862,P＜0.01）.两组间竖脊肌横截面积、腰大肌退变程度（脂肪浸润百分比、肌肉横截面积）无统计学意义.退变组与对照组患者腰椎前凸角分别为（43.9±15.6）°和（39.3±14.2）°,两组间差异有统计学意义（P＜0.05）.结论 退变性腰椎不稳患者与对照组相比多裂肌、竖脊肌存在退变,且多裂肌退变明显;椎旁肌各肌群退变程度不一致与退变性腰椎不稳腰椎生理前凸角增大相关.Objectives To compare the paravertebral muscle （such as multifidus,erector spinae,psoas muscle） changes between the patients with degenerative lumbar instability and normal person by MRI and to observe the degeneration of paravertebral muscles.To analyze the relationship between paravertebral muscle degeneration and lumbar curvature of degenerative lumbar instability.Methods Sixty patients with degenerative lumbar instability were retrospectively enrolled from December 2011 to July 2013 as degeneration group,meanwhile 60 health persons with no degenerative lumbar instability were selected as control group.No significant differences were found in the gender,age and body mass index between the two groups.The cross-sectional area （CSA） and percentage of fat infiltration area （FIA） of the paravertebral muscles at the L4-S1 levels were measured using T2-weighted axial MRI and Image J soft ware.And the lumbar curvature（expressed as lumbar lordosis angle） of all the patients in lumbar X-ray were measured in the two groups.The measured data were analyzed with independent samples t-test.Results The difference of multifidus cross-sectional area and the percentage of fat infiltration in the patients of degenerative lumbar instability at the L4-L5,L5-S1 level,compared with the control group,was statistically significant （t =2.768,t =6.216,P ＜ 0.05）.Between the two groups,the percentage of fatty infiltration in erector spinae showed significant differences（t =5.862,P ＜ 0.05）.The cross-sectional area of erector spinae and the degeneration of the psoas muscle between the two groups was not statistically significant.The lumbar lordsis angle in the patients with degenerative lumbar instability was （43.9 ± 15.6）°,which was higher than the （39.3 ± 14.2） °in control group（t =2.915,P ＜ 0.05）.Conclusions Compared with the control group,patients with degenerative lumbar instability exists erector spinae and multifidus muscle degeneration,and erector spinae is more obvious.The degeneration a

关 键 词：腰椎 椎旁肌 不稳 退变 

分 类 号：R687.3[医药卫生—骨科学]