单节段退行性腰椎滑脱及腰椎管狭窄症患者椎旁肌的影像学分析  

Imaging analysis of paraspinal muscles in single segment degenerative lumbar spondylolisthesis and lumbar spinal stenosis

作　　者：穆月明 阎崇楠[1] 崔少千[1] 金国鑫[1] 张磊[1] 王欢[1] Mu Yueming;Yan Chongnan;Cui Shaoqian;Jin Guoxin;Zhang Lei;Wang Huan(Department of Spine Surgery,Shengjing Hospital of China Medical Universit,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院脊柱外科,沈阳110004

出　　处：《中华骨科杂志》2021年第9期568-575,共8页Chinese Journal of Orthopaedics

摘　　要：目的探究椎旁肌退变在单节段退行性腰椎滑脱及退行性腰椎管狭窄中的差异及其临床意义。方法回顾分析2014年1月至2020年10月于中国医科大学附属盛京医院脊柱外科明确诊断为L_(4,5)节段并行手术治疗的退行性腰椎滑脱患者30例,年龄为(61.63±8.42)岁(范围44~82岁),身体质量指数(24.07±3.17)kg/m^(2);退行性腰椎管狭窄症患者30例,年龄(59.67±12.89)岁(范围31~80岁),身体质量指数(25.29±3.48)kg/m^(2);健康对照组选取门诊体检健康成人30名,年龄(58.33±7.36)岁(范围52~83岁),身体质量指数(25.72±2.58)kg/m^(2);三组均为男性。选取所有患者L_(3,4)、L_(4,5)、L_(5)S_(1)节段椎间盘水平的轴位MRI,应用盛京医院与中科院沈阳自动化研究所合作研发的深度学习自动分割测量系统测量被选取图像中多裂肌横截面积(multifidus muscle cross sectional area,MMCSA)、竖脊肌横截面积(erector spinaecross sectional area,ESCSA)、多裂肌脂肪浸润程度(multifidus muscle fatty infiltration rate,MMFIR)和竖脊肌脂肪浸润程度(erector spinaefatty infiltration rate,ESFIR),采用单因素ANOVA检验比较三组多裂肌、竖脊肌的影像学参数,再采用LSD-t检验对各节段椎旁肌影像学参数进行两两比较。结果三组的年龄(H=5.303,P>0.05)、身体质量指数(F=2.267,P>0.05)的差异均无统计学意义,且性别均为男性。多裂肌横截面积在L_(3,4)节段,退行性腰椎滑脱组较退行性腰椎管狭窄组增加189.11 mm^(2)(P=0.010);在L_(4,5)节段,退行性腰椎滑脱组较健康对照组减少205.52 mm^(2)(P=0.002),退行性腰椎管狭窄组比健康对照组减少184.14 mm^(2)(P=0.006);在L_(5)S_(1)节段,退行性腰椎滑脱组较退行性腰椎管狭窄组减少174.93 mm^(2)(P=0.018),退行性腰椎滑脱组较健康对照组减少406.06 mm^(2)(P<0.001),退行性腰椎管狭窄组较健康对照组减少231.13mm^(2)(P=0.002)。竖脊肌横截面积在L_(4,5)节段,退行性腰椎管狭窄组较健康对照组�Objective To explore the difference and clinical significance of paraspinal muscle degeneration between single-segment degenerative lumbar spondylolisthesis and degenerative lumbar spinal stenosis.Methods From January 2014 to October 2020,a retrospective analysis of 30 patientswere diagnosed with L_(4,5) degenerative lumbar spondylolisthesis,aged 61.63±8.42 years old(range 44 to 82 years old),body mass index 24.07±3.17 kg/m^(2) and 30 patientswere diagnosed with L_(4,5) degenerative lumbar spinal stenosis,aged 59.67±12.89 years old(range 31 to 80 years old),body mass index 25.29±3.48kg/m^(2),both of them went on surgery in department of spine surgery,shengjing hospital,China Medical University.30 healthy people were selected from outpatient physical examination in the control group,aged 58.33±7.36 years old(range 52 to 83 years old),body mass index 25.72±2.58 kg/m^(2).These three groups were all male.Select all patients with L_(3,4),L_(4,5) and L_(5)S_(1) disc level axial MRI images,and use the deep learning automatic segmentation measurement system developed by our hospital and Shenyang Institute of Automation Chinese Academy of Sciences to measure multifidus muscle cross sectional area(MMCSA),erector spinae cross sectional area(ESCSA),multifidus muscle fatty infiltration rate(MMFIR)and erector spinae fatty infiltration rate(ESFIR).One-way ANOVA was used to test the imaging parameters of multifidus and erector spinae of the three groups,and LSD-t test was used to compare the imaging parameters in each segment of paraspinal muscles.Results The gender of three groups were male,there was no significant difference in age(H=5.303,P>0.05),and there was no significant difference in body mass index(F=2.267,P>0.05).Multifidus muscle cross-sectional area in L_(3,4):degenerative lumbar spondylolisthesis groupincreased 189.11 mm^(2) compared with degenerative lumbar spinal stenosis group(P=0.010).Multifidus muscle cross-sectional area in L_(4,5):compared with healthy people group,degenerative lumbar spondylolisthesis

关 键 词：腰椎 椎间盘退行性变 脊椎滑脱 椎管狭窄 

分 类 号：R687.3[医药卫生—骨科学]