骨骼肌质量与老年退行性腰椎管狭窄患者椎管狭窄程度的相关性分析  

Correlation Analysis Of Skeletal Muscle Mass And Spinal Stenosis Degree In Elderly Patients With Degenerative Lumbar Spinal Stenosis

作　　者：尤立攀 魏波 You Lipan;Wei Bo(Department of Orthopedics,Affiliated Hospital of Guangdong Medical University,Zhanjiang 524000,China)

机构地区：[1]广东医科大学附属医院骨科,广东湛江524000

出　　处：《实用骨科杂志》2022年第5期390-393,411,共5页Journal of Practical Orthopaedics

摘　　要：目的探讨骨骼肌质量与老年退行性腰椎管狭窄(degenerative lumbar spinal stenosis,DLSS)患者椎管狭窄程度的相关性。方法选择2019年6月至2021年10月广东医科大学附属医院收治的80例老年退行性腰椎管狭窄患者(DLSS组)和45例体检志愿者(对照组),测量绝对跛行距离(absolute claudication distance,ACD)评估DLSS椎管狭窄程度,根据DLSS椎管狭窄程度分级将DLSS患者分为轻度组(5~6级,22例)、中度组(3~4级,41例)和重度组(1~2级,17例),根据是否合并肌肉减少症将患者分为肌肉减少症组(23例)和无肌肉减少症组(57例)。双能X射线吸收仪测量检测全身骨骼肌质量、四肢骨骼肌质量,计算相对骨骼肌指数(relative skeletal muscle index,RSMI),MRI测量总多裂肌横截面积(total cross-sectional area,TCSA)、总无脂肪多裂肌横截面积(total fatless cross-sectional area,TFCSA),计算TFCSA/TCSA比值。分析全身骨骼肌质量、四肢骨骼肌质量、RSMI与TCSA、TFCSA、TFCSA/TCSA比值与DLSS椎管狭窄程度分级相关性。结果DLSS组上肢骨骼肌质量、下肢骨骼肌质量、全身骨骼肌质量、RSMI、TFCSA、TFCSA/TCSA比值均低于对照组(P<0.05)。肌肉减少症组上肢骨骼肌质量、下肢骨骼肌质量、全身骨骼肌质量、RSMI、TFCSA、TFCSA/TCSA比值均低于无肌肉减少症组(P<0.05)。重度组上肢骨骼肌质量、下肢骨骼肌质量、全身骨骼肌质量、RSMI、TFCSA、TFCSA/TCSA比值均低于中度组和轻度组(P<0.05),且中度组低于轻度组(P<0.05)。DLSS组患者上肢骨骼肌质量、下肢骨骼肌质量、全身骨骼肌质量、RSMI与TFCSA、TFCSA/TCSA比值呈正相关(P<0.05),与椎管狭窄程度分级呈负相关(P<0.05)。结论老年DLSS患者四肢和全身骨骼肌质量与腰部多裂肌萎缩和椎管狭窄程度存在一定相关性。Objective To investigate the correlation between skeletal muscle mass and spinal stenosis degree in elderly patients with degenerative lumbar spinal stenosis(DLSS).Methods From June 2019 to October 2021,80 elderly patients with degenerative lumbar spinal stenosis(DLSS group)and 45 physical examination volunteers(control group)were selected.Absolute claudication distance(ACD)was measured to evaluate the degree of DLSS spinal stenosis.According to the degree of DLSS spinal stenosis,DLSS patients were divided into mild group(grade 5~6,22 cases),moderate group(grade 3~4,41 cases)and severe group(grade 1~2,17 cases),and were divided into sarcopenia group(23 cases)and no sarcopenia group(57 cases)according to whether or not combined with sarcopenia.Skeletal muscle mass of the whole body and limbs were measured by dual-energy X-ray absorptiometry,and the relative skeletal muscle index(RSMI)was calculated.The total cross-sectional area(TCSA)and total fatless cross-sectional area(TFCSA)of multifidus were measured by MRI,and the TCSA/TFCSA ratio was calculated.The relation between all skeletal muscle mass,limb skeletal muscle mass,RSMI and TCSA,TFCSA,TFCSA/TCSA ratio and DLSS spinal stenosis were analyzed.Results The skeletal muscle mass of upper limb,lower limb,whole body,RSMI,TFCSA and TFCSA/TCSA ratio in DLSS group were lower than those in control group(P<0.05).The skeletal muscle mass of upper limb,lower limb,whole body,RSMI,TFCSA and TFCSA/TCSA ratios in sarcopenia group were lower than those in no sarcopenia group(P<0.05).The skeletal muscle mass of upper limb,lower limb,whole body,RSMI,TFCSA and TFCSA/TCSA ratios in severe group were lower than those in moderate group and mild group(P<0.05),and those in moderate group were lower than those in mild group(P<0.05).In DLSS group,skeletal muscle mass of upper limb,lower limb,whole body and RSMI were positively correlated with TFCSA and TFCSA/TCSA ratio(P<0.05),but negatively correlated with spinal stenosis grade(P<0.05).Conclusion Skeletal muscle mass in extremities and

关 键 词：骨骼肌质量 肌肉减少症 退行性腰椎管狭窄 

分 类 号：R681.5[医药卫生—骨科学]