腰椎退行性滑脱患者椎间盘退变和椎旁肌改变的定量MRI和X线分析  

Quantitative MRI and X–ray analysis of intervertebral disc degeneration and paraspinal muscle changes in patients with lumbar degenerative spondylolisthesis

作　　者：程纪皓 宋侠 樊树峰 CHENG Jihao;SONG Xia;FAN Shufeng(Department of Radiology,the Second Affiliated Hospital of Zhejiang Chinese Medicial University,Hangzhou 310005,China)

机构地区：[1]浙江中医药大学附属第二医院放射科,浙江杭州310005

出　　处：《中国现代医生》2022年第24期5-9,共5页China Modern Doctor

基　　金：浙江中医药科技计划科研基金项目(2021ZA072)。

摘　　要：目的 通过MRI及X线研究腰椎退行性滑脱(lumbar degenerative spondylolisthesis,LDS)患者椎间盘及椎旁肌肉含量的变化。方法 回顾性选取2019年1月至2022年1月于浙江中医药大学附属第二医院行腰椎MRI和X线检查诊断为LDS患者72例,设为病例组;另选取同期浙江中医药大学附属第二医院收治的慢性腰痛患者72例,设为对照组。比较两组患者的椎间盘退变程度、椎间盘高度改变及椎旁肌含量变化情况,再通过多因素Logistic回归分析证实LDS的独立诱发因素。结果 相较于对照组,病例组患者的椎间盘退变程度更大,前椎间盘高度下降显著,多裂肌萎缩而竖脊肌肥厚,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,前椎间盘高度下降、多裂肌萎缩是LDS的独立诱发因素(P<0.05),而竖脊肌肥厚是独立的保护因素(P<0.05)。结论 椎间盘退变、前椎间盘高度下降、多裂肌的萎缩是导致LDS的原因;竖脊肌肥厚可能是一种补偿机制,以补偿腰椎的不稳定性。Objective To study the changes of intervertebral disc height and paravertebral muscle content in patients with lumbar degenerative spondylolisthesis(LDS) by MRI and X–ray. Methods A retrospective study of 72 patients with lumbar degenerative spondylolisthesis diagnosed by lumbar MRI and X–ray examination in the Second Affiliated Hospital of Zhejiang Chinese Medicial University from January 2019 to January 2022 were collected and seted as the case group, another 72 patients with chronic lumbago admitted to the Second Affiliated Hospital of Zhejiang Chinese Medicial University during the same period were selected as the control group. The degree of intervertebral disc degeneration, intervertebral disc height and paraspinal muscle content were compared between the two groups. The independent predisposing factors of LDS were confirmed by multivariate logistic regression analysis. Results Compared with the control group, the degree of intervertebral disc degeneration was greater;in the case group, the height of the anterior intervertebral disc decreased significantly;the multifidus muscle atrophy and the erector spinae hypertrophy, the differences were statistically significant(P<0.05). Multifidus atrophy and erector spinae hypertrophy, the differences were statistically significant(P<0.05). Multivariate Logistic regression analysis showed that, it was confirmed that decreased anterior intervertebral disc height and multifidus muscle atrophy were independent factors for LDS(P<0.05), while erector spinae hypertrophy was an independent protective factor(P<0.05). Conclusion Disc degeneration, decreased anterior disc height, and atrophy of the multifidus muscle are the causes of LDS;erector spinae hypertrophy may be a compensatory mechanism to compensate for the instability of the lumbar spine.

关 键 词：腰椎退行性滑脱 预测因素 椎间盘退变 椎旁肌肉 

分 类 号：R681[医药卫生—骨科学]