椎旁肌参数与退行性胸腰段后凸角度的相关性研究  

Correlation between paraspinal muscle parameters and the angle of degenerative thoracolumbar segmental kyphosis

作　　者：臧泽桐 吴文凯 王玲 段芳芳 王任先[4] 郭安忆 郎昭 肖斌 刘亚军 Zang Zetong;Wu Wenkai;Wang Ling;Duan Fangfang;Wang Renxian;Guo Anyi;Lang Zhao;Xiao Bin;Liu Yajun(Department of Spine Surgery,Beijing Jishuitan Hospital,Capital Medical University(National Center for Orthopaedics),Beijing 100035,China;Department of Radiology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;Clinical Epidemiology Research Center,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;Beijing Research Institute of Traumatology and Orthopaedics,Beijing 100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院(国家骨科医学中心)脊柱外科,北京100035 [2]首都医科大学附属北京积水潭医院放射科,北京100035 [3]首都医科大学附属北京积水潭医院临床流行病学研究中心,北京100035 [4]北京市创伤骨科研究所,北京100035

出　　处：《中华骨科杂志》2024年第11期771-777,共7页Chinese Journal of Orthopaedics

基　　金：北京市医院管理中心项目(DFL20220401)。

摘　　要：目的分析椎旁肌参数与退行性胸腰段后凸角度的相关性。方法回顾性分析2021年11月至2023年4月于北京积水潭医院脊柱外科接受手术治疗的腰椎退行性疾病的女性患者90例,年龄(67.62±4.98)岁(范围60~80岁),身高(1.58±0.05)m(范围1.48~1.70)m,体重(63.79±9.13)kg(范围47~90 kg),体质指数(25.48±3.35)kg/m^(2)(范围18.37~36.05 kg/m^(2))。胸腰段后凸角为6.65°±10.38°(范围-17.34°~9.34°)。疾病诊断:腰间盘突出症32例、腰椎管狭窄症58例。摄站立位胸腰段正侧位X线片测量胸腰段后凸角度;摄胸腰段定量CT并采用Osirix软件测量T_(12)、L_(3)、L_(5)水平椎旁肌参数,包括椎旁肌横截面积、骨骼肌面积和组织密度、脂肪浸润比例和身高矫正的骨骼肌面积指数。分析椎旁肌参数与胸腰段后凸角度之间的相关性,采用多重线性回归分析影响胸腰段后凸角度的因素。结果相关性分析结果显示胸腰段后凸角与T_(12)骨骼肌组织密度(r=-0.303,P=0.004)和L_(5)骨骼肌组织密度(r=-0.219,P=0.038)呈负相关。年龄与T_(12)骨骼肌组织密度(r=-0.263,P=0.012)、T_(12)身高矫正的骨骼肌面积指数(r=-0.221,P=0.036)、T_(12)椎旁肌横截面积(r=-0.280,P=0.007)、L_(3)骨骼肌组织密度(r=-0.266,P=0.011)和L_(5)骨骼肌组织密度(r=-0.290,P=0.006)呈负相关。骨密度与椎旁肌参数无相关性(P>0.05)。多重线性回归显示T_(12)骨骼肌组织密度(β=-1.125,P<0.001)、T_(12)脂肪浸润比例(β=-0.849,P=0.001)、L_(3)骨骼肌组织密度(β=0.996,P<0.001)和L_(3)脂肪浸润比例(β=0.496,P=0.020)是影响胸腰段后凸角的独立因素。结论T_(12)和L_(3)椎旁肌密度和脂肪浸润比例是影响胸腰段后凸角的独立因素。T_(12)椎旁肌密度和脂肪浸润比例越小、L_(3)椎旁肌密度和椎旁肌脂肪浸润比例越大,胸腰段后凸角度越大。Objective To analyze the correlation between paraspinal muscle parameters and the angle of degenerative thoracolumbar segmental kyphosis.Methods From November 2021 to April 2023,a total of 90 female patients with lumbar degenerative disease who underwent surgical treatment in the Department of Spine Surgery,Beijing Jishuitan Hospital were retrospectively analyzed.The average age was 67.62±4.98 years(range,60-80 years),and the average height was 1.58±0.05 m(range,1.48-1.70 m).Weight 63.79±9.13 kg(range,47-90 kg),body mass index 25.48±3.35 kg/m^(2)(range,18.37-36.05 kg/m^(2)).The angle of kyphosis of the thoracolumbar segments was 6.65°±10.38°(range,-17.34°to 9.34°).Disease diagnosis:32 cases of lumbar disc herniation and 58 cases of lumbar spinal stenosis.Frontal and lateral radiographs of the thoracolumbar segments in the standing position were taken to measure the angle of kyphosis of the thoracolumbar segments;quantitative CT of the thoracolumbar segments and Osirix software were used to measure the parameters of the paravertebral muscles at the levels of T_(12),L_(3),and L_(5),including paravertebral muscle cross-sectional area,skeletal muscle area,and tissue density,the proportion of fat infiltration,and the height-corrected skeletal muscle area index.The correlation between paraspinal muscle parameters and the angle of thoracolumbar segmental kyphosis was analyzed,and the factors affecting the angle of thoracolumbar segmental kyphosis were analyzed using multiple linear regression.Results Correlation analysis showed a negative correlation between the angle of thoracolumbar segmental kyphosis and the tissue density of T_(12) skeletal muscle(r=-0.303,P=0.004)and L_(5) skeletal muscle(r=-0.219,P=0.038).Age was negatively correlated with T_(12) skeletal muscle tissue density(r=-0.263,P=0.012),T_(12) height-corrected skeletal muscle area index(r=-0.221,P=0.036),T_(12) paravertebral muscle cross-sectional area(r=-0.280,P=0.007),L_(3) skeletal muscle tissue density(r=-0.266,P=0.011)and L_(5) skeletal muscl

关 键 词：脊柱后凸 背部肌肉 脂肪组织 数据相关性 

分 类 号：R682.3[医药卫生—骨科学]