峡部裂腰椎滑脱患者椎旁肌对脊柱-骨盆矢状面的影响:肌肉数量和质量的评估  

Influence of paravertebral muscles on spinopelvic sagittal plane in patients with isthmic spondylolisthesis:an evaluation of muscle quantity and quality

作　　者：宋汉林 胡天宇 高浩然 史耀洲 高啸 冯虎 Song Hanlin;Hu Tianyu;Gao Haoran;Shi Yaozhou;Gao Xiao;Feng Hu(Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属医院,江苏省徐州市221000

出　　处：《中国组织工程研究》2025年第21期4445-4451,共7页Chinese Journal of Tissue Engineering Research

基　　金：徐州市科技项目(XZSYSKF2023004),项目负责人:高啸。

摘　　要：背景:横截面积和脂肪浸润为量化椎旁肌的标准参数,但是太过繁琐和费时,需要引入新的量化指标。目的:探讨峡部裂性腰椎滑脱患者椎旁肌和脊柱-骨盆矢状面参数测量值之间的关系,以及腰椎压痕值对矢状面平衡的预测价值。方法:选择诊断为峡部裂性腰椎滑脱的患者87例,均为Meyerding分型Ⅱ度滑脱,男40例,女47例,平均年龄(51.4±9.1)岁。测量患者脊柱-骨盆矢状面参数矢状面轴向距离、骨盆入射角、骨盆倾斜角、骶骨倾斜角、腰椎前凸角、胸椎后凸角、骨盆投射角与腰椎前凸角之差,以及腰椎旁肌的总横截面积、功能横截面积和脂肪浸润。使用Pearson相关分析法探讨矢状面参数与椎旁肌测量值的相关性;使用多元线性回归分析腰椎压痕值、年龄、性别和体质量指数对脊柱骨盆矢状面平衡的影响。通过受试者工作特征曲线寻找腰椎压痕值的最佳截断点,评价矢状面轴向距离和骨盆投射角与腰椎前凸角之差的关系。结果与结论:(1)根据Pearson相关分析结果,多裂肌总横截面积与腰椎前凸角(r=0.464,P <0.01)和骨盆投射角与腰椎前凸角之差(r=-0.306,P <0.01)显著相关;多裂肌功能横截面积与腰椎前凸角(r=0.367,P <0.01)和骨盆投射角与腰椎前凸角之差(r=-0.228,P <0.05)存在显著相关性;腰椎压痕值与矢状面轴向距离(r=-0.300,P <0.01)、腰椎前凸角(r=0.417,P <0.01)、胸椎后凸角(r=0.351,P <0.01)和骨盆投射角与腰椎前凸角之差(r=-0.319,P <0.01)有显著相关性;(2)根据多元线性回归分析结果,腰椎压痕值和骨盆投射角与腰椎前凸角之差以及矢状面轴向距离独立相关;腰椎压痕值≤11.5 mm的患者矢状面轴向距离≤50 mm发生率为55%(11/20),而腰椎压痕值> 11.5 mm的患者矢状面轴向距离≤50 mm发生率为96%(64/67);骨盆投射角与腰椎前凸角之差≤11.5 mm的患者骨盆投射角与腰椎前凸角之差≤10°的发生率为30%(6/20),而腰椎�BACKGROUND:Cross-sectional area and fat infiltration are the standard parameters for quantifying paravertebral muscle,but it is too cumbersome and time-consuming to introduce new quantifying indicators.OBJECTIVE:To investigate the relationship between paravertebral muscle and spinopelvic sagittal parameters and the predictive value of lumbar indentation value for sagittal balance in patients with isthmic spondylolisthesis.METHODS:The study included 87 patients diagnosed with spondylolisthesis,all of whom had grade II spondylolisthesis according to Meyerding classification,including 40 males and 47 females,with a mean age of(51.4±9.1)years.The sagittal vertical axis,pelvic incidence angle,pelvic inclination angle,sacral inclination angle,lumbar lordosis,thoracic kyphosis,and the difference between pelvic incidence and lumbar lordosis were measured.The total cross-sectional area,functional cross-sectional area,and fat infiltration of lumbar paracolateral muscles were measured.Pearson correlation analysis was used to investigate the correlation between sagittal parameters and paravertebral muscle measurements.Multiple linear regression was used to analyze the effects of lumbar indentation value,age,sex,and body mass index on spinopelvic sagittal balance.The receiver operating characteristic curve was used to find the best cut-off point of the indentation value of the lumbar spine,and the relationship of sagittal vertical axis and pelvic incidence with lumbar lordosis was evaluated.RESULTS AND CONCLUSION:(1)According to Pearson correlation analysis,the total cross-sectional area of the multifidus muscle was significantly correlated with lumbar lordosis(r=0.464,P<0.01)and the difference between pelvic incidence and lumbar lordosis(r=-0.306,P<0.01).The functional cross-sectional area of multifidus muscle was significantly correlated with lumbar lordosis(r=0.367,P<0.01)and the difference between pelvic incidence and lumbar lordosis(r=-0.228,P<0.05).The indentation value of lumbar spine was significantly correlated with

关 键 词：峡部裂性腰椎滑脱 横截面积 腰椎压痕值 脊柱-骨盆矢状面参数 椎旁肌 脂肪浸润 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R683