伴单侧神经根性症状的腰椎间盘突出症及腰椎滑脱症患者的多裂肌不对称性改变  

Asymmetry of multifidus muscle in patients with unilateral lumbosacral radiculopathy due to lumbar disc herniati and lumbarspondylolisthesis

作　　者：邱晨生 孔德茂[2] 赵永生[1] 冯利彬 相宏飞[3] 郭柱 伊远学 陈伯华[3] Qiu Chensheng;Kong Demao;Zhao Yongsheng;Feng Libin;Xiang Hongfei;Guo Zhu;Yi Yuanxue;Chen Bohua(Department of Spinal Surgery,Qingdao Municipal Hospital,Qingdao 26601l,China;Interventional Department,Qingdao Municipal Hospital,Qingdao 266011,China;Department of Orthopedics,Afiliated Hospital of Qingdao University,Qingdao 266003,China;Chongqing Precision Medical Industry Technology Research Institute,Chongging 404100,China;不详)

机构地区：[1]青岛市市立医院脊柱外科,青岛266011 [2]青岛市市立医院微创介入治疗中心,青岛266011 [3]青岛大学附属医院骨科,青岛266003 [4]重庆精准医疗产业技术研究院,重庆404100 [5]不详

出　　处：《中华骨科杂志》2024年第21期1384-1392,共9页Chinese Journal of Orthopaedics

基　　金：山东省自然科学基金资助项目(ZR2022QC165);青岛市自然科学基金资助项目(23-2-1-150-zyyd-jch)。

摘　　要：目的探讨伴单侧下肢神经根性症状的腰椎间盘突出症和腰椎滑脱症患者腰椎多裂肌的形态学改变及其临床意义。方法回顾性分析2017年1月至2023年1月于青岛市市立医院住院的单纯腰痛患者以及行经皮内镜或传统腰椎后路开放手术治疗的伴单侧根性症状的L_(4.5)或L_(5)S_(1)单节段腰椎间盘突出症和腰椎滑脱症患者的临床资料,单纯腰痛53例、腰椎间盘突出症170例(L_(4.5)101例、L_(5)S_(1)69例)、腰椎滑脱症129例(退变型L_(4.5)腰椎滑脱91例、L_(5)S_(1)9例,峡部裂型L_(4.5)腰椎滑脱11例、L_(5)S_(1)18例)。采集腰椎MRI中L_(3.4)、L_(4.5)、L_(5)S_(1)三个节段横断面椎间盘中间层面图像,采用Image J软件测算患、健(或左、右)两侧相对总多裂肌面积(relativetotal cross-sectional area,rTCSA)、相对功能性多裂肌面积(relative functional cross-sectional area,rFCSA)、多裂肌脂肪浸润比例(fat infiltration rate,FIR)、相对多裂肌脂肪厚度(relative fatdistance,rFD)和脂肪浸润比例差值(differential value FIR,D-FIR)。结果单纯腰痛组双侧多裂肌未见形态学差异表现(P>0.05)。腰椎间盘突出症L_(4.5)组的L_(4.5)节段患侧rFCSA较健侧小[(0.34±0.10)和0.35±0.10)],FIR[29.92(22.21,36.46)和26.48(17.54,34.55)]和rFD[0.39(0.290.54)和0.32(0.21,0.43)]较健侧大;L_(5)S_(1)节段患侧FIR[(34.83±11.34)和(31.44±10.94))和rFD[0.59(0.43,0.77)和0.51(0.37,0.69)]较健侧大,差异均有统计学意义(P<0.05)。腰椎间盘突出症L_(5)S_(1)组的L_(5)S_(1)节段患侧rFCSA较健侧小[(0.41±0.11)和(0.42±0.12),FIR[26.84(22.9235.29)和24.02(20.03,32.87)]和rFD(0.51±0.28和0.42±0.26)较健侧大,差异有统计学意义(P<0.05)。退变型腰椎滑脱L_(4.5)组的L_(4.5)节段患侧FIR较健侧大[(36.49±9.76)和(34.72±9.86)],L_(5)S_(1)节段患侧较健侧大[35.03(28.64,41.85)和33.34(26.37,39.76)],差异均有统计学意义(P<0.05)。退变型腰椎滑脱LS,组的L_(5)S_(1)节段患侧FIR[42.53(37.94,46.81)和40.7Objective To investigate the morphological difference and clinical significance of bilateral lumbar multifidus muscles in patients with unilateral lumbosacral radiculopathy due to lumbar disc herniation and lumbar spondylolisthesis.Methods A retrospective analysis was conducted on patients with low back pain,lumbar disc herniation and lumbar spondylolisthesis.Patients with lumbar disc herniation or lumbar spondylolisthesis underwent single segment lesion either at L4.s or LSi,while those accompanied with unilateral lumbosacral radiculopathy underwent percutaneous endoscopic lumbar discectomy or conventional open surgery at Qingdao Municipal Hospital between January 2017 and January 2023.Patients with lumbar spondylolisthesis were subdivided into degenerative lumbar spondylolisthesis and isthmic spondylolisthesis.53 patients with low back pain met the inclusion criteria.170 patients with lumbar disc herniation met the inclusion criteria,with 101 at L_(4.5)and 69 at L_(5)S_(1)level.129 patients with lumbar spondylolisthesis met the inclusion criteria,including 91 of degenerative lumbar spondylolisthesis at L_(4.5)level and 9 at L_(5)S_(1)level,and 11 of isthmic spondylolisthesis at L_(4.5)level and 18 at L_(5)S_(1)level.Cross-sectional images at the mid-disc of L_(3.4),L_(4.5)and L_(5)S_(1)segments in MRI were acquired.Relative total cross-sectional area(rTCSA),relative functional cross-sectional area(rFCSA),fat infiltration rate(FIR),relative fat distance(rFD)and differential value FIR(D-FIR)in bilateral lumbar multifidus muscle were measured respectively by using Image J software,and were then used to evaluate the atrophy and fat infiltration of bilateral lumbar multifidus muscles.Results No significant difference was found between the both sides of multifidus muscle in low back pain patients.L_(4.5)lumbar disc herniation group had smaller rFCSA(0.34±0.10 and 0.35±0.10)and larger FIR[29.92(22.21,36.46)and 26.48(17.54,34.55)]and rFD[0.39(0.29,0.54)and 0.32(0.21,0.43)]on the affected side compared to the unaffect

关 键 词：椎旁肌 椎间盘移位 脊椎滑脱 脂肪浸润 

分 类 号：R681.5[医药卫生—骨科学]