腰大肌形态与症状性多节段退行性腰椎管狭窄症患者临床症状关系  

The Relationship between the Morphology of Psoas Major and Clinical Symptoms in Patients with Symptomatic Multisegmental Degenerative Lumbar Spinal Stenosis

作　　者：张艺武 卢锦婷 肖玉辉[1] 欧阳林[1] ZHANG Yi-wu;LU Jin-ting;XIAO Yu-hui;OUYANG Lin(Radiology Department of the Ninth Hospital and Medical Imaging Research Institute of Southeast Hospital Affiliated to Xiamen University,Zhangzhou 363000,Fujian Province,China)

机构地区：[1]第九〇九医院放射诊断科、厦门大学附属东南医院医学影像研究所,福建漳州363000

出　　处：《中国CT和MRI杂志》2024年第12期167-170,共4页Chinese Journal of CT and MRI

基　　金：福建省科学技术厅区域发展项目(2019Y3007)。

摘　　要：目的探讨症状性多节段退行性腰椎管狭窄症(SMDLSS)的MRI和CT上腰大肌形态学参数与患者临床症状的相关性。方法回顾性分析2021年1月到2023年12月我院收治的122例SMDLSS患者临床资料。根据患者Oswestry功能障碍指数(ODI)评分将全部患者分为轻-中度功能障碍组(≤42%)和重度功能障碍组(>42%)。根据患者腰背部和下肢疼痛视觉模拟量表(VAS)评分将患者分为无或轻度疼痛组(≤3分)和中-重度疼痛(>3分)组。选择L3/4椎间盘水平相对应的轴向CT图像测量腰大肌指数、腰大肌平均CT值和腰大肌形态变化评分(双侧腰大肌的短轴与长轴比值的平均值)。使用多因素Logistic回归分析可能影响重度功能障碍和中-重度疼痛的危险因素。结果男性患者腰大肌指数高于女性(P<0.001)。重度功能障碍组的腰大肌指数(P<0.001)和腰大肌平均CT值(P<0.001)均低于轻-中度功能障碍组患者。无或轻度疼痛(VAS≤3)患者的腰大肌指数和腰大肌平均CT值高于腰背部中-重度痛患者(P<0.001)。多因素Logistic回归分析显示,腰大肌平均CT值升高(OR=0.802,P=0.016)是SMDLSS患者重度功能障碍的保护因素,腰大肌指数增加(OR=0.763,P=0.012)是影响SMDLSS患者腰背部中-重度痛的保护因素。结论SMDLSS患者腰大肌平均CT值和腰大肌指数增加分别是SMDLSS患者发生功能障碍和中-重度痛的保护因素。Objective To investigate the correlation between MRI and CT morphological parameters of psoas major and clinical symptoms in patients with symptomatic multi-segmental degenerative lumbar spinal stenosis(SMDLSS).MethodsA retrospective analysis was conducted on the clinical data of 122 patients with SMDLSS who were admitted to our hospital from January 2021 to December 2023.All patients were divided into groups with mild-moderate dysfunction(≤42%)and severe dysfunction(>42%)based on their Oswestry disability index(ODI)scores.Patients were also divided into groups with no or mild pain(≤3 on the visual analog scale,VAS)and moderate-severe pain(>3 on the VAS).Axial CT images corresponding to the L3/4 intervertebral disc level were selected to measure the psoas major index,average CT value of the psoas major,and psoas major morphological change score(the average ratio of the short axis to the long axis of both psoas major muscles).Multivariate Logistic regression analysis was used to identify risk factors that may affect severe dysfunction and moderate-severe pain.Results Male patients had higher psoas major indices than female patients(P<0.001).Patients in the severe dysfunction group had lower psoas major indices(P<0.001)and average CT values of the psoas major(P<0.001)compared with patients in the mild-moderate dysfunction group.Patients with no or mild pain(VAS≤3)had higher psoas major indices and average CT values of the psoas major than patients with moderate-severe back pain(P<0.001).Multivariate Logistic regression analysis showed that an increase in the average CT value of the psoas major(OR=0.802,P=0.016)was a protective factor for severe dysfunction in patients with SMDLSS,and an increase in the psoas major index(OR=0.763,P=0.012)was a protective factor for moderate-severe back pain in these patients.ConclusionIn patients with SMDLSS,an increase in the average CT value of the psoas major and psoas major index are protective factors for the development of dysfunction and moderate-severe back pain,respec

关 键 词：症状性多节段腰椎管狭窄症 腰大肌 影像 临床症状 

分 类 号：R681.57[医药卫生—骨科学]