中老年女性椎旁肌退变与骨质疏松性椎体压缩骨折Genant分级的相关性  

Correlation between paraspinal muscle degeneration and Genant grade of osteoporotic vertebral compression fracture in middle-aged and elderly women

作　　者：张立博 宋萌晨 贾杰[1] 宋辉 冷子宽 尚国伟[1] 陈松峰 寇红伟[1] 唐海[2] 毛克亚[3] 刘宏建[1] ZHANG Li-bo;SONG Meng-chen;JIA Jie;SONG Hui;LENG Zi-kuan;SHANG Guo-wei;CHEN Song-feng;KOU Hong-wei;TANG Hai;MAO Ke-ya;LIU Hong-jian(Department of Orthopedics,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Orthopedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Orthopedics,First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]郑州大学第一附属医院骨科医学部,郑州450052 [2]首都医科大学附属北京友谊医院骨科,北京100050 [3]中国人民解放军总医院骨科,北京100853

出　　处：《中华骨质疏松和骨矿盐疾病杂志》2025年第1期21-27,共7页Chinese Journal Of Osteoporosis And Bone Mineral Research

基　　金：国家自然科学基金(82172484);郑州市协同创新专项项目(XTCX2023003)。

摘　　要：目的分析骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fractures,OVCFs)患者椎旁肌特征和相关参数,探究椎旁肌退变与OVCFs的Genant分级之间的相关性。方法回顾性分析2020年1月至2024年1月郑州大学第一附属医院收治的女性OVCFs患者82例,依据患者Genant分级将研究对象分为3组,轻度骨折组(GenantⅠ级)26例,中度骨折组(GenantⅡ级)29例,重度骨折组(GenantⅢ级)27例。收集患者年龄、身高、体质量指数(body mass index,BMI)、骨密度(bone mineral density,BMD)等资料,在横断面MRI图像上测量所有患者的椎旁肌横截面积和脂肪浸润面积,计算椎旁肌脂肪浸润率。比较3组一般资料和椎旁肌相关参数差异是否有统计学意义,将有统计学意义且不存在共线性的因素纳入多元有序Logistic回归分析,进一步分析其与Genant分级之间的相关性。结果相较于轻度骨折组,重度骨折组年龄更大(P<0.05)。3组L3椎体平面的多裂肌脂肪浸润率(multifidus muscle fat infiltration ratio,MFIR)和L4椎体平面的MFIR、竖脊肌脂肪浸润率(erector spinae muscle fat infiltration ratio,EFIR)、椎旁肌总脂肪浸润率(total fat infiltration ratio,tFIR)差异有统计学意义。根据共线性分析结果,排除相关性强的影响因素后,将年龄、BMD、L3椎体平面的MFIR、L4椎体平面的EFIR等4个因素纳入有序Logistic回归分析,结果显示,年龄增大和L3椎体平面MFIR增加是发生重度OVCFs的独立危险因素。结论椎旁肌的脂肪浸润对OVCFs的Genant分级有显著影响。年龄增大和L3椎体平面MFIR增加是重度OVCFs的独立危险因素。Objective To analyze the characteristics and related parameters of paraspinal muscle in patients with severe osteoporotic vertebral compression fractures(OVCFs),and to explore the correlation between paraspinal muscle degeneration and Genant grade of OVCFs.Methods A retrospective analysis was made on 82 female OVCFs patients admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to January 2024.According to their Genant grade,the subjects were divided into three groups as mild fracture group(GenantⅠ,n=26),moderate fracture group(GenantⅡ,n=29)and severe fracture group(GenantⅢ,n=27).The data of age,body mass index(BMI)and bone mineral density(BMD)were collected.The paraspinal muscle cross-sectional area and fat infiltration area of all patients were measured on cross-sectional MRI images,and the paraspinal muscle fat infiltration rate was calculated.The general data and paraspinal muscle-related parameters were compared among the three groups.The factors with statistical differences and no collinearity were included in multivariate ordered Logistic regression analysis to further analyze the correlation between them and Genant grade.Results Compared with the mild fracture group,the severe fracture group was older(P<0.05).The multifidus muscle fat infiltration ratio(MFIR)of the L3 vertebral body plane and the MFIR,erector spinae muscle fat infiltration ratio(EFIR)and total fat infiltration ratio(tFIR)of the L4 vertebral body plane were significantly different among the three groups.According to the results of collinearity analysis,after excluding factors with strong correlation,four factors including age,BMD,MFIR of L3 vertebral plane and EFIR of L4 vertebral plane were included in the ordered Logistic regression analysis.The results showed that increasing age and the increased MFIR of L3 vertebral plane were the independent risk factor for the occurrence of severe OVCFs.Conclusion The fat infiltration of paraspinal muscles has a significant effect on the Genant grade of OVCFs.Incre

关 键 词：椎旁肌 骨质疏松 椎体压缩骨折 脂肪浸润 

分 类 号：R683.2[医药卫生—骨科学]