基于MRI半定量分析退行性腰椎滑脱症患者椎旁肌群的改变  

Semi-quantitative analysis of paraspinal muscle in patients with single-segment degenerative lumbar spondylolisthesis based on MRI

作　　者：佘成龙 苏彤 贺丽娜 韩剑 SHE Chenglong;SU Tong;HE Lina;HAN Jian(Department of Radiology,Ningxia Hui Autonomous Region Hospital and Research Institute of Traditional Chinese Medicine,Yinchuan 750000;Shanghai United Imaging Medical Imaging Diagnostic Center Co.,Ltd,Shanghai 200030)

机构地区：[1]宁夏回族自治区中医医院暨中医研究院放射科,银川750000 [2]上海联影医学影像诊断中心有限公司,上海200030

出　　处：《颈腰痛杂志》2025年第1期162-166,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：宁夏医科大学校级科研项目(XM2020046)。

摘　　要：目的本文旨在基于腰椎常规MRI检查,应用Image J后处理软件定量评估椎旁肌的退变程度,以探讨轻度单节段退行性腰椎滑脱症(DLS)患者椎旁肌群(腰大肌、多裂肌及竖脊肌)的改变。方法回顾性研究轻度单节段DLS患者及健康受检对照组。所有病例行腰椎常规核磁扫描,于T2WI序列获取L_(3)、L_(4)、L_(5)椎体下缘终板水平的轴位图像,使用Image J软件由两人分别测量两侧腰大肌、竖脊肌、多裂肌横截面积值(CSA),得出椎旁肌萎缩指数,并使用阈值技术获得肌肉脂肪浸润百分比(FSF),采用Kalichman等的分级方法进行FSF分级。多组间比较用方差分析,两组间指标比较采用独立样本t检验,等级资料采用秩和检验。以P<0.05表示差异有统计学意义。结果L_(3)、L_(4)、L_(5)下缘水平,滑脱组多裂肌、腰大肌CSA及肌肉萎缩指数均低于对照组,差异有统计学意义(P<0.05),其中以多裂肌肌肉萎缩指数最低。滑脱组多裂肌、腰大肌脂肪浸润程度显著高于对照组,其中以多裂肌脂肪浸润程度最高(P>0.05)。两组竖脊肌CSA、萎缩指数及脂肪浸润程度均无明显差异(P>0.05)。结论椎旁肌群肌肉萎缩与脂肪浸润等退行性改变对DLS有一定的影响,DLS患者与正常受试者相比,多裂肌及腰大肌肉萎缩更严重,脂肪浸润程度更高,影响腰椎的稳定性并参与了DLS的发生发展过程。临床上对待DLS患者时,需要考虑到椎旁肌群退变情况,对于后续诊疗及康复方案具有一定的指导意义。Objective The purpose of this study was to quantitatively evaluate the degeneration degree of paravertebral muscles using image J post-processing software based on routine MRI of lumbar spine,so as to explore the changes of paravertebral muscle in patients with mild single-segment degenerative lumbar spondylolisthesis(DLS).Methods Patients with mild single-level DLS were collected,and healthy subjects were as control group.Lumbar MRI was performed in all cases,and axial images were obtained at the level of L_(3),L_(4) and L_(5) vertebral lower margin endplate on T2WI sequence.Two people used Image J software to measure the cross-sectional area(CSA)of the psoas major(PS),erector spinae(ES),and multifidus(MF)on both sides,respectively.Paravertebral muscle atrophy index was obtained,and fat saturation fraction(FSF)was obtained using the threshold technique.FSF grading using the Kalichman grading method.Analysis of variance was used for comparison among multiple groups,independent samples t test was used for comparison of indexes between two groups,and rank sum test was used for rank data.The difference was statistically significant with P<0.05.Results At the lower edge of L_(3),L_(4) and L_(5),the CSA and muscle atrophy index of MF and PS in the DLS group were lower than those in the control group,the differences were statistically significant(P<0.05),and the muscle atrophy index of MF was the lowest.The degree of FSF in MF and PS major in DLS group was significantly higher than that in control group,and the degree of FSF in MF was the highest(P>0.05).There were no significant differences in CSA,atrophy index and degree of FSF of ES between the two groups(P>0.05).Conclusion The degenerative changes such as paraspinal muscle atrophy and fat infiltration have a certain impact on DLS.Compared with normal subjects,DLS patients have more severe muscle atrophy and fat infiltration in the MF and PS,which affects the stability of lumbar spine and is involved in the occurrence and development of DLS.

关 键 词：腰椎滑脱 椎旁肌退变 Image J MRI半定量分析 椎旁肌萎缩指数 脂肪浸润百分比 

分 类 号：R618[医药卫生—外科学]