腰椎椎旁肌的研究进展  

Advances in research of paravertebral muscles of the lumbar spine

作　　者：王景明 王磊 许小多 邢文强 张兆岩 黄伟敏 Wang Jingming;Wang Lei;Xu Xiaoduo;Xing Wenqiang;Zhang Zhaoyan;Huang Weimin(Department of Osteopathy,960th Hospital,Joint Logistic Support Force,People's Liberation Army,Jinan 250031,China;Staff Section 1,960th Hospital,Joint Logistic Support Force,People's Liberation Army,Jinan 250031,China)

机构地区：[1]中国人民解放军联勤保障部队第九六〇医院骨病科,济南250031 [2]中国人民解放军联勤保障部队第九六〇医院干部一科,济南250031

出　　处：《中华临床医师杂志(电子版)》2024年第9期846-852,共7页Chinese Journal of Clinicians(Electronic Edition)

基　　金：山东省医药卫生发展计划(202204071067)

摘　　要：腰椎椎旁肌作为稳定脊柱的重要结构,其随着年龄增加及腰椎退变出现脂肪浸润增加。核磁共振作为研究椎旁肌形态及脂肪浸润程度的最佳测量方式,目前得到广泛应用。不同学者提出了包括半定量(Goutallier分级系统)、定量(肌肉脂肪指数MFI)、功能评价(伊藤实验)等多种测量方法,用于评价椎旁肌,均具有良好的可靠性。研究发现椎旁肌肉萎缩与慢性腰痛相关,与腰椎间盘突出症、腰椎滑脱等腰椎退行性疾病显著相关,与骨质疏松以及脊柱骨折次数相关。另外,影像学研究发现,椎旁肌萎缩导致椎间盘退变、终板异常、椎间盘真空征增加,小关节突骨性关节炎增加,腰椎前凸减少和骨盆倾斜增加。椎旁肌改变影响患者手术预后,椎旁肌脂肪浸润指数与术后患者较差的ODI评分相关,是男性椎间融合器下沉的独立危险因素,是成人脊柱畸形术后近段交界性后凸(PJK)的独立危险因素,是椎体成形术后再骨折发生,以及残余腰痛的潜在危险因素。在对椎旁肌肉的基因表达谱研究中发现,COL3A1表达增加和椎旁肌脂肪浸润降低相关,mTOR表达的减少与椎旁肌功能性横截面积(FCSA)增大相关。Lumbar paravertebral muscles,which play an important role in stabilizing the spine,have been observed to exhibit an increase in fat infiltration with age and lumbar degeneration.Magnetic resonance imaging(MRI)has emerged as a valuable tool for studying the morphology of paravertebral muscles and the degree of fat infiltration.A variety of measurement methods have been proposed by scholars for evaluating paravertebral muscles,including semi-quantitative(Goutallier grading system),quantitative(muscle fat index MFI),and functional evaluations(Ito test).All of these methods have been demonstrated to have good reliability.Paravertebral muscle atrophy has been demonstrated to be associated with chronic low back pain,exhibiting a significant correlation with lumbar degenerative diseases such as lumbar disc herniation and lumbar spondylolisthesis.Additionally,it has been linked to osteoporosis and the number of spinal fractures.Furthermore,imaging studies have demonstrated that paravertebral muscle atrophy is associated with disc degeneration,endplate abnormalities,increased disc vacuum sign,increased osteoarthritis of the facet joints,decreased lumbar lordosis,and increased pelvic tilt.The surgical prognosis of patients is affected by alterations in paravertebral muscles.The fat infiltration index of paraspinal muscles correlates with poorer Oswestry Disability Index scores in postoperative patients.Furthermore,it is an independent risk factor for severe cage subsidence in men,an independent risk factor for postoperative proximal junctional kyphosis(PJK)in adult spinal deformities,and a potential risk factor for the occurrence of re-fracture after vertebroplasty and residual low back pain.A gene expression profiling study of paravertebral muscles revealed that increased COL3A1 expression was associated with a reduction in the fat infiltration in these muscles,while decreased mTOR expression was associated with an increase in the functional cross-sectional area of paravertebral muscles.

关 键 词：椎旁肌 核磁共振 脊柱退行性病变 临床预后 

分 类 号：R681.5[医药卫生—骨科学]