腰椎间盘突出症患者受累下肢骨骼肌代谢与功能的18氟代脱氧葡萄糖正电子发射/计算机辅助断层扫描成像研究

Study of lower extremity muscle metabolism and function in lumbar disc herniation patients by ^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography imaging

目的通过18氟代脱氧葡萄糖(18F-FDG)正电子发射/计算机辅助断层扫描成像(PET/CT)分析并比对腰椎间盘突出患者下肢骨骼肌组织中葡萄糖代谢的改变情况。方法对22例单侧单节段腰椎间盘突出症患者的双侧小腿肌肉进行18F-FDG PET/CT检测,将单侧受累下肢肌群设为病例组,将对侧健康肢体设为对照组。测定双下肢小腿受累肌群最大标准化摄取值(SUVmax)并进行比对,分析检测结果与Oswestry功能障碍指数、日本骨科协会(JOA)腰椎评分及视觉类比疼痛评分(VAPS)的相关性。结果病例组L4~L5椎间盘突出累及小腿前侧肌群和L5~S1椎间盘突出累及小腿后侧肌群的△SUVmax分别为0.05±0.03和0.06±0.03,均显著低于对照组的0.29±0.13和0.23±0.18(P值均<0.01)。病例组△SUVmax与Oswestry功能障碍指数呈正相关(R2=0.974,P<0.01),与JOA评分呈负相关(R2=-0.779,P<0.01),与VAPS呈正相关(R2=0.608,P<0.05)。6例手术治疗的患者术后6个月患侧受累肌群△SUVmax均显著高于术前(P值均<0.01)。结论腰椎间盘突出症患者腰骶神经慢性卡压可致下肢受累,骨骼肌发生葡萄糖代谢改变,可通过18F-FDG PET/CT测定评估。18F-FDG PET/CT可作为腰椎间盘突出症患者下肢肌肉功能改变的评估方法之一。

Objective To investigate the glucose metabolism of lower extremity muscles in lumbar disc herniation （LDH） patients by 18F-fluorodeoxyglucose （18F-FDG） positron emission tomography/computed tomography （PET/CT） imaging. Methods Twenty-two patients with single-level unilateral lumbar disc herniation were enrolled in this study. SUVmax of their lower extremities were detected by 18 F-FDG PET/CT, and the results were compared with contralateral healthy muscles. The relationship between SUVmax and Osweestry disability index, Japanese Orthopaedic Association （JOA） score, and visual analogue pain scale （VAPS） were analyzed. Results The involved anterior and posterior muscle SUVmax values were significantly lower than those of the contralateral muscles （0.05±0.03 vs. 0.29± 0. 13,0.06 ± 0.03 vs. O. 23±0. 18, P 〈 0.01 ）. The differences between ipsilateral and contralateral SUVmax values were positively correlated with Oswestry disability index （R2 =0. 974, P〈0. 01 ） and negatively correlated with JOA score （R2 = -0. 779, P〈0.01 ）. The SUVmaxs in 6 patients receiving surgical treatment were significantly higher 6 months after operation compared with that before operation （P〈0.01）. Conclusion Chronic compression of lumbosacral nerve in LDH patients can induce glucose metabolism changes in the involved lower extremity muscles; these changes can be detected by 18F_FDG PET/OT,which may be one of methods to evaluate lower extremity muscle function in LDH patients. （Shanghai Med J, 2011, 34： 776-778）