超声在评估健康人和慢性腰椎间盘突出症患者多裂肌形态中的应用

Lumbar multifidus morphology assessed by ultrasonography in chronic lumbar disc herniation

目的探讨健康人和慢性腰椎间盘突出（CLDH）患者疼痛侧与非疼痛侧多裂肌的形态变化，比较其超声影像的差异性。方法选取CLDH患者32例（实验组）和健康受试者35例（对照组），采用超声分别观察俯卧位时L4-5节段双侧多裂肌的前后径（A—P）、横径（Lat）、多裂肌扁平率（FR）及横截面积（CSA）。结果健康受试者双侧多裂肌A—P、Lat、FR及CSA值间比较，差异无统计学意义（P〉0．05），CLDH患者疼痛侧A—P、Lat、CSA值均较非疼痛侧小（P〈0．05）；实验组疼痛侧多裂肌A-P[（2．9028±0．3960）cm]、Lat[（2．8607±0．3656）em]、FR（1．0355±0．2169）及CSA[（6．4850±0．9528）em。]与对照组比较，差异有统计学意义（P〈0．05），非疼痛侧Lat[（3．2993±0．3950）cm]、FR（0．9683±0．1681）与对照组比较，差异有统计学意义（P〈0．05）。实验组与对照组A—P、Lat、FR及CSA值平均差异百分比之间比较，差异有统计学意义（P〈0．05）。结论CLDH患者的双侧多裂肌均发生局部萎缩，且呈现出不对称性改变，超声可作为评价其指标变化的手段之一。

Objective To observe any differences in the morphology of the lumbar multifidus （LM） muscles between normal subjects and persons with chronic lumbar disc herniation （CLDH）. Methods Thirty-two persons with CLDH and thirty-five matched, healthy controls performed various maneuvers in prone lying. Ultrasound imaging was used to measure the antero-posterior diameter （A-P）, lateral diameter （Lat）, cross sectional area （CSA） and flattening ratio （FR） of the bilateral LM muscles at the L4/5 level. Results In the control subjects, A-P, Lat, CSA and FR were not significantly different between the left and right sides. In those with CLDH, A-P, Lat and CSA were significantly smaller on the painful side than on the no-pain side, and this difference showed asymmetry between the two sides. Average A-P, Lat, FR and muscle CSA were all significantly smaller among the CLDH subjects on both sides compared with the controls. Conclusion CLDH induces asymmetric local atrophy of the bilateral muhifidus muscles which can be detected and measured using ultrasound.