腰大肌及椎旁肌脂含量在退变性脊柱侧凸中的作用的影像学研究

Effects of Fat Deposition in Psoas and Paravertebral Muscle on Degenerative Lumbar Scoliosis

目的探讨腰大肌、椎旁肌脂含量在退变性脊柱侧凸(DLS)中的作用以及其与Cobb's角的相关性。方法搜集34例DLS及30例年龄匹配的健康体检者行L3/4水平腹部横断面3D-VIBE MRI水/脂分离成像,计算腰大肌、椎旁肌肌脂分数(MLF)。测定DLS患者Cobb's角。评价两位观察者测量MLF的一致性,分析组间MLF差异及Cobb's角与MLF的相关性。结果两次扫描期间测定MLF的变异系数为2.38%。观察者内或观察者间测量MLF值具有较好一致性,组内相关系数ICC均>0.900。DLS组Cobb's角与腰大肌、椎旁肌MLF均存在一定正相关性(r=4.304~5.897)。DLS组腰大肌及椎旁肌凹侧MLF值分别较凸侧增高31.2%、19.7%,且DLS组腰大肌[(8.85±1.43)%]或椎旁肌MLF[(26.39±3.53)%]均值显著高于正常对照组[(5.64±1.06)%,(15.95±2.86)%](P值均<0.05)。结论腰大肌、椎旁肌脂浸润是DLS的危险因素,脂质浸润程度与DLS侧凸程度有关。

Objective To explore the effects of fat deposition in psoas and paravertebral muscle on degenerative lumbar scoliosis（ DLS） and its relationship with Cobb＇s angle. Methods DLS patients（ n = 34） and age-matched healthy controls（ n = 30） underwent 3D-VIBE water/fat separation MRI at L3/4 levels to quantify muscle lipid fraction（ MLF） of psoas and paravertebral muscle. Cobb＇s angle was calculated for each participant. The reliability of MLF measurements was assessed using ICC. We analyzed the differences in MLF between DLS and healthy controls,and the relationships of Cobb＇s angle with MLF. Results The variation of coefficient was 2. 38% for MLF measurements between scan and rescan. The inter-and intra-rater agreements were excellent for MLF measurements（ ICC 0. 900 for all）. There were positive associations between Cobb＇s angle and fat infiltrations in psoas and paravertebral muscle（ r = 4. 304 - 5. 897）. As compared with the convex side in DLS patients,MLF in the concave side of the psoas and the paravertebral muscle increased by 31. 2%and 19. 7%,respectively. The mean MLF of psoas（ 8. 85 ± 1. 43） % or paravertebral muscle（ 26. 39 ± 3. 53） % in DLS patients was higher than that of controls [（ 5. 64 ± 1. 06） % and（ 15. 95 ± 2. 86） % ]（ all P〈0. 05）. Conclusion Fat infiltration in psoas and paravertebral muscle is a risk factor of DLS,and it has correlation with the severity of scoliosis.