退变性腰椎滑脱症和腰椎管狭窄症与椎体周围肌容量的相关性:CT和MRI影像资料分析

Correlation between degenerative lumbar spondylolisthesis and spinal stenosis and muscle volume around the vertebral body: CT and MRI data analysis

背景:既往的相关研究主要集中研究退变性腰椎滑脱症和下腰痛与椎旁肌容量之间的关系,对于腰椎管狭窄症与椎旁肌的研究较少。目的:对比退变性腰椎滑脱症、椎管狭窄症患者和对照组之间椎旁肌、腰大肌横截面积的差异。方法:回顾分析在2017年1月至2018年8月同时行腹部或者腰椎CT和MRI扫描的90例女性患者的影像学资料,根据疾病类型分为3组,每组30例。A组为L4/5单一节段腰椎管狭窄症患者,B组为L4/5单一节段腰椎滑脱症患者,C组(对照组)为既往无腰椎相关疾病和症状的人群。所有患者对诊疗方案均知情同意,且得到医院伦理委员会批准。选取经过L3,4,5椎体下缘的轴位MRI图像测量肌肉横截面面积,选取经过L3,4,5双侧椎弓根下缘的椎体轴位图像测量椎体横截面积。使用Image-PROPlus6.0软件计算图像中目的肌肉和椎体的横截面积,并进行组间对比。结果与结论:①3组在年龄分布上差异无显著性意义(P=0.986);②腰大肌、椎旁肌横截面积:A组与B组差异无显著性意义(P> 0.05),而A、B组均小于C组(P <0.001);③椎体横截面积:3组之间差异无显著性意义(P> 0.05);④提示L4/5单一节段退变性腰椎管狭窄症和退变性腰椎滑脱症患者,在L3,L4,L5椎体下缘水平均可以观察到腰大肌横截面积及椎旁肌横截面积较对照组减少,且具有一致性,但二者在肌肉减少的机制上可能不完全相同。

BACKGROUND: Previous studies have focused on the relationship between degenerative lumbar spondylolisthesis and low back pain and paraspinal muscle volume, and there are few studies on lumbar spinal stenosis and paraspinal muscle volume. OBJECTIVE: To compare the differences in the cross-sectional areas of paravertebral muscles and psoas muscles between degenerative lumbar spondylolisthesis, degenerative lumbar spinal stenosis and control group. METHODS: A retrospective analysis of the imaging data of 90 female patients undergoing abdominal or lumbar CT and MRI scans from January 2017 to August 2018 was performed. The patients were divided into group A, lumbar spinal stenosis at L4/5, group B, lumbar spondylolisthesis at L4/5 and group C (control group), no lumbar disease or symptoms. All patients signed the informed consents and the study was approved by the ethics committee of the hospital. MRI images of the axial position through the lower edge of the L3, 4, 5 vertebrae were selected to measure the muscle cross-sectional area. The vertebral body axial image was measured through the lower edge of the L3, 4, 5 bilateral pedicles to measure the cross-sectional area of the vertebral body. The Image-PRO Plus 6.0 software was used to calculate the cross-sectional area of the target muscle and vertebral body in the image, and results were compared. RESULTS AND CONCLUSION:(1) There was no significant difference in the age distribution among groups (P=0.986).(2) There were no significant differences in the cross-sectional areas of psoas muscle and paraspinal muscle between groups A and B (P > 0.05), while the cross-sectional areas in the groups A and B were significantly less than those in the group C (P < 0.001).(3) There were no significant differences in vertebral cross-sectional areas among groups (P > 0.05).(4) In summary, in L4/5 single segment of degenerative lumbar spinal stenosis and degenerative lumbar spondylolisthesis patients, at L3, L4, L5 vertebral body lower level, the lower extremity cross-sectional areas and paraspinal muscle cross-sectional areas were decreased compared with the control group, with consistency, but the mechanisms of muscle reduction may not be exactly the same.