退行性腰椎滑脱症患者多裂肌退行性变与临床症状的相关性

Correlation between multifidus muscle degeneration and clinical symptoms in patients with degenerative lumbar spondylolisthesis

目的 探讨退行性腰椎滑脱症患者多裂肌退行性变程度与腰椎前凸角、腰腿痛视觉模拟量表(VAS)评分以及Oswestry功能障碍指数(ODI)的相关性。方法 回顾性分析51例退行性腰椎滑脱症患者的腰痛VAS评分、下肢痛VAS评分和ODI等临床资料。通过腰椎X线片判断滑脱严重程度并测量腰椎前凸角,其中Ⅰ度滑脱30例(L4/L520例、L5/S110例),Ⅱ度滑脱21例(L4/L515例、L5/S16例)。通过腰椎MRI测量患者L4/L5、L5/S1水平双侧多裂肌平均横截面积和脂肪浸润率,用Pearson相关分析评估多裂肌横截面积、脂肪浸润率与腰椎前凸角、腰痛VAS评分、下肢痛VAS评分和ODI的相关性。结果 不同滑脱程度患者腰椎前凸角、腰痛VAS评分、下肢痛VAS评分、ODI差异无统计学意义(P>0.05)。在相同节段,不同滑脱程度患者多裂肌横截面积差异无统计学意义(P>0.05);Ⅰ度滑脱者多裂肌脂肪浸润率均低于Ⅱ度滑脱者,差异有统计学意义(P<0.05)。多裂肌横截面积、脂肪浸润率与腰椎前凸角、腰痛VAS评分、下肢痛VAS评分和ODI均无相关性。结论 不同严重程度退行性腰椎滑脱症患者多裂肌的退行性变程度存在差异,多裂肌退行性变可能参与了退行性腰椎滑脱的进程,但尚不能证明多裂肌退行性变程度与临床症状存在相关性。

Objective To analyze the correlation between multifidus muscle degeneration and lumbar lordosis angle,low back and leg pain visual analogue scale(VAS)score,and Oswestry disability index(ODI)in degenerative lumbar spondylolisthesis patients.Methods The clinical data of 51 degenerative lumbar spondylolisthesis patients,such as low back pain VAS score,leg pain VAS score and ODI,were retrospectively analyzed.The severity of spondylolisthesis and lumbar lordosis angle were judged by lumbar roentgenograph.Among them,30 had gradeⅠspondylolisthesis(L4/L5 20 cases,L5/S1 10 cases),21 gradeⅡspondylolisthesis(L4/L5 15 cases,L5/S1 6 cases).The mean cross-sectional area and fat infiltration rate of bilateral multifidus were measured by lumbar MRI in L4/L5 and L5/S1.The Pearson correlation analysis was used to analyze the correlation between the cross-sectional area of multifidus,fat infiltration rate of multifidus and the lumbar lordosis angle,low back pain VAS score,leg pain VAS score and ODI.Results There were no significant differences in lumbar lordosis angle,low back pain VAS score,leg pain VAS score and ODI between the patients with different grades of spondylolisthesis(P>0.05).At the same level,there was no significant difference in the cross-sectional area of multifidus between the patients with different grades of spondylolisthesis(P>0.05);the fat infiltration rate of multifidus in the patients with gradeⅠspondylolisthesis was lower than that in the patients with gradeⅡspondylolisthesis,with a significant difference(P<0.05).There were no significant correlations between the cross-sectional area of multifidus,fat infiltration rate of multifidus and lumbar lordosis angle,low back pain VAS score,leg pain VAS score and ODI.Conclusion There is difference in multifidus degenerative degree in patients with different severity of degenerative spondylolisthesis.Degenerative grade of the multifidus muscle may be involved in the course of degenerative lumbar spondylolisthesis,but it can not prove the correlation between the grade of multifidus muscle degeneration and clinical symptoms.