退变性腰椎滑脱患者多裂肌萎缩与滑脱程度相关性研究

The correlation between degree of multifidus muscle atrophy and severity in patients with degenerative lumbar spondylolisthesis

目的分析退变性腰椎滑脱症患者滑脱节段多裂肌萎缩程度与腰椎滑脱程度的相关性。方法回顾分析2008年1月至2019年4月本院就诊的103例腰椎退变性滑脱症的患者资料,其中男22例,女81例;年龄(58.55±0.88)岁(范围:37~77岁)。L2滑脱2例,L3滑脱10例,L4滑脱81例,L5滑脱10例。所有患者均摄腰椎侧位X线片,行腰椎MR检查。收集影像学资料,采用Image-Pro Plus进行数据测量:①腰椎侧位X线片上测量腰椎滑脱比;②腰椎MR上分别测量退变性滑脱节段的总多裂肌横截面积(total multifidus muscle cross sectional area,TCSA)与无脂肪浸润多裂肌横截面积(fat-free multifidus muscle cross sectional area,FCSA),并计算FCSA/TCSA比值,用来评估多裂肌萎缩程度,该数值越大表明多裂肌萎缩越轻;采用同样的方法测量退变性滑脱节段的上一非滑脱节段的TCSA与FCSA,并计算FCSA/TCSA比值。结果对两位医生的测量结果进行一致性检验,腰椎滑脱比数据进行一致性检验,ICC=>0.75,说明数据一致性高,结果可信度高。退变滑脱节段上一非滑脱节段和退变滑脱节段的多裂肌萎缩程度(FCSA/TCSA比值)分别为0.66±0.09和0.74±0.08,差异有统计学意义(t=-12.618,P=0.000);103例中Ⅰ度滑脱66例(64.1%,66/103),Ⅱ度滑脱患者37例(35.9%,37/103),无Ⅲ度及Ⅳ度滑脱患者;滑脱比与退变滑脱节段FCSA/TCSA存在相关性(P=0.000),相关系数γ=-0.425,滑脱比与退变节段FCSA/TCSA存在高度负相关。结论退变性腰椎滑脱症患者退变滑脱节段多裂肌萎缩程度较退变滑脱节段上一非滑脱节段多裂肌萎缩程度严重;退变性腰椎滑脱症患者退变滑脱节段多裂肌萎缩程度与腰椎滑脱程度存在正相关。

Objective To investigate the correlation between degree of multifidus muscle atrophy and severity in patients with degenerative lumbar spondylolisthesis.Methods A total of 103 patients with lumbar degenerative spondylolisthesis were retrospectively analyzed,including 22 male patients(21.4%)and 81 female patients(78.6%).There were 2 cases of L2 spondylolisthesis,10 cases of L3 spondylolisthesis,81 cases of L4 spondylolisthesis,and 10 cases of L5 spondylolisthesis.The average age was 58.55±0.88 years old.Each patient underwent lumbar lateral X-ray,and lumbar MRI,and the imaging data were collected.MRI images were obtained to measure and calculatethe ratio of the fat-free multifidus muscle cross sectional area to total multifidus muscle cross sectional area(LCSA/TCSA)in slipped segments and non-slipped segments.Lumbar lateral radiographs were obtained to measure and calculate slipped ratio.All data were analyzed by SPSS 23.0.Paired-samples T test was carried out to investigate whether there were LCSA/TCSA differences between in slipped segments and non-slipped segments.The correlation between LCSA/TCSA in slipped segments and slipped ratio was analyzed by using Pearson correlation coefficient system.P=0.000 was considered statistically significant.Results The degree of multifidus muscle atrophy(FCSA/TCSA)in the upper non-spondylolisthesis segments and the multifid muscle atrophy(FCSA/TCSA)in the degenerative spondylolisthesis segments(t=-12.618,P=0.000).there was significant difference between them.The degree of multifidus muscle atrophy(FCSA/TCSA)of degenerative spondylolisthesis was correlated with the spondylolisthesis ratio,and the correlation coefficient was-0.425.There was a high negative correlation between FCSA/TCSA ratio and spondylolisthesis ratio of degenerative spondylolisthesis.Conclusion The degree of multifidus muscle atrophy in degenerative spondylolisthesis is more serious than that in the upper non-spondylolisthesis segments,and there is a positive correlation between the degree of multifidus muscle atrophy in degenerative lumbar spondylolisthesis and the degree of lumbar spondylolisthesis in degenerative lumbar spondylolisthesis patients.