退变性腰椎管狭窄患者多裂肌萎缩与椎管狭窄程度的相关性研究

Correlation between multifidus atrophy and stenosis severity in patients with degenerative lumbar spinal stenosis

目的分析退变性腰椎管狭窄症患者多裂肌萎缩程度与椎管狭窄节段、狭窄程度和症状侧的相关性。方法回顾分析2017年1月至2019年10月,116例于潍坊市人民医院治疗的退变性腰椎管狭窄症患者的影像学资料,所有患者均为中央管型或侧隐窝型狭窄,其中男24例,女92例;平均年龄(54.04±4.31)岁;L3~4狭窄11例,L4~5狭窄86例,L5~S1狭窄19例。通过纳入者的腰椎MRI,测量L3~4、L4~5、L5~S1层面的多裂肌的横截面积(multifidus muscle cross-sectional area,CSA)、多裂肌的净横截面积(fat-free multifidus muscle cross-sectional area,FCSA),并计算CSA/FCSA数值以评估多裂肌萎缩程度,比较多裂肌萎缩程度与椎管狭窄节段、狭窄程度和症状侧的相关性。结果本组患者病变节段与非病变节段多裂肌萎缩程度差异有统计学意义(P<0.05),非病变节段之间多裂肌萎缩程度差异无统计学意义(P>0.05);椎管狭窄程度不同的患者多裂肌萎缩程度差异有统计学意义(P<0.001),且椎管狭窄程度与多裂肌萎缩程度显著相关(r=0.842);双侧症状不对称者双侧多裂肌萎缩程度亦不对称(P=0.002)。结论退变性腰椎管狭窄症患者椎管狭窄节段较非狭窄节段多裂肌萎缩程度重,病变节段多裂肌退变程度与椎管狭窄程度显著相关,症状侧较对侧多裂肌萎缩更明显。

Objective To analyze the correlation between multifidus atrophy and spinal stenosis segment,severity,symptomatic side in patients with degenerative lumbar spinal stenosis.Methods Imaging data of 116 patients with degenerative lumbar spinal stenosis were analyzed retrospectively from January 2017 to October 2019.All patients were of central tubular stenosis or lateral fossa stenosis,including 24 males and 92 females.The average age was (54.04±4.31) years.There were 11 cases with L3-4 stenosis,86 cases with L4-5 stenosis,and 19 cases with L5-S1 stenosis.Multifidus muscle cross-sectional area (CSA) and fat-free multifidus muscle cross-sectional area (FCSA)at L3-4,L4-5 and L5-S1 levels were measured by the lumbar MRI,which were calculated to evaluate the severity of multifidus atrophy.The correlation between multifidus atrophy and spinal stenosis segment,severity,symptomatic side was analyzed.Results Statistically significant differences in the correlation between multifidus atrophy and affected /unaffected segments were observed (P < 0.05),while not among unaffected segments (P > 0.05).Statistically significant differences in the correlation between multifidus atrophy and spinal stenosis severity were noted (P < 0.001,r=0.842).Asymmetries symptoms indicated asymmetric multifidus atrophy (P=0.002).Conclusions Multifidus atrophy is severer in the stenotic segment than that in the non-stenotic segment in patients with degenerative lumbar spinal stenosis.Multifidus degeneration in the diseased segment is significantly related to the severity of spinal stenosis.Muscular atrophy in the symptomatic side is more obvious than that in the opposite side.