腰椎躯干肌横截面积与腰椎后路椎间融合率和融合时间相关性的回顾性研究

Retrospective study of the correlation between the cross-sectional area of the lumbar trunk muscle and the posterior lumbar interbody fusion rate and fusion time

目的探讨腰椎躯干肌横截面积(muscle sectional cross area,MSCA)与腰椎后路椎间融合率和融合时间的相关性。方法选择2015年1月~2019年3月在本院接受L 3-4和L 4-5椎体PLIF手术治疗的171例患者作为对象,依据随访至54周时是否融合进行分组观察。收集其年龄、性别、手术方法、手术节段、体质量指数、骨密度、手术时间、术中出血量、术前疼痛评分、术前ODI指数等指标,采用MRI检测腰大肌(psoas major,PS)、竖脊肌(erector spinae muscle,ES)和多裂肌(multifidus muscle,MF)的MSCA,采用Spearman相关分析屈肌(PS)和伸肌(ES、MF)MCSA与融合时间的相关性。结果171例患者中,L 3-4节段和L 4-5节段融合率分别为86.54%和88.24%。L 3-4节段融合组患者年龄低于非融合组,L 3-4、L 4-5屈肌MSCA,以及L 2-3、L 4-5伸肌MSCA均显著高于非融合组,差异有统计学意义(P<0.05);L 4-5节段融合组的L 3-4、L 4-5、L 5-S 1屈肌MSCA,以及L 4-5和L 5-S 1伸肌MSCA均显著高于非融合组,差异均有统计学意义(P<0.05)。L 3-4节段患者的融合时间与L 3-4、L 4-5屈肌和L 4-5伸肌MSCA呈负相关,差异存在统计学意义(P<0.05);L 4-5节段患者的融合时间与L 3-4、L 4-5、L 5-S 1屈肌以及L 3-4、L 4-5伸肌MSCA呈负相关,差异存在统计学意义(P<0.05)。结论屈肌和伸肌MSCA与腰椎后路椎间融合率和融合时间相关,可能是预测融合率的潜在指标。

Objective To investigate the correlation between the muscle sectional cross area(MSCA)and the fusion rate and time of posterior lumbar interbody fusion.Methods From January 2015 to March 2019,171 patients who received PLIF in our hospital were selected in this study,and the patients were divided into two groups according to whether they fused or not during the follow-up to 54 weeks.The age,sex,operation method,operation segment,body mass index,bone density,operation time,intraoperative bleeding volume,preoperative pain score,preoperative ODI index and other indicators were collected.MSCA of psoas major muscle(PS),erector spine muscle(ES)and multifidus muscle(MF)were detected by MRI.The correlation between MCSA of flexor muscle(PS)and extensor muscle(ES,MF)and fusion time was analyzed by Spearman correlation.Results In 171 patients,the fusion rates of L 3-4 and L 4-5 segments were 86.54%and 88.24%,respectively.The age of patients in the L 3-4 segment fusion group was lower than that in the non fusion group,and the MSCA of L 3-4 flexor,L 4-5 flexor,L 2-3 extensor and L 4-5 extensor were higher than those in the non fusion group,and the differences were statistically significant(P<0.05).The MSCA of L 3-4,L 4-5,L 5-S 1 flexors,L 4-5 and L 5-S 1 extensors in L 4-5 fusion group were significantly higher than those in non fusion group(P<0.05).The fusion time of L 3-4 segment was negatively correlated with MSCA of L 3-4,L 4-5 flexor and L 4-5 extensor(P<0.05).The fusion time of L 4-5 segment was negatively correlated with MSCA of L 3-4,L 4-5,L 5-S 1 flexors and L 3-4,L 4-5 extensors(P<0.05).Conclusion MSCA of flexor and extensor is related to the fusion rate and fusion time of lumbar posterior approach,which may be a potential index to predict the fusion rate.