多裂肌萎缩的影像学评价与退变性腰椎滑脱的临床相关性分析

Clinical correlation between imaging evaluation of multifidus atrophy and degenerative lumbar spondylolisthesis

目的探讨退变性腰椎滑脱患者多裂肌萎缩程度与腰椎滑脱程度和Oswestry功能障碍指数(ODI)的相关性。方法回顾性评估了上海市第一人民医院2017年2月—2019年12月收治的62例退变性腰椎滑脱患者,所有患者均拍摄腰椎正侧位X线片和腰椎MRI检查,使用图像处理软件ImageProPlus计算滑脱节段和滑脱相邻节段的双侧多裂肌总横断面积和多裂肌净横截面积,计算两者比值以评估多裂肌萎缩程度,(数值越小表明多裂肌萎缩程度越重)。结果退变性腰椎滑脱患者退变节段多裂肌萎缩程度比相邻正常节段增加5.5%,差异有统计学意义(t=2.826,P=0.008);退变性腰椎滑脱患者Ⅱ度滑脱多裂肌萎缩程度比Ⅰ度滑脱增加6.9%,差异有统计学意义(t=2.236,P=0.027);退变性腰椎滑脱患者ODI评分平均为(42.7±3.6)%,退变性腰椎滑脱患者多裂肌萎缩程度与ODI评分存在正相关。结论多裂肌退变程度可能参与了退变性腰椎滑脱的进程,退变性腰椎滑脱患者多裂肌萎缩程度与腰椎滑脱程度和腰椎功能障碍存在正相关。

Objective To investigate the correlations of multifidus atrophy extert with lumbar spondylolisthesis extert and Oswestry Disability Index(ODI)in degenerative lumbar spondylolisthesis patients.Methods A total of 62 patients with lumbar degenerative spondylolisthesis were retrospectively analyzed in Shanghai General Hospital from February 2017 to December 2019.Each patient underwent lumbar X-ray and lumbar MRI examinations.Image Pro Plus software was used to calculate the ratio of fat-free multifidus muscle cross sectional area to total multifidus muscle cross sectional area in slipped segments and non⁃slipped segments,and a smaller ratio indicated more severe atrophy.Results The ratio of fat-free multifidus muscle cross sectional area to total multifidus muscle cross sectional area in degenerative segments was 5.5%higher than the value in non⁃degenerative segments of the degenerative lumber spondylolisthesis patients(t=2.826,P=0.008).The ratio inⅡdegree spondylolisthesis segments was 6.8%higher than that inⅠdegree spondylolisthesis segments(t=2.236,P=0.027).The mean ODI of the selected participants was(42.7±3.6)%.The degree of multifidus atrophy was positively correlated with the ODI value.Conclusion Degenerative multifidus muscle may be involved in the development of degenerative lumbar spondylolisthesis.The degree of multifidus atrophy is correlated with the degree of spondylolisthesis and lumber dysfunction.