腰椎矢状位序列及椎旁肌形态与原发性腰痛性质的相关性

The correlation between the sagittal lumbar spinal alignment and the paraspinal muscle morphology with the pain characteristics in patients with primary low back pain

目的:分析原发性腰痛病人腰椎矢状位序列及椎旁肌形态与疼痛性质的相关性。方法:选取临床影像学资料完整的原发性腰痛病人85例,记录病人基线时腰痛发作的持续性、部位、视觉模拟评分法(visual analogue scale,VAS)评分、病程、药物缓解情况以及疼痛对生活的影响。于腰椎侧位X线片测量腰椎前凸、腰椎前凸顶椎和上端椎位置、骶骨倾斜角(sacral slope,SS),于腰椎MR影像测量L_(5)S_(1)节段椎旁肌横截面积和脂肪浸润比例(fat infiltration rate,FIR)。分别按SS是否小于<35°、顶椎是否位于L_(4)中心以下、上端椎是否位于L1以上、椎旁肌FIR是否≥10%分组,比较不同分组因素各组间疼痛性质的差异。结果:SS<35°组发生持续性腰痛的比例明显大于SS≥35°组(34例vs.18例),椎旁肌FIR≥10%组发生持续性腰痛的比例明显大于椎旁肌FIR<10%组(36例vs.16例)。持续性腰痛组SS<35°、椎旁肌FIR≥10%的比例明显高于非持续性腰痛组(34例vs.9例;36例vs.14例)。逻辑回归分析显示椎旁肌FIR≥10%与持续性腰痛存在显著相关性(P=0.021,OR=4.390)。结论:原发性腰痛病人腰椎矢状位序列特征和椎旁肌脂肪化与非特异性腰痛的持续发作可能相关,对于脊柱矢状位序列和椎旁肌形态的深入研究有助于探索原发性腰痛的发病机制并为改善临床诊疗手段提供参考。

Objective:To investigate the correlation between the lumbar sagittal profile and the paraspinal muscle with the pain characteristics in patients with primary low back pain(LBP).Methods:Eighty-five patients with primary LBP were retrospective enrolled.The pain characteristic including visual analogue scale,pain continuous and position,symptom duration,drug usage and life influence were recorded.The lumbar lordosis,sacral slope(SS),the apical and upper end vertebral body of lumbar lordosis and fatty infiltration rate(FIR)of the paraspinal muscle at L_(5)S_(1) disc level were evaluated.All the enrolled patients were further stratified by SS<35°or FIR≥10%,the position of apical and upper end vertebral body of lumbar lordosis.Results:There were significantly more patient with continuous pain in SS<35°group and in FIR≥10%group compared to SS≥35°group and FIR<10%group,respectively(34 vs.18;36 vs.16).Both the proportion of the patients with SS<35°and of the patients with paraspinal muscle FIR≥10%were significantly higher in group of patients with continuous pain compared to the group of patients with non-continuous pain(34 vs.9;36 vs.14).The logistic regression analysis demonstrated that FIR≥10%was significantly associated with the continuous symptom(P<0.021,OR=4.390).Conclusion:There might be a correlation between the pain onset with lumbar sagittal profile and fatty infiltration in paraspinal muscle in patients diagnosed with primary low back pain.