椎旁肌退变与矢状位力线的关系

Relationship between the degeneration of paraspinal muscle and sagittal alignment

背景:脊柱骨盆各参数间相互关联,其数值的改变与一些退行性脊柱疾病的发生、发展及患者症状密切相关。现阶段临床工作者关注术后冠状面与矢状面参数变化,以评价术后脊柱整体平衡性,而忽略了与椎旁肌的联系以及椎旁肌在脊柱退行性病变进程中的作用。目的:将已有描述椎旁肌退变与矢状位力线关系的研究进行全面汇总,并对脊柱退行性病变进程中骨性结构位置变化和椎旁肌退变的相互影响进行分析。方法:以“脊柱矢状面畸形,矢状位力线,脊柱骨盆参数,椎旁肌,退行性病变,人类尸体模型;影像学、磁共振成像”为中文关键词,在中国知网、维普、万方等中文数据库中检索,并以“sagittal spinal deformity,sagittal alignment,spinal-pelvic parameter,paraspinal muscle,degeneration,imaging,MRI”作为英文关键词,在Medline、PubMed、Web of Science等数据库中检索。通过阅读标题及摘要进行初步筛选,按纳入及排除标准筛选文献,最终共纳入78篇文献进行结果分析。结果与结论:(1)近年来研究者们开始注意到椎旁肌在维持矢状位力线稳定中具有相应作用,保护和改善椎旁肌功能可以延缓脊柱退行性变;(2)研究者运用不同方法检测椎旁肌退变程度,选取不同种类的矢状位参数来描述矢状位力线;在分析椎旁肌的退变和矢状面参数改变后,发现两者具有相关性,同时该相关性受年龄、种族等因素影响;(3)矢状位力线不良是决定椎旁肌退变重要的解剖因素,较大的骨盆投射角值为矢状位参数改变的危险因素,但较小的骨盆投射角值通过椎旁肌的代偿能力较小,更易出现矢状位失衡;(4)椎旁肌通过代偿机制持续影响矢状位力线,在脊柱退变进程中为了对抗脊柱失平衡,椎旁肌处于高负荷状态,引起疼痛、疲劳及萎缩退变。

BACKGROUND:The parameters of the spine and pelvis are interrelated.The changes in their values are closely related to the occurrence,development and symptoms of degenerative spinal diseases.At the present stage,clinical workers focus on the changes in postoperative coronal and sagittal parameters to evaluate the overall balance of the spine after operation,while ignoring the relationship with paraspinal muscle and the role of paraspinal muscle in the process of spinal degeneration.OBJECTIVE:To summarize the previous studies on the relationship between the degeneration of paraspinal muscle and sagittal alignment,and analyze the interaction between changes in the relative position of skeleton structures and degeneration of paraspinal muscle during spinal degeneration.METHODS:A computer-based online retrieval of CNKI,WanFang,and VIP was conducted with the Chinese key words“sagittal spinal deformity,sagittal alignment,spinal-pelvic parameter,paraspinal muscle,degeneration,human cadaver model,imaging,MRI”.The retrieval of Medline,PubMed,and Web of Science databases was performed with the English key words“sagittal spinal deformity,sagittal alignment,spinal-pelvic parameter,paraspinal muscle,degeneration,imaging,MRI”.The preliminary screening was carried out by reading the title and abstract,and the literature was screened according to the inclusion and exclusion criteria.Finally,a total of 78 articles were included for result analysis.RESULTS AND CONCLUSION:(1)In recent years,researchers have noticed that paraspinal muscles play a corresponding role in maintaining sagittal alignment,and spinal degeneration can be delayed by protecting and improving paraspinal muscle function.(2)The researchers used different methods to detect the degree of paraspinal muscle degeneration,and selected different kinds of sagittal parameters to describe the sagittal alignment.After analyzing the degeneration of paraspinal muscles and the changes in sagittal parameters,we found that there was a correlation between them,and the correlation was affected by age,race and other factors.(3)Poor sagittal alignment is an important anatomic factor determining paraspinal muscle degeneration.A high pelvic incidence of anatomical parameters has often been reported as a risk factor for sagittal alignment.However,the smaller pelvic incidence is more prone to sagittal imbalance due to the smaller compensatory capacity of paraspinal muscles.(4)The paraspinal muscles continue to affect the sagittal alignment through a compensatory mechanism continuously.To combat spinal imbalance during spinal degeneration,the paraspinal muscles are in a state of high muscle load,causing pain,fatigue,atrophy and degeneration.