腰椎滑脱患者腰椎椎旁肌质量与滑脱严重程度的关系

Relationship between lumbar paravertebral muscle mass and percentage of lumbar spondylolisthesis in patients with degenerative and isthmic lumbar spondylolisthesis

目的探讨退行性腰椎滑脱(degenerative spondylolisthesis,DS)和峡部裂性腰椎滑脱(isthmic spondylolisthesis,IS)患者腰椎椎旁肌质量与滑脱严重程度的相关性。方法选择2019年1月~2021年6月在本院就诊的DS(n=124)和IS(n=93)患者作为研究对象。在站立位腰椎侧位X线片上测量椎体滑移百分比(slip percentage,SP),在MRI测量患者腰大肌、多裂肌、竖脊肌的校正横截面积(corrected cross-sectional area,CCSA),观察腰大肌、多裂肌、竖脊肌的CCSA与SP的相关性。结果DS组患者年龄高于IS组,滑脱程度低于IS患者,差异均有统计学意义(P<0.05)。DS组患者SP、腰大肌CCSA、多裂肌CCSA和竖脊肌CCSA水平均低于IS患者,差异均有统计学意义(P<0.05)。Spearman相关性分析和线性回归分析均显示,腰大肌、多裂肌的CCSA与DS患者的SP均不存在相关性(P>0.05),但与IS患者的SP均存在负相关关系(P<0.05);竖脊肌CCSA与DS和IS患者的SP均不存在相关性(P>0.05)。结论IS患者的多裂肌和腰大肌CCSA与腰椎SP呈负相关,DS患者的椎旁肌CCSA与SP可能不存在相关性。

Objective To investigate the correlation between the mass of lumbar paravertebral muscle and the slip percentage(SP)in patients with degenerative spondylolisthesis(DS)and isthmic spondylolisthesis(IS).Methods Patients with DS(n=124)and IS(n=93)in our hospital from January 2019 to June 2021 were selected in this research.SP was measured on standing lumbar lateral X-ray film,and the corrected cross-sectional area(CCSA)of psoas major,multifidus and erector spinalis were measured on MRI.The correlation between CCSA and SP of psoas major,multifidus and erector spinaliswas was observed.Results The age of patients in DS group was older than that in IS group,and the degree of slippage was lower than that in IS group(P<0.05).The levels of SP,psoas major CCSA,multifidus CCSA and erector spinalis CCSA in DS group were lower than those in IS group(P<0.05).Spearman correlation analysis and linear regression analysis showed that there was no correlation between CCSA in psoas major muscle and multifidus muscle and SP in DS patients(P>0.05),but there was a negative correlation between CCSA and SP in IS patients(P<0.05).There was no correlation between CCSA in the erector spinal muscle and SP in both DS and IS patients(P>0.05).Conclusion Psoas major and multifidus CCSA in patients with IS are negatively correlated with lumbar SP,and there may be no correlation between paravertebral muscle CCSA and SP in patients with DS.