脊髓型颈椎病患者颈椎旁肌退变评估及与矢状位参数的相关性分析

Evaluation of Cervical Paraspinal Muscle Degeneration and Its Correlation with Sagittal Parameters in Patients with Cervical Canal Stenosis

目的通过颈椎MRI评估脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者的颈椎旁肌影像学形态,并探索其对颈椎矢状位平衡(cervical sagittal balance,CSB)和颈椎活动度的影响。方法选取2019年1月至2022年1月陆军第八十三集团军医院骨科收治的30例脊髓型颈椎病患者和同时段行健康体检的42例健康人群为研究对象,分别作为观察组和对照组。观察组男21例,女9例;年龄30~78岁,平均(59.9±12.2)岁。对照组男23例,女19例;年龄33~76岁,平均(55.7±10.1)岁。基于两组人群的颈椎MRI,借助Image J软件分别测量颈椎多裂肌(multifidus,MF)、颈椎半棘肌(semispinalis cervicis,Scer)、头半棘肌(semispinalis capitis,Scap)、头夹肌(splenius capitis,SPL)和颈长肌(longus colli,LC)的肌肉横截面积(cross sectional area,CSA)、有效横截面积(effective cross sectional area,ECSA)、相对横截面积(relative cross sectional area,RCSA)和脂肪浸润度(fat infiltration,FI),并在两组人群中分别选取15例重复测量进行方法学研究。基于观察组患者标准颈椎正侧位和过伸过屈位X线片,测量CSB参数和颈椎活动度。采用同类相关系数(intralcass correlation coefficient,ICC)双侧随机模型评价Image J软件测量颈椎旁肌退变水平的一致性,通过两样本t检验对比两组人群颈椎旁肌退变水平,通过Pearson相关系数评估观察组颈椎旁肌退变对颈椎相关影像学指标的影响。结果观察组和对照组颈椎椎旁肌CSA及颈椎旁肌FI测量的组间和组内ICC总范围为0.771~0.956。观察组MF、Scap、SPL的CSA、RCSA相比对照组明显升高(P<0.05),而ECSA与对照组相比差异无统计学意义(P>0.05);观察组LC、Scer的CSA、RCSA及ECSA平均值与对照组相比差异无统计学意义(P>0.05);观察组MF、Scer、Scap、SPL、LC的FI平均值相对于对照组均明显升高(P<0.05)。SPL的ECSA与颈椎屈曲角呈显著负相关(P<0.05),其余颈椎旁肌群与颈椎矢状位参数无明显相关性。LC的CSA、ECSA与颈椎前凸角呈显著负相关(P<0.05),LC的CSA、ECSA与颈椎过伸角及屈伸角呈显著负相关(P<0.05),LC的FI与颈椎C 2~7矢状面轴向距离呈显著正相关(P<0.05)。结论基于颈椎MRI的Image J软件测量法可有效反映颈椎旁肌的影像学形态。脊髓型颈椎病患者的颈椎旁肌退变主要表现为颈椎旁肌群肥大增生和脂肪化改变,其中以Scap和SPL的退变最为显著。LC的退变与颈椎矢状位的失平衡和过伸活动度受限密切相关。

Objective To evaluate the imaging status of the paraspinal muscle in patients with cervical spondylotic myelopathy(CSM)and explore the effects on cervical sagittal balance and cervical range of motion with cervical MRI.Methods Thirty patients with cervical spondylotic myelopathy admitted to the Department of Orthopedics of the 83rd Group Military Hospital of the Army from January 2019 to January 2022 and 42 healthy people who underwent physical examination at the same time were selected as the observation group and the control group.In the observation group,there were 21 males and 9 females.The average age was(59.9±12.2)years,ranging from 30 to 78 years.In the control group,there were 23 males and 19 females.The average age was(55.7±10.1)years,ranging from 33 to 76 years.Based on the cervical MRI of the two groups of people,the cervical multifidus(MF),cervical semispinalis cervicis(Scer)and cervical semispinalis capitis(Scap)were measured by Image J software,respectively.Cross sectional area(CSA)of Scap,splenius capitis(SPL),and longus colli(LC)muscles,Effective cross-sectional area(ECSA),Relative cross-sectional area(RCSA)and fat infiltration(FI).15 cases of repeated measurement in two groups were selected for methodological research.Cervical sagittal balance parameters and cervical motion were measured based on standard cervical spine anterolateral and hyperextension and flexion X-ray films of patients in the observation group.A bilateral random model with intralcass correlation coefficient(ICC)was used to evaluate the consistency of Image J’s measurement of the level of paracyclinal muscle degeneration.The two-sample t test was used to compare the level of paracyclinal muscle degeneration between the two groups.Pearson correlation coefficient was used to evaluate the influence of cervical paracyclinal muscle degeneration on cervical imaging indexes in the observation group.Results The total range of intergroup and intragroup ICC measured by CSA and FI of cervical paravertebral muscle in observation group and control group was 0.771~0.956.The mean values of CSA and RCSA of multifidus muscle,semitinous capitis muscle and capicular pinus muscle in the observation group were significantly higher than those in the control group(P<0.05),but there was no significant difference in the average value of ECSA compared with the control group(P>0.05).There was no significant difference in CSA,RCSA and ECSA between the observation group and the control group(P>0.05).Compared with the control group,the average FI of multifidus muscle,cervical semispectinus muscle,cephalic semispectinus muscle and cervical longus muscle in the observation group were significantly higher(P<0.05).ECSA of pinus capitis muscle was negatively correlated with cervical flexion angle(P<0.05).There was no significant correlation between the other cervical paraspinal muscles and the sagittal parameters of the cervical spine.There was a significant negative correlation between CSA,ECSA and cervical lordosis angle(P<0.05),CSA and ECSA were significantly negatively correlated with cervical hyperextension angle and flexion extension angle(P<0.05).The cervical longus muscle FI was significantly positively correlated with C 2~7 SVA of cervical spine(P<0.05).Conclusion The Image J software measurement method based on cervical MRI can effectively reflect the imaging function of the paracyclinal muscles.The degeneration of the paracyclinal muscles in patients with cervical spondylotic myelopathy is mainly manifested by hypertrophy and fatty changes of the paracyclinal muscles,in which the degeneration of the capitis hemi-spinosus and the capitis clipper muscles is the most significant.The degeneration of the longus cervical muscle is closely related to sagittal disequilibrium of the cervical spine and limited hyperextension range of motion.