椎间孔镜术后残留腰痛患者腰段多裂肌脂肪浸润与脊柱-骨盆参数的相关性研究

Correlation between spinopelvic parameters and area of fatinfiltration in lumbar multifidus muscles for patients with residual pain after percutaneous transforaminal endoscopic discectomy

目的探讨椎间孔镜术后残留腰痛患者腰段多裂肌(lumbar multifidus muscle,LMM)脂肪浸润程度与脊柱-骨盆参数之间有无相关性,为腰椎术后进行脊柱骨盆康复训练提供理论依据。方法根据数字病案记录,对125名接受过经皮穿刺椎间孔镜手术(percutaneous transforaminal endoscopic discectomy,PTED)术后仍残留腰痛症状的腰椎间盘突出症(lumbar disc heniation,LDH)患者一般临床资料和L_(3-4)、L_(4-5)、L_(5)-S_(1)节段MRI下的双侧LMM脂肪浸润面积(cross-sectional area,CSA),以及骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)、骨盆投射角(pelvic incidence,PI)分别进行计算统计,并利用Pearson相关分析以及ROC曲线研究其中的关系。结果在L_(3-4)和L_(4-5)节段,SS、PI与LMM的脂肪浸润CSA呈正相关(P<0.01);在L_(3-4)节段,SS与LMM的脂肪浸润CSA低度正相关(|r|>0.3),PI与LMM的脂肪浸润CSA微弱正相关(0<|r|<0.3);在L_(4-5)节段,SS、PI与LMM的脂肪浸润CSA均显著正相关(0.5<|r|<0.8),其中PI对LMM脂肪浸润程度预测能力评估的AUC值为0.836。结论根据PI值可以较准确地判断L_(4-5)节段LMM的脂肪浸润程度,PI值越大则L_(4-5)节段的LMM脂肪浸润程度越重。因此,腰椎术后进行脊柱骨盆功能训练能够改善术后残留疼痛症状,可能是通过改善骨盆前倾、激活多裂肌实现改善目的。

Objective To focus on the correlation between spinopelvic parameters and area of fat infiltration in lumbar multifidus muscles(LMM)for patients with residual pain after lumbar surgery,and meanwhile,to provide theoretical basis for spinopelvic exercises after lumbar percutaneous transforaminal endoscopic discectomy(PTED).Methods According to digitized medical records,cross-sectional area(CSA)of bilateral fat infiltration in LMM of L_(3-4),L_(4-5) and L_(5)-S_(1),sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI)and clinical dates for 125 patients with residual pain after lumbar surgery were recorded.Analysis of Pearson correlation and receiver operating characteristic curve(ROC)on above were performed.Results At L_(3-4) and L_(4-5) levels,SS and PI were positively correlated with CSA of fat infiltration in LMM(P<0.01).At L_(3-4) level,there was a positive low correlation(|r|>0.3)between SS and CSA of fat infiltration and a positive weak correlation(0<|r|<0.3)between PI and CSA of fat infiltration.At L_(4-5) level,SS and PI had significant positive correlation with CSA of fat infiltration(0.5<|r|<0.8),and the AUC was 0.836.Conclusion At L_(4-5),the degree of fat infiltration in LMM can be accurately judged according to the PI value,and the bigger the PI,the severer the degree of fat infiltration.Therefore,spinopelvic exercises can improve the residual pain after lumbar surgery possibly by improving anterior tilt of pelvis and activating LMM.