功能性相对椎旁肌横截面积对腰椎间盘突出症的诊断价值及与椎间盘退变的关系

Diagnostic value of functional relative cross-sectional area of paraspinal muscles in lumbar disc herniation and the relationship with disc degeneration

目的研究功能性相对椎旁肌横截面积对腰椎间盘突出症(LDH)的诊断价值及与椎间盘退变的关系。方法选取2020年6月—2023年8月,以LDH收治入我院的96名患者为观察组;选取同期行腰椎MRI的50名体检者(无腰椎退行性疾病)作为对照组。根据Pfirrmann分级将观察组L_(4)/L_(5)和L_(5)/S_(1)层面椎间盘进行分级;使用Image J软件测量2组研究对象椎旁肌横截面积、肌肉脂肪化横截面积和椎间盘横截面积,并计算对应层面功能性相对椎旁肌横截面积。比较2组研究对象功能性相对椎旁肌横截面积;采用受试者工作特征(ROC)曲线分析功能性相对椎旁肌横截面积对LDH的诊断价值;比较不同椎间盘退变程度等级患者对应的功能性相对椎旁肌横截面积;分析椎间盘退变程度等级与功能性相对椎旁肌横截面积的相关性并分析功能性相对椎旁肌横截面积的影响因素。结果对照组研究对象L_(5)/S_(1)、L_(4)/L_(5)层面功能性相对椎旁肌横截面积均大于观察组,差异均有统计学意义(P<0.05)。观察组不同椎间盘退变程度等级患者的功能性相对腰大肌横截面积、功能性相对多裂肌横截面积、功能性相对竖脊肌横截面积差异均有统计学意义(P<0.05)。相关分析结果显示,在L_(5)/S_(1)平面上,功能性相对腰大肌横截面积、功能性相对多裂肌横截面积、功能性相对竖脊肌横截面积与腰椎间盘退变程度等级的相关系数rs值分别为-0.388、-0.344、-0.360(P<0.001);在L_(4)/L_(5)平面上,功能性相对腰大肌横截面积、功能性相对多裂肌横截面积、功能性相对竖脊肌横截面积与腰椎间盘退变程度等级的相关系数rs值分别为-0.500、-0.489、-0.501(P<0.001)。在L_(5)/S_(1)平面,功能性相对腰大肌横截面积、功能性相对多裂肌横截面积、功能性相对竖脊肌横截面积诊断LDH的曲线下面积(AUC)分别为0.892(95%CI:0.830~0.937)、0.911(95%CI:0.852~0.951)、0.640(95%CI:0.557~0.718);在L_(4)/L_(5)平面上,功能性相对腰大肌横截面积、功能性相对多裂肌横截面积、功能性相对竖脊肌横截面积诊断LDH的AUC分别为0.850(95%CI:0.782~0.904)、0.919(95%CI:0.862~0.958)、0.848(95%CI:0.780~0.902)。回归分析结果显示,腰椎间盘退变程度等级是功能性相对椎旁肌横截面积的独立影响因素(P<0.05)。结论功能性相对椎旁肌横截面积对临床LDH的诊断具有重要参考价值,且其与椎间盘退变程度等级存在负相关,同时腰椎间盘的退变是椎旁肌退变的独立影响因素。

Objective To investigate the diagnostic value of the functional relative cross-sectional area(CSA)of paraspinal muscles in lumbar disc herniation(LDH)and its relationship with disc degeneration.Methods Ninety-six LDH patients treated at our hospital from June 2020 to August 2023 were selected as the observation group,and 50 individuals without lumbar degenerative diseases who underwent lumbar MRI during the same period were selected as the control group.The observation group's L_(4)/L_(5)and L_(5)/S_(1)discs were graded according to the Pfirrmann classification.ImageJ software was used to measure the paraspinal muscle CSA,muscle fat infiltration CSA,and disc CSA in both groups,and the functional relative CSA was calculated.The functional relative CSA of the paraspinal muscles was compared between the two groups.The diagnostic value of functional relative CSA for LDH was analyzed using ROC curves,and the relationship between disc degeneration severity and functional relative CSA was analyzed along with the influencing factors.Results The functional relative CSA of the L/S_(1)and L_(4)/L_(5)discs in the control group was significantly larger than that in the observation group(P<0.05).Significant differences were found in the functional relative CSA of the psoas major,multifidus,and erector spinae among patients with different disc degeneration grades in the observation group(P<0.05).Correlation analysis showed that at the L_(5)/S_(1)level,the correlation coefficients(rs)between the functional relative CSA of the psoas major,multifidus,erector spinae,and disc degeneration severity were-0.388,-0.344,and-0.360,respectively(P<0.001);at the L_(4)/L_(5)level,the rs values were-0.500,-0.489,and-0.501(P<0.001).The AUCs for diagnosing LDH using the functional relative CSA of the psoas major,multifidus,and erector spinae at the L_(5)/S_(1)level were 0.892(95%CI:0.830-0.937),0.911(95%CI:0.852-0.951),and 0.640(95%CI:0.557-0.718),respectively;at the L_(4)/L_(5)level,the AUCs were 0.850(95%CI:0.782-0.904),0.919(95%CI:0.862-0.958),and 0.848(95%CI:0.780-0.902).Regression analysis showed that disc degeneration severity was an independent influencing factor for functional relative CSA(P<0.05).Conclusion Functional relative CSA of the paraspinal muscles has an important reference value for diagnosing LDH and is negatively correlated with disc degeneration severity.Disc degeneration is an independent influencing factor for paraspinal muscle degeneration.