椎旁肌参数与退行性胸腰段后凸角度的相关性研究

Correlation between paraspinal muscle parameters and the angle of degenerative thoracolumbar segmental kyphosis

目的分析椎旁肌参数与退行性胸腰段后凸角度的相关性。方法回顾性分析2021年11月至2023年4月于北京积水潭医院脊柱外科接受手术治疗的腰椎退行性疾病的女性患者90例,年龄(67.62±4.98)岁(范围60~80岁),身高(1.58±0.05)m(范围1.48~1.70)m,体重(63.79±9.13)kg(范围47~90 kg),体质指数(25.48±3.35)kg/m^(2)(范围18.37~36.05 kg/m^(2))。胸腰段后凸角为6.65°±10.38°(范围-17.34°~9.34°)。疾病诊断:腰间盘突出症32例、腰椎管狭窄症58例。摄站立位胸腰段正侧位X线片测量胸腰段后凸角度;摄胸腰段定量CT并采用Osirix软件测量T_(12)、L_(3)、L_(5)水平椎旁肌参数,包括椎旁肌横截面积、骨骼肌面积和组织密度、脂肪浸润比例和身高矫正的骨骼肌面积指数。分析椎旁肌参数与胸腰段后凸角度之间的相关性,采用多重线性回归分析影响胸腰段后凸角度的因素。结果相关性分析结果显示胸腰段后凸角与T_(12)骨骼肌组织密度(r=-0.303,P=0.004)和L_(5)骨骼肌组织密度(r=-0.219,P=0.038)呈负相关。年龄与T_(12)骨骼肌组织密度(r=-0.263,P=0.012)、T_(12)身高矫正的骨骼肌面积指数(r=-0.221,P=0.036)、T_(12)椎旁肌横截面积(r=-0.280,P=0.007)、L_(3)骨骼肌组织密度(r=-0.266,P=0.011)和L_(5)骨骼肌组织密度(r=-0.290,P=0.006)呈负相关。骨密度与椎旁肌参数无相关性(P>0.05)。多重线性回归显示T_(12)骨骼肌组织密度(β=-1.125,P<0.001)、T_(12)脂肪浸润比例(β=-0.849,P=0.001)、L_(3)骨骼肌组织密度(β=0.996,P<0.001)和L_(3)脂肪浸润比例(β=0.496,P=0.020)是影响胸腰段后凸角的独立因素。结论T_(12)和L_(3)椎旁肌密度和脂肪浸润比例是影响胸腰段后凸角的独立因素。T_(12)椎旁肌密度和脂肪浸润比例越小、L_(3)椎旁肌密度和椎旁肌脂肪浸润比例越大,胸腰段后凸角度越大。

Objective To analyze the correlation between paraspinal muscle parameters and the angle of degenerative thoracolumbar segmental kyphosis.Methods From November 2021 to April 2023,a total of 90 female patients with lumbar degenerative disease who underwent surgical treatment in the Department of Spine Surgery,Beijing Jishuitan Hospital were retrospectively analyzed.The average age was 67.62±4.98 years(range,60-80 years),and the average height was 1.58±0.05 m(range,1.48-1.70 m).Weight 63.79±9.13 kg(range,47-90 kg),body mass index 25.48±3.35 kg/m^(2)(range,18.37-36.05 kg/m^(2)).The angle of kyphosis of the thoracolumbar segments was 6.65°±10.38°(range,-17.34°to 9.34°).Disease diagnosis:32 cases of lumbar disc herniation and 58 cases of lumbar spinal stenosis.Frontal and lateral radiographs of the thoracolumbar segments in the standing position were taken to measure the angle of kyphosis of the thoracolumbar segments;quantitative CT of the thoracolumbar segments and Osirix software were used to measure the parameters of the paravertebral muscles at the levels of T_(12),L_(3),and L_(5),including paravertebral muscle cross-sectional area,skeletal muscle area,and tissue density,the proportion of fat infiltration,and the height-corrected skeletal muscle area index.The correlation between paraspinal muscle parameters and the angle of thoracolumbar segmental kyphosis was analyzed,and the factors affecting the angle of thoracolumbar segmental kyphosis were analyzed using multiple linear regression.Results Correlation analysis showed a negative correlation between the angle of thoracolumbar segmental kyphosis and the tissue density of T_(12) skeletal muscle(r=-0.303,P=0.004)and L_(5) skeletal muscle(r=-0.219,P=0.038).Age was negatively correlated with T_(12) skeletal muscle tissue density(r=-0.263,P=0.012),T_(12) height-corrected skeletal muscle area index(r=-0.221,P=0.036),T_(12) paravertebral muscle cross-sectional area(r=-0.280,P=0.007),L_(3) skeletal muscle tissue density(r=-0.266,P=0.011)and L_(5) skeletal muscle tissue density(r=-0.290,P=0.006).There was no correlation between bone mineral density and paravertebral muscle parameters(P>0.05).Multiple linear regression showed that T_(12) skeletal muscle tissue density(β=-1.125,P<0.001),T_(12) fat-infiltrated proportion(β=-0.849,P=0.001),L_(3) skeletal muscle tissue density(β=0.996,P<0.001),and L_(3) fat-infiltrated proportion(β=0.496,P=0.020)were independent factors influencing the angle of thoracolumbar segmental kyphosis.Conclusion T_(12) and L_(3) paraspinal muscle density and fat-infiltrated proportion are independent factors affecting the angle of thoracolumbar kyphosis.The smaller the density and fat-infiltrated proportion of T_(12) paraspinal muscle,and the larger the density and fat-infiltrated proportion of L_(3) paraspinal muscle,the larger the angle of thoracolumbar kyphosis.