腰部椎旁肌和腰大肌RCSA与腰椎曲度的关系及临床意义

Correlation of relative cross-sectional area of lumbar paravertebral muscle and psoas with lumbar curvature and its clinical significance

目的探讨腰部椎旁肌群和腰大肌的相对横截面积(RCSA)与腰椎曲度的变化及临床意义。方法该研究为回顾性横断面研究,选取上海中医药大学附属曙光医院2023年1―4月在骨科和伤科就诊的患者中,MRI检查仅存在腰椎生理曲度改变或未见明显异常的中青年患者107例为观察对象,分别于L3椎体下缘、L3/L4、L4/L5和L5/S1椎间盘位置测量左右椎旁肌与腰大肌的RCSA值并与腰椎曲度做相关性分析。结果107例患者的年龄(30.51±4.64)岁,女性比例占71.96%;L3下缘、L3/L4、L4/L5和L5/S1椎间盘位置肌肉群RCSA差异均有统计学意义(左腰大肌F=30.21,P<0.001;右腰大肌F=31.63,P<0.001;左椎旁肌F=31.04,P<0.001;右椎旁肌F=26.55,P<0.001),从L3至S1,腰大肌RCSA增加,椎旁肌RCSA减少;总椎旁肌的RCSA值/总腰大肌的RCSA值在L3椎体下缘与腰椎曲度存在正相关(r=0.40,P<0.001),该相关性可同时见于L3/L4(r=0.31,P=0.001)、L4/L5(r=0.24,P=0.012)。在考虑左右肌群对腰椎曲度的影响后,除了L5/S1椎间盘位置的肌肉横截面积与腰椎曲度无相关性(P>0.05),其他腰椎节段的肌肉横截面积依然有相关性(P<0.05)。结论腰大肌相对椎旁肌的RCSA增大可能使腰椎曲度变直,椎旁肌相对腰大肌的RCSA增大可能使腰椎曲度变大,通过改善椎旁肌肉质量可能恢复腰椎生理曲度,具有临床应用价值。

Objective To investigate the correlation of relative cross-sectional area of lumbar paravertebral muscle and psoas with lumbar curvature and its clinical significance.Methods This study was conducted as a retrospective cross-sectional study.Among the patients treated at the Department of Orthopedics and Traumatology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January to April 2023,107 middle-aged and young patients with changes in lumbar physiological curvature or no apparent abnormalities were included in this study based on MRI findings.The relative cross-sectional area(RCSA)values of the left and right paravertebral muscles and psoas were measured at the lower margin of the L3 vertebral body and at the L3/L4,L4/L5,and L5/S1 intervertebral discs.Furthermore,the correlation between these RCSA values and lumbar curvature was analyzed.Results The 107 patients were(30.51±4.64)years old,and the proportion of females accounted for 71.96%.There were differences in RCSA between the lower margin of L3,L3/L4,L4/L5,and L5/S1 intervertebral discs(left psoas F=30.21,P<0.001;right psoas F=31.63,P<0.001;left paravertebral muscle F=31.04,P<0.001;right paravertebral muscle F=26.55,P<0.001).From L3 to S1,the RCSA of the psoas increased,while the RCSA of the paravertebral muscle decreased.The RCSA values of the total paravertebral muscle/RCSA values of the total psoas major muscle were positively correlated with lumbar curvature at the lower margin of the L3 vertebral body(r=0.40,P<0.001).This correlation could be seen at both L3/L4(r=0.31,P=0.001)and L4/L5(r=0.24,P=0.012).However,after considering the influence of left and right muscle groups on lumbar curvature,there was no correlation between the muscle cross-sectional area at the L5/S1 disc position and lumbar curvature(P>0.05).Nevertheless,there was still a correlation between the muscle cross-sectional area at other lumbar segments(P<0.05).Conclusion An increase in the RCSA of the psoas relative to the paraspinal muscle may lead to straightening of the lumbar spine curvature,whereas an increase in the RCSA of the paraspinal muscle relative to the psoas may result in an increase in lumbar spine curvature.Improving the quality of the paraspinal muscle may restore the physiological curvature of the lumbar spine,which holds clinical application value.