腰椎管狭窄症患者多裂肌退变与腰椎小关节骨性关节炎的相关性研究

Correlation study between multifidus muscle degeneration and lumbar facet joint osteoarthritis in patients with lumbar spinal stenosis

目的探讨腰椎管狭窄症患者多裂肌退变与腰椎小关节骨性关节炎的相关性。方法回顾性选取自2021年5月至2023年1月就诊于首都医科大学附属北京友谊医院的96例腰椎管狭窄症患者作为研究对象。按照关节突关节的Kalichman分级,将2级和3级的患者纳入腰椎小关节骨性关节炎组(n=62),将0级和1级的患者纳入对照组(n=34)。记录两组患者的临床评价指标(腰椎骨密度、腰部疼痛情况)、影像学评价指标[多裂肌相对横截面积(rCSA)、脂肪浸润程度(DFI)和双侧多裂肌横截面积的对称比(SR-CSA)]。采用多因素Logistic回归分析影响腰椎小关节发生骨性关节炎的因素。结果两组腰椎骨密度、多裂肌的SR-CSA比较,差异均无统计学意义(P>0.05);骨关节炎组患者的腰椎VAS评分、多裂肌的DFI分别为(5.94±1.56)分、(31.37±7.92)%,均显著高于对照组[(5.24±1.53)分、(24.66±6.27)%],多裂肌的rCSA为(67.37±8.72)%,显著低于对照组[(71.66±7.68)%],差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果提示,多裂肌的DFI是腰椎小关节发生骨性关节炎的独立影响因素(OR=1.125,95%CI=1.042~1.194,P<0.05)。结论多裂肌的肌纤维萎缩和DFI,是导致腰椎管狭窄症患者腰椎小关节发生骨性关节炎的重要机制。多裂肌的DFI是腰椎小关节发生骨性关节炎独立危险因素,具有一定的临床预测价值。

Objective To investigate the correlation between multifidus degeneration and lumbar facet joint osteoarthritis in patients with lumbar spinal stenosis.Methods A total of 96 patients with lumbar spinal stenosis who visited Beijing Friendship Hospital,Capital Medical University from May 2021 to January 2023 were retrospectively selected as the study subjects.According to the Kalichman classification of the facet joints,patients at level 2 and level 3 were included in the lumbar osteoarthritis group(n=62),while patients at level 0 and level 1 were included in the control group(n=34).Lumbar bone density,lower back pain,and imaging evaluation indicators of two groups of patients[relative cross-sectional area(rCSA),degree of fatty infiltration(DFI)and symmetry ratio of cross-sectional area(SR-CSA)]weres recorded.The factors affecting the occurrence of osteoarthritis in the lumbar facet joints were analyzed using multivariate Logistic regression analysis.Results There were no statistically significant differences in bone density and SR-CSA of the multifidus muscle between the two groups(P>0.05);the lumbar VAS score and DFI of the multifidus muscle in lumbar osteoarthritis group were(5.94±1.56)points and(31.37±7.92)%,respectively,which were significantly higher than those in the control group[(5.24±1.53)points and(24.66±6.27)%],the rCSA of the multifidus muscle in the lumbar osteoarthritis group was(67.37±8.72)%,which was significantly lower than that in the control group[71.66±7.68)%],and the differences were statistically significant(P<0.05).The results of multivariate Logistic regression analysis suggest that the DFI of the multifidus muscle was an independent influencing factor for the occurrence of osteoarthritis in the lumbar facet joints(OR=1.125,95%CI:1.042-1.194,P<0.05).Conclusion In individuals with lumbar spinal stenosis,the occurrence of osteoarthritis in small joints may exacerbate lower back pain severity.The findings suggest that atrophy and fat infiltration within the multifidus muscle play significant roles in the pathogenesis of osteoarthritis in the lumbar facet joints.Notably,fat infiltration in the multifidus muscle emerged as an independent risk factor for osteoarthritis,possessing substantial clinical prognostic significance.