多裂肌脂肪浸润的Goutallier分级与腰椎融合术后相邻节段退变的相关性分析

Goutallier classification of fat infiltration in multifidus muscle is associated with adjacent segment degeneration after lumbar fusion

目的探讨多裂肌脂肪浸润Goutallier分级与腰椎融合术后邻近节段退变(ASD)的相关性。方法选择2017年1月至2020年6月在该院接受经椎间孔腰椎椎间融合术(TLIF)治疗的168例L 4腰椎滑脱患者资料进行回顾性分析,根据轴向T1加权MRI图像,采用Goutallier分级对L 3、L 4、L 5节段的多裂肌脂肪浸润情况进行评估。观察术后ASD发生率,观察是否ASD患者术前多裂肌的Goutallier分级,以及患者术前多裂肌的Goutallier分级与术后发生ASD的关系。结果随访期间共有41例出现ASD,发生率24.40%。ASD组L 3、L 4、L 5节段的多裂肌脂肪浸润程度均显著高于非ASD患者,差异均有统计学意义(P<0.05)。ASD组患者年龄、骨盆倾斜角(PT)、腰椎前凸角(LL)、术前邻近节段退变的占比高于非ASD组,骶骨倾斜角(SS)低于非ASD组,差异均有统计学意义(P<0.05);ASD和非ASD患者的性别和体质量指数差异无统计学意义(P>0.05)。多因素Logistic回归分析显示,控制混杂因素后,术前多裂肌的Goutallier分级是ASD的风险因素,L 3节段多裂肌的Goutallier分级与ASD的OR值最高。结论术前多裂肌Goutallier分级是退行性腰椎滑脱患者行TLIF术后发生ASD的风险因素。

Objective To investigate the correlation between the Goutallier classification of multifidus muscle fatty infiltration and adjacent segment degeneration(ASD)after lumbar fusion surgery.Methods A retrospective analysis was conducted on data from 168 patients with L 4 lumbar spondylolisthesis who underwent transforaminal lumbar interbody fusion(TLIF)at our hospital from January 2017 to June 2020.The Goutallier classification was used to assess multifidus muscle fatty infiltration at the L 3,L 4,and L 5 segments based on axial T 1-weighted MRI images.The incidence of postoperative ASD was observed,and the preoperative Goutallier classification of multifidus muscle in patients with or without ASD,as well as the relationship between the preoperative Goutallier classification and the occurrence of postoperative ASD,were analyzed.Results During the follow-up period,41 cases of ASD occurred,with an incidence rate of 24.40%.The degree of multifidus muscle fatty infiltration at the L 3,L 4,and L 5 segments in the ASD group was significantly higher than that in the non-ASD group,with statistically significant differences(P<0.05).The age,pelvic tilt(PT),lumbar lordosis(LL),and preoperative proportion of adjacent segment degeneration were higher in the ASD group than in the non-ASD group,while the sacral slope(SS)was lower in the ASD group,with statistically significant differences(P<0.05).There were no statistically significant differences in gender and body mass index between the ASD and non-ASD groups(P>0.05).Multivariate logistic regression analysis showed that after controlling for confounding factors,the preoperative Goutallier classification of multifidus muscle was a risk factor for ASD,with the highest odds ratio(OR)for ASD observed in the L 3 segment.Conclusion The preoperative Goutallier classification of multifidus muscle is a risk factor for the occurrence of ASD after TLIF surgery in patients with degenerative lumbar spondylolisthesis.