椎旁肌横截面积与腰椎椎管狭窄症临床表现的相关性分析
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摘要
目的:通过MRI分析椎旁肌横截面积与腰椎椎管狭窄症临床表现之间的相关性。方法:选取确诊为腰椎椎管狭窄症且资料齐全的患者159例(病例组)及同期在我院体检的健康人78名(对照组)为研究对象,用Image J2x软件测量MRI T2W1上L_3～L_5椎体下方平面的两侧椎旁腰大肌及多裂肌的横截面积。根据视觉模拟疼痛评分(VAS)及中医症候评分评估症状持续的时间、行走的距离、腿部放射性疼痛或者麻木。利用Pearson相关分析得到腰大肌及多裂肌横截面积的改变与临床症状的严重程度之间的相关性。结果:病例组在L_5层面双侧多裂肌横截面积减小,差异有统计学意义(左侧,t=5.165,P=0.024<0.05;右侧,t=4.078,P=0.031<0.05);在L_4～S_1节段狭窄患者中,L_5层面双侧多裂肌面积减小较为显著,差异有统计学意义(右侧,t=8.38,P=0.03<0.05;左侧,t=9.23,P=0.04<0.05);病例组L_4～S_1节段狭窄症患者中腰部疼痛及腿部疼痛的VAS评分较其他节段明显增高,差异有统计学意义(腰部疼痛,t=10.35,P=0.02<0.05;腿部疼痛,t=12.35,P=0.01<0.05),而各狭窄节段间歇性跋行程度(中医症候评分)差异无统计学意义(t=2.33,P=0.12>0.05)。通过Pearson相关分析可知:病例组患者中腰部疼痛及腿部疼痛的VAS评分较高者,其L_5层面双侧多裂肌面积减小较为显著,有明显相关性(腰部疼痛,r=0.334,P<0.05;腿部疼痛,r=0.212,P<0.05)。结论:多裂肌在L_5椎体平面横截面积的改变与腰椎椎管狭窄症患者腰及腿部疼痛程度有明显的相关性。
Objective:to examine the relationship between the paravertebral muscle cross-sectional area in MRI and the severity of symptoms in patients with lumbar spinal stenosis.Methods:159 patients(case group)with lumbar spinal stenosis and 78 patients without lumbar spinal stenosis(control group) were selected as the study subjects.The cross-sectional area of paravertebral muscles in the lower plane of L_3～L_5 vertebral body was measured by Image J2 x software on MRI T2 W1.The duration of symptoms,walking distance,radiation pain or numbness of legs were assessed according to visual analogue pain VAS scale and TCM symptom score.Pearson correlation analysis was used to obtain the correlation between the changes of paravertebral muscle cross-sectional area and the severity of clinical symptoms.Results:The cross-sectional area of bilateral multifidus muscle at L_5 level decreased significantly in the two groups(left,t=5.165,P=0.024<0.05;right,t=4.078,P=0.031<0.05).In patients with L_4～S_1 segmental stenosis,the area of bilateral multifidus muscle at L_5 level decreased significantly(right,t=8.38,P=0.03<0.05;left,t=9.23,P=0.04<0.05).The VAS scores of lumbar pain and leg pain were significantly higher than those of other segments(t=10.35,P=0.02<0.05;t=12.35,P=0.01<0.05),but there was no significant difference in the degree of intermittent trudging among narrow segments(t=2.33,P=0.12>0.05).Pearson correlation analysis showed that the area of bilateral multifidus muscle at L_5 level decreased significantly in patients with higher VAS scores of lumbar pain and leg pain(lumbar pain,r=0.334,P<0.05;leg pain,r= 0.212,P<0.05).Conclusion:The change of the cross-sectional area of the multifidus muscle in L_5 vertebral plane is significantly correlated with the pain degree of lumbar and leg in patients with lumbar spinal stenosis.
Objective:to examine the relationship between the paravertebral muscle cross-sectional area in MRI and the severity of symptoms in patients with lumbar spinal stenosis.Methods:159 patients(case group)with lumbar spinal stenosis and 78 patients without lumbar spinal stenosis(control group) were selected as the study subjects.The cross-sectional area of paravertebral muscles in the lower plane of L_3～L_5 vertebral body was measured by Image J2 x software on MRI T2 W1.The duration of symptoms,walking distance,radiation pain or numbness of legs were assessed according to visual analogue pain VAS scale and TCM symptom score.Pearson correlation analysis was used to obtain the correlation between the changes of paravertebral muscle cross-sectional area and the severity of clinical symptoms.Results:The cross-sectional area of bilateral multifidus muscle at L_5 level decreased significantly in the two groups(left,t=5.165,P=0.024<0.05;right,t=4.078,P=0.031<0.05).In patients with L_4～S_1 segmental stenosis,the area of bilateral multifidus muscle at L_5 level decreased significantly(right,t=8.38,P=0.03<0.05;left,t=9.23,P=0.04<0.05).The VAS scores of lumbar pain and leg pain were significantly higher than those of other segments(t=10.35,P=0.02<0.05;t=12.35,P=0.01<0.05),but there was no significant difference in the degree of intermittent trudging among narrow segments(t=2.33,P=0.12>0.05).Pearson correlation analysis showed that the area of bilateral multifidus muscle at L_5 level decreased significantly in patients with higher VAS scores of lumbar pain and leg pain(lumbar pain,r=0.334,P<0.05;leg pain,r= 0.212,P<0.05).Conclusion:The change of the cross-sectional area of the multifidus muscle in L_5 vertebral plane is significantly correlated with the pain degree of lumbar and leg in patients with lumbar spinal stenosis.
引文
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[14] 华焱,张德宏,王兴盛,等.核心肌群功能与退行性腰椎管狭窄症的关系浅析[J].中国中医骨伤科杂志,2018,26(4):83-85.
[15] DANNEELS L A,VANDERSTRAETEN G G,CAMBIER D C,et al.CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects[J].Eur Spine J,2010,9(4):266-272.
[16] 乔培柳,塔依尔·阿不都哈德尔.腰椎退行性疾病椎旁肌的渐进变化[J].中国组织工程研究,2014,18(44):7205-7210.
[2] 李孟军,周友良,王骏,等.高龄腰椎椎管狭窄症患者的手术治疗[J].脊柱外科杂志,2017,15(6):366-368.
[3] 胥少汀.实用骨科学[M].4版.北京:人民军医出版社,2017:1714-1715.
[4] 张学民,唐萌芽,张一鸣.后路减压植骨内固定术配合中药薰蒸治疗退变性腰椎管狭窄症疗效观察[J].中医正骨,2013,25(11):33-36.
[5] 宋建华,武政,常宝生.通督健步汤结合手术治疗混合型退变性腰椎管狭窄症所致腰腿痛临床观察[J].陕西中医,2011,38(8):1034-1036.
[6] 余俊,熊昌源,杨傲飞,等.独活寄生汤加减配合腰背肌功能锻炼治疗腰椎管狭窄症36例[J].中国中医骨伤科杂志,2012,20(9):51-52.
[7] 游军,陈子华,陈文超.老年退行性腰椎管狭窄症非手术治疗与手术治疗疗效对比[J].临床医学工程,2017,24(1):61-62.
[8] HUBLEY-KOZEY C L,VEZINA M J.Muscle activation during exercises to improve trunk stability in men with low back pain[J].Arch Phys Med Rehabil,2002,83(8):1100-1108.
[9] HODGES P,HOLM A K,HANSSON T,et al.Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury[J].Spine(Phila Pa 1976),2006,31(25):2926-2933.
[10] BATTIé M C,NIEMELAINEN R,GIBBONS L E,et al.Is level- and side-specific multifidus asymmetry a marker for lumbar disc pathology[J].Spine J,2012,12(10):932-939.
[11] KANNO H,ENDO T,OZAWA H,et al.Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis:does it reproduce the positional change of the dural sac detected by upright myelography?[J].Spine,2012,37(16):985-992.
[12] OGUZ H,LEVENDOGLU F,OGüN T C,et al.Loading is more effective than posture in lumbar spinal stenosis:a study with a treadmill equipment[J].Eur Spine J,2007,16(7):913-918.
[13] KANNO H,OZAWA H,KOIZUMI Y,et al.Changes in lumbar spondylolisthesis on axial-loaded MRI:do they reproduce the positional changes in the degree of olisthesis observed on X-ray images in the standing position[J].Spine J,2014,15(6):1255-1262.
[14] 华焱,张德宏,王兴盛,等.核心肌群功能与退行性腰椎管狭窄症的关系浅析[J].中国中医骨伤科杂志,2018,26(4):83-85.
[15] DANNEELS L A,VANDERSTRAETEN G G,CAMBIER D C,et al.CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects[J].Eur Spine J,2010,9(4):266-272.
[16] 乔培柳,塔依尔·阿不都哈德尔.腰椎退行性疾病椎旁肌的渐进变化[J].中国组织工程研究,2014,18(44):7205-7210.
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