退行性腰椎侧凸椎旁肌横截面积和脂肪化程度的变化及临床意义

目的 探讨退行性腰椎侧凸(DLS)椎旁肌横截面积和脂肪化程度的变化及其临床意义.方法 纳入2018年9月—2020年3月遂宁市第一人民医院收治的70例DLS患者作为研究组,同期70名健康体检者作为对照组,均进行腰椎X线片、MRI检查.比较2组患者的腰椎前凸角(LL)、腰椎冠状位侧凸Cobb角、腰椎顶锥旋转畸形分级、椎旁肌横截面积(CSA)及脂肪化程度、椎体CSA,并比较研究组患者腰椎凸侧和凹侧椎旁肌CSA及脂肪化程度.结果 研究组LL低于对照组,腰椎冠状位侧凸Cobb角高于对照组,差异均有统计学意义(P<0.05).研究组腰椎顶锥旋转畸形分级1级33例,2级25例,3级10例,4级2例;对照组患者均无腰椎顶锥旋转畸形.研究组竖脊肌CSA、多裂肌CSA、腰大肌CSA低于对照组,椎体CSA、椎旁肌脂肪化程度高于对照组,差异均有统计学意义(P<0.05).研究组腰椎凸侧竖脊肌CSA、多裂肌CSA、腰大肌CSA高于腰椎凹侧,腰椎凸侧椎旁肌脂肪化程度低于凹侧,差异均有统计学意义(P<0.05).结论 DLS患者椎旁肌CSA及脂肪化程度高于无DLS者,且腰椎凸侧和凹侧椎旁肌CSA及脂肪化程度亦有明显差异,临床上可根据患者椎旁肌群退行性变程度了解腰椎退行性变情况.

Changes and clinical significance of paravertebral muscle cross-sectional area and fatty degree in degenerative lumbar scoliosis

Objective To investigate the changes and clinical significance of paravertebral muscle cross-sectional area and fatty degree in degenerative lumbar scoliosis(DLS). Methods Seventy DLS patients who were admitted to Suining First People''s Hospital from September 2018 to March 2020 were included in the study group, and 70 healthy physical examination subjects were taken as the control group, and all of them were examined by lumbar roentgenography and MRI. The lumbar lordosis(LL), lumbar coronal scoliosis Cobb''s angle, lumbar apical cone rotation deformity classification, paraspinal muscle cross-sectional area(CSA) and fatty degree, vertebral CSA were compared between the 2 groups. The paraspinal muscle CSA and fatty degree between the convex side and concave side of lumbar spine in the study group were compared as well. Results The LL of the study was significantly lower than that of the control group, and the lumbar coronal scoliosis Cobb''s angle was significantly higher than that of the control group;and the differences were statistically significant(P < 0.05). In the study group, lumbar apical cone rotation deformity were 33 cases in grade 1, 25 in grade 2, 10 in grade 3, and 2 in grade 4. The control group had no lumbar apical cone rotation deformity. The CSA of erector spinae, multifidus and psoas major in the study group were significantly lower than those of the control group, the CSA of vertebral and paraspinal muscle fatty degree were significantly higher than those of the control group, and the differences were statistically significant(P < 0.05). In the study group, the CSA of the erector spinae, multifidus and psoas major on the convex side of the lumbar spine were significantly higher than those of the concave side, and the paraspinal muscle fatty degree of the convex side of the lumbar spine was significantly lower than that of the concave side;and the differences were statistically significant(P < 0.05). Conclusions The CSA and fatty degree of paravertebral muscles in DLS patients are higher than those in non DLS patients, and there are significant differences between the convex and concave sides of the lumbar spine. The degenerative degree of lumbar vertebrae can be known according to the degenerative degree of paravertebral muscles.