Ultrasound imaging of lumbar multifidus muscle: normal reference ranges for measurements and practical guidance on the technique

This cross-sectional, prospective study aimed to produce normal reference data for measurements of the lumbar multifidus muscle. A total of 120 subjects, 68 females (aged 20-64 years) and 52 males (20-69 years) were studied. Bilateral transverse ultrasound images were made of multifidus at the fourth and fifth lumbar vertebrae (L4 & L5). Cross-sectional area (CSA, cm(2)) and linear dimensions (AP, anteroposterior; Lat, lateral) were measured and the latter expressed as a ratio (AP/Lat) to reflect shape. Relationships between CSA and anthropometric measures were examined. Multifidus CSA was larger in males (P<0.001) and age had no effect. The CSA was larger at L5 than L4 (P<0.001) and highly correlated between the two levels (males r=0.82, females 0.80). Differences in muscle shape were observed for gender, age and vertebral level. Between-side symmetry was high for size but not shape (CSA <10% difference). Linear measurements multiplied (APxLat) correlated highly with CSA (all groups r0.94, P<0.0001). The AP dimension was also acceptably predictive of CSA at L4 (r0.79). There were no clinically useful correlations between CSA and anthropometric measures. These findings provide normal references ranges for objective assessment of lumbar multifidus. This paper also addresses specific practical issues when scanning multifidus.     

Size and shape of the posterior neck muscles measured by ultrasound imaging: normal values in males and females of different ages

Measurements of muscle strength or size are valuable indicators of muscle status in health and disease. When force cannot be measured directly, due to a particular muscle being one of a functional group or because of pain, size measurements may be the only option. For such data to be useful, normal values for age and gender are necessary. Procedures for scanning and measuring semispinalis capitis and the deep posterior neck muscles (semispinalis cervicis, multifidus and rotatores) using ultrasound imaging are described and normal data provided on size, shape and symmetry of these muscles from a sample of 99 healthy subjects (46 males aged 20-72 years and 53 females aged 18-70 years). Significant gender differences were found (P<0.001) but muscle size did not alter significantly with age. Between-side symmetry can be used to assess abnormality of the deep neck muscle group but not semispinalis capitis. A regression equation is provided for predicting the cross-sectional area (CSA) of the deep neck muscles from spinous process length in males. Clinically, linear measurements can be used to predict the neck muscle CSAs (r=0.66-0.84, P<0.001). The method described for assessing the neck muscles is a potentially valuable tool in clinical practice.     

The Association of Nutritional Status and Gender with Cross-Sectional Area of the Multifidus Muscle in Establishing Normative Data

Abstract

Despite recognized evidence for the importance of the multifidus muscle in stabilizing the lumbar spine, identifying subjects at risk for injury and subsequent loss of intrinsic spinal stabilization remains difficult. Previous research has failed to associate multifidus muscle size and height, weight, or body mass index (BMI). The purpose of this study was to begin to establish normative data for the multifidus muscle cross-sectional area (CSA) at the L5 level and to identify factors associated with size. Twenty-five participants (17 female), with a mean age of 32.5 (SD 11.6) years without history of LBP were considered for inclusion. Participants' height and weight were recorded and BMI calculated. Ultrasound imaging was used to obtain a CSA in cm 2 of the subjects' multifidus muscles at the L5 level bilaterally; testing was done by two trained testers. Prior to testing, intra- and intertester reliability were determined. Percent body fat was determined using a three-site skinfold caliper measurement, also using two trained testers. Mean BMI was 24.18 and mean body fat (%) was 22.88 for all participants. As expected, age and BMI were moderately correlated. Left and right multifidus muscle CSA were highly correlated (r = 0.92, p < 0.001). The mixed model ANOVA indicated a significant main effect for gender as males exhibited larger CSA than females. Participants without history of low back pain present with symmetrical multifidus muscle CSA at the L5 level. Clear gender differences in CSA show that males tend to have larger multifidus muscles at the L5 level, indicating a need to establish gender-specific norms for clinicians examining the L5 multifidus muscle.     

Lumbar multifidus muscle size does not differ whether ultrasound imaging is performed in prone or side lying

This methodological study examined the influence of body position when measuring multifidus muscle size using real-time ultrasound imaging. Previous studies examined multifidus with the subject prone but people with certain conditions cannot be studied in this position, so side lying was investigated as an alternative posture. In 20 normal females (aged 19-45 years), the cross-sectional area (CSA) of lumbar multifidus was measured at the level of the fifth lumbar vertebra (L5) on both the right and left sides, with the subject in prone and in side lying.Multifidus CSA was highly correlated between the two positions on both the right (r=0.90) and left (r=0.91) sides. Paired t-tests found no significant differences between the measurements made in the two scanning postures (right P=0.77; left P=0.16). Bland and Altman plots showed good agreement between the two positions, with no systematic difference.These findings demonstrate that measurements of lumbar multifidus at L5 can be made in either prone or side lying and a valid comparison of the results obtained in both positions can be made.     

Multiplying linear dimension techniques may predict the cross-sectional area of multifidus muscle at all levels of lumbar spine

Objective: This study was designed to find out the relationship between the multiplied linear dimensions (MLD) measurement and the cross-sectional area (CSA) measurement of the lumbar multifidus muscle. Methods: Sixty healthy female subjects participated in this study. The CSA of the lumbar multifidus muscle from L2 to L5 was bilaterally measured by tracing around the muscle margins with an on- screen cursor. The linear dimensions including lateral dimension (LD), anteroposterior dimension (APD) and MLD of the muscles were also calculated at the same levels of lumbar vertebrae. Results: The linear regression between CSA and MLD for each vertebral level was significant (r=0.89 to 0.97, p<0.0001). In addition, there was significant correlation between CSA and APD (r=0.69 to 0.87, p<0.05).Conclusions: MLD method can be used to predict the CSA of the lumbar multifidus muscle. The method described for assessing the multifidus muscle is a potentially valuable, quick and easy way to evaluate muscle size at different levels of the lumbar vertebrae in clinical practice.     

Multifidus size and symmetry among chronic LBP and healthy asymptomatic subjects

Previous studies have provided evidence of multifidus muscle atrophy in people with low back pain (LBP). In cases of acute LBP, these studies have shown that the pattern of atrophy is both vertebral level and side specific. For chronic LBP, there are conflicting reports about the extent and location of muscle atrophy. The purpose of this study was to compare chronic LBP patients and asymptomatic subjects on measures of multifidus size (cross-sectional area; CSA) and symmetry (proportional difference of relatively larger side to smaller side). Data were obtained from 40 asymptomatic subjects without a prior history of LBP (13 females, 27 males), and a retrospective audit was undertaken of records from 50 chronic low back pain patients (27 females, 23 males) presenting to a back pain clinic. Results of the analysis showed that chronic LBP patients had significantly smaller multifidus CSAs than asymptomatic subjects at the lowest two vertebral levels. Males were found to have significantly larger multifidus CSAs than females at all vertebral levels except L5, the most common symptomatic level as determined by manual examination. The greatest asymmetry between sides was seen at the L5 vertebral level in patients with unilateral pain presentations. The smaller multifidus CSA was ipsilateral to the reported side of pain in all cases. The results of this study support previous findings that the pattern of multifidus muscle atrophy in chronic LBP patients is localized rather than generalized. Furthermore, between side asymmetry may be seen in chronic LBP patients presenting with a unilateral pain distribution.     

Ultrasound transducer shape has no effect on measurements of lumbar multifidus muscle size

ObjectiveEvidence is currently lacking for guidance on ultrasound transducer configuration (shape) when imaging muscle to measure its size. This study compared measurements made of lumbar multifidus on images obtained using curvilinear and linear transducers.MethodFifteen asymptomatic males (aged 21–32 years) had their right lumbar multifidus imaged at L3. Two transverse images were taken with two transducers (5 MHz curvilinear and 6 MHz linear), and linear and cross-sectional area (CSA) measurements were made off-line. Reliability of image interpretation was shown using intra-class correlation coefficients (0.78–0.99). Muscle measurements were compared between transducers using Bland and Altman plots and paired t-tests. Relationships between CSA and linear measurements were examined using Pearson's Correlation Coefficients.ResultsThere were no significant differences (p > 0.05) in the measurements of the two transducers. Thickness and CSA measurements had small differences between transducers, with mean differences of 0.01 cm (SDdiff = 0.21 cm) and 0.03 cm² (SDdiff = 0.58 cm²) respectively. Width measures had a mean difference of 0.14 cm, with the linear transducer giving larger measures. Significant correlations (p < 0.001) were found between all linear measures and CSA, with both transducers (r = 0.78–0.89).ConclusionMeasurements of multifidus at L3 were not influenced by the configuration of transducers of similar frequency. For the purposes of image interpretation, the curvilinear transducer produced better definition of the lateral muscle border, suggesting it as the preferable transducer for imaging lumbar multifidus.     

Reliability of ultrasonography for the cervical multifidus muscle in asymptomatic and symptomatic subjects

A test-retest and inter-tester study was designed to assess the reliability of ultrasonography to depict the size of the cervical multifidus muscle in asymptomatic and symptomatic subjects. Ten asymptomatic women (range 19-48 years) and 10 women with chronic whiplash associated disorder (WAD), grade II, (range 19-49 years), matched for height and weight participated. The women were imaged by ultrasonography on two separate occasions by two different testers. On each occasion the cross-sectional area (CSA), and the transverse versus the anterior-posterior dimensions (shape ratio) at the C4 level were measured. The repeated measurements of the CSA were plotted against their means to reveal the limit of agreement. Good agreement was found for the asymptomatic group measurements and the intra-tester agreement for the symptomatic group. The inter-tester agreement for the symptomatic group was questionable. The size of the multifidus muscle was significantly reduced in the symptomatic group ( P<0.05 ). The results indicate that loss of clarity of the fascial layer between the semispinalis cervicis muscle and the cervical multifidus muscle may be a diagnostic sign of muscle atrophy. Ultrasonography can be used to precisely measure the size of the cervical multifidus muscle at the C4-level in asymptomatic young female subjects; it is also reliable for symptomatic subjects if the same tester performs the measurements. Additional criteria are recommended to improve the inter-tester agreement for symptomatic subjects.     

The Evaluation of Chronic Low Back Pain by Determining the Ratio of the Lumbar Multifidus Muscle Cross-sectional Areas of the Unaffected and Affected Sides

[Purpose] The primary purpose of this study was to evaluate chronic low back pain by determining the ratio of the cross-sectional areas of the lumbar multifidus of the unaffected and affected sides at the L5 level using the ultrasound imaging. [Subjects and Methods] The subjects were 24 young people (10 males, 14 females) with chronic low back pain lasting for more than 6 months on one side. The visual analog scale (VAS) value of pain was assessed and the cross-sectional areas of the bilateral multifidus muscle were measured with the subjects in a supine position in a resting state using ultrasound imaging. Correlation and linear regression analysis were performed on the VAS and the ratio of the cross-sectional areas of the lumbar multifidus of the unaffected and affected sides. [Results] The VAS and the ratio of the cross-sectional areas of the lumbar multifidus were linearly correlated. [Conclusion] The results of this research indicate that when the ratio of the cross-sectional areas of the lumbar multifidus of the unaffected and affected sides increases, the symptom of chronic low back pain deteriorates.Key words: Multifidus, Chronic low back pain, Ultrasound imaging     

The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle

Decreases in the size of the multifidus muscle have been consistently documented in people with low back pain. Recently, ultrasound imaging techniques have been used to measure contraction size of the multifidus muscle, via comparison of the thickness of the muscle at rest and on contraction. The aim of this study was to compare both the size (cross-sectional area, CSA) and the ability to voluntarily perform an isometric contraction of the multifidus muscle at four vertebral levels in 34 subjects with and without chronic low back pain (CLBP). Ultrasound imaging was used for assessments, conducted by independent examiners. Results showed a significantly smaller CSA of the multifidus muscle for the subjects in the CLBP group compared with subjects from the healthy group at the L5 vertebral level (F = 29.1, p = 0.001) and a significantly smaller percent thickness contraction for subjects of the CLBP group at the same vertebral level (F = 6.6, p = 0.02). This result was not present at other vertebral levels (p > 0.05). The results of this study support previous findings that the pattern of multifidus muscle atrophy in CLBP patients is localized rather than generalized but also provided evidence of a corresponding reduced ability to voluntarily contract the atrophied muscle.     

MRI成像Dixon-VIBE序列定量评估退变性腰椎侧凸患者椎旁肌退变程度的可行性

目的探讨MRI多回波三维容积内插水脂分离快速扰相(three-dimensional multi-echo Dixon volumetric interpolated breath-hold examination,Dixon-VIBE)序列在退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者椎旁肌退变程度定量评估中的价值。方法20例DLS患者为观察组,同期20例体检健康者为对照组,2组均行腰椎MRI成像Dixon-VIBE序列扫描。分析横断位图像L4-5椎间盘中心层面椎旁肌横截面积(cross-sectional area,CSA)和脂肪浸润度(fat infiltration,FI),并于7 d后重复测量。采用同类相关系数(intra-class correlation coefficient,ICC)双侧随机模型评估研究者间信度和复测信度,比较观察组凸、凹侧椎旁肌CSA、FI,计算椎旁肌CSA、FI不对称度,统计椎旁肌形态异常例数。结果观察组和对照组椎旁肌CSA测量的组间ICC分别为0.78~0.94、0.88~0.93,组内ICC分别为0.79~0.97、0.81~0.97,FI测量的组间ICC分别为0.78~0.91、0.82~0.98,组内ICC为0.76~0.95、0.91~0.97,组内及组间测量结果均具有较好一致性;观察组多裂肌、竖脊肌FI[(32.6±10.0)%、(30.5±8.8)%]均高于对照组[(22.4±8.5)%、(24.4±8.0)%](P<0.05);腰大肌FI[(17.6±5.4)%]及多裂肌、竖脊肌和腰大肌CSA[(7.9±1.8)、(13.6±2.6)、(9.8±2.9)cm2]与对照组[(14.9±3.3)%、(8.1±1.5)cm^2、(13.3±2.2)cm^2、(10.5±3.0)cm^2]比较差异无统计学意义(P>0.05);观察组凸侧多裂肌、竖脊肌和腰大肌CSA、FI与凹侧椎旁肌比较差异无统计学意义(P>0.05);观察组多裂肌、竖脊肌、腰大肌CSA不对称度分别为[(7.6±5.3)%、(9.6±6.2)%、(10.7±8.7)%],FI不对称度分别为[(6.1±4.7)%、(7.4±4.2)%、(3.7±2.0)%],多裂肌、竖脊肌和腰大肌CSA不对称度>10%者分别有7、9、12例,FI不对称度>10%者分别有3、5、2例。结论MRI成像Dixon-VIBE序列可定量评估DLS患者椎旁肌形态改变,DLS患者椎旁肌退变主要表现为多裂肌和竖脊肌脂肪化程度增加、凹凸侧椎旁肌群CSA不对称改变。     

The Reliability of Rehabilitative Ultrasound Imaging of the Cross-sectional Area of the Lumbar Multifidus Muscles in the PNF Pattern

[Purpose] The primary purpose of this study was to evaluate the intraclass correlation coefficient (ICC) in obtaining the cross-sectional area of the lumbar multifidus muscles in patients with chronic low back pain (LBP) at rest and during contractions facilitated by PNF patterns by ultrasound imaging. [Subjects] The subjects were 15 (4 males, 11 females) who had chronic LBP on one side for more than 6 months. [Methods] Subjects were asked to lie on their sides with the painful side facing up. They then rested or received a front or backward lower pelvic pattern of PNF treatment. The cross-sectional area of the multifidus muscle was measured twice using ultrasonography. [Results] The intraclass correlation coefficient of the cross-sectional area of the multifidus muscle measured by ultrasonography was excellent. [Conclusion] Our results show that measurement with ultrasound imaging can be used in the treatment of LBP as an objective assessment.Key words: Ultrasound imaging, Low back pain, Multifidus muscle     

Multifidus muscle size in adolescents with and without back pain using ultrasonography

Objective

The purposes of this study were; a) to compare multifidus muscle cross sectional area (CSA) in male adolescents suffering from low back pain (LBP) with healthy male adolescents using ultrasonography (US), and b) to assess the correlation between multifidus muscle size and demographic variables.

The Association of Nutritional Status and Gender with Cross-Sectional Area of the Multifidus Muscle in Establishing Normative Data

Despite recognized evidence for the importance of the multifidus muscle in stabilizing the lumbar spine, identifying subjects at risk for injury and subsequent loss of intrinsic spinal stabilization remains difficult. Previous research has failed to associate multifidus muscle size and height, weight, or body mass index (BMI). The purpose of this study was to begin to establish normative data for the multifidus muscle cross-sectional area (CSA) at the L5 level and to identify factors associated with size. Twenty-five participants (17 female), with a mean age of 32.5 (SD 11.6) years without history of LBP were considered for inclusion. Participants'' height and weight were recorded and BMI calculated. Ultrasound imaging was used to obtain a CSA in cm² of the subjects'' multifidus muscles at the L5 level bilaterally; testing was done by two trained testers. Prior to testing, intra- and inter-tester reliability were determined. Percent body fat was determined using a three-site skinfold caliper measurement, also using two trained testers. Mean BMI was 24.18 and mean body fat (%) was 22.88 for all participants. As expected, age and BMI were moderately correlated. Left and right multifidus muscle CSA were highly correlated (r = 0.92, p < 0.001). The mixed model ANOVA indicated a significant main effect for gender as males exhibited larger CSA than females. Participants without history of low back pain present with symmetrical multifidus muscle CSA at the L5 level. Clear gender differences in CSA show that males tend to have larger multifidus muscles at the L5 level, indicating a need to establish gender-specific norms for clinicians examining the L5 multifidus muscle.KEYWORDS: Lumbar Spine, Multifidus, SonographyPerhaps one of the most frequent health complaints in modern medicine, low back pain (LBP) remains a burden to individuals and society. The prevalence of LBP and its associated disability, including the related financial burden, remain ever-increasing in the U.S.¹ and among other industrialized countries². Each year in the U.S., for example, it is estimated that approximately 15% of adults will experience an episode of LBP lasting two weeks or longer³. The World Health Organization estimates the cost of work-related LBP at 818,000 lost disability-adjusted life years annually⁴. LBP as a condition is induced by a variety of wide-ranging factors, which may be categorized into two classes in the development of the disorder: internal or endogenous (genotypical and phenotypical factors) and external or exogenous (physical and psychosocial)⁵.While identification of participants at risk for injury and subsequent loss of intrinsic spinal stabilization remains difficult, and a plethora of risk factors have been identified as interacting⁶, there is recognized evidence for the importance of the multifidus muscle in stabilizing the lumbar spine^7–10. Previous research has established fat-free mass as the best correlate to maximal back strength, regardless of gender in a pain-free population (males: r = 0.67; females: r = 0.64)¹¹. In addition, the multifidus muscle cross-sectional area, gender, and pain on exertion are powerful predictors of back muscle strength in participants with chronic LBP^12,13. However, prior research has failed to conclusively associate measures of nutritional status (e.g., body mass index (BMI), the relation between body weight and the square of height) and back muscle strength^14,15 or the incidence of LBP¹⁶.It is well established that patients with chronic LBP present with a weakness impairment of the lumbar multifidus muscles¹⁷. Gross lower body weakness is also associated with LBP, in particular, weakness of the hip flexors and adductors and, the transversus abdominis muscles, but loss of muscle power in the back extensor muscles, including the multifidus, predominates^18,19. This weakness, as evidenced by multifidus muscle atrophy that can be seen clearly on ultrasound imaging, is injury-side and level specific²⁰.The multifidus is a deep back muscle occupying the groove between the transverse and spinous processes and is best developed in the lumbar region²¹. Here it is comprised of fascicles of varying lengths arranged in a spino-transverse pattern. Innervation of each fascicle of a given lumbar level (and the facet joint of that level) is derived from the medial branch of the dorsal ramus²². Aspden²³ has suggested that this segmental innervation allows the multifidus the ability to control or adjust a particular segment to match applied loads. In regards to size, the cross-sectional area of the multifidi gradually increase on progression from L2-S1²⁴.The purpose of this study was to begin to establish normative data of the multifidus muscle cross-sectional area (CSA) measured bilaterally at the L5 level through ultrasound imaging and to identify factors associated with size. Strength of muscle is related to CSA of muscle. In both male and female groups^25–27 as well as old and young²⁸, there exists a positive correlation between muscle strength and cross-sectional area. Those factors that correlate with smaller multifidus muscle CSA might be implicated as potential risk factors for lumbar injury. Prior to this study, a reliability study was conducted to establish the tester''s ability to accurately detect muscle size.     

Comparison of the Efficacy of Different Long-term Interventions on Chronic Low Back Pain Using the Cross-sectional Area of the Multifidus Muscle and the Thickness of the Transversus Abdominis Muscle as Evaluation Indicators

[Purpose] The purpose of this study was to examine the different effects of long-term intervention between proprioceptive neuromuscular facilitation (PNF) and neuromuscular joint facilitation (NJF) patterns for the pelvis on chronic low back pain as assessed by the cross-sectional area of the multifidus muscle and the thickness of the transversus abdominis muscle. [Subjects] The subjects were 12 young people (five males, seven females) who had experienced chronic low back pain on one side for more than 6 months. [Methods] The subjects were treated by resting, PNF or NJF therapy, and each treatment was administered for one month. Ultrasonography was used to measure the changes in the transversus abdominis muscle thickness and the multifidus muscle cross-sectional area. [Results] The thickness of the transversus abdominis muscle and the cross-sectional area of the multifidus muscle in the NJF group, after resting, increased significantly and were higher than those in the PNF group. [Conclusion] The results show that significantly better improvement can be obtained for chronic low back pain by applying long-term intervention of NJF patterns.Key words: Neuromuscular joint facilitation (NJF), Long-term intervention, Low back pain     

Effects of different verbal instructions on change of lumbar multifidus muscle thickness in asymptomatic adults and in patients with low back pain

Background: Spinal stabilisation exercise has been shown to be effective in the rehabilitation of low back pain (LBP). Due to the isometric nature of spinal stabilisation exercise, manual therapists use various verbal instructions to elicit lumbar multifidus muscle contraction.

Objectives: The purpose of this study was to assess whether or not three verbal instructions would alter muscle thickness of the lumbar multifidus muscle differently in asymptomatic individuals and patients with LBP.

Methods: Three verbal instructions were selected for this study: (1) swell the muscle underneath the transducer, (2) draw your belly button in towards your spinal column and (3) think about tilting your pelvis but without really doing it. Lumbar multifidus muscle thickness was determined using parasagittal ultrasound (US) imaging. Measurements of muscle thickness were collected at rest and during verbal instructions from 21 asymptomatic adults and 21 patients with LBP. Percent changes of muscle thickness during contraction and at rest were compared between groups and across verbal instructions.

Results: ANOVA results showed no significant interaction for both L4-5 and L5-S1, but a significant main effect of verbal instruction (P?=?0.049) at L4-5.Post hoc analysis showed a greater increase with verbal instruction #3 than verbal instruction #2 (P?=?0.009). There was no significant main effect of group at either segment.

Discussion: The results of the study suggest that both groups responded similarly to the three verbal instructions. Verbal instructions may increase lumbar multifidus muscle thickness by different amounts at L4-5, but by the same amount at L5-S1.     

定量CT分析椎旁肌与骨密度的相关性

目的采用定量CT探讨骨密度与椎旁肌的增龄性改变及二者的相关性。方法对2020年6~11月于我院行定量CT骨密度检查的患者进行回顾性分析,采用定量CT测量L3中部层面的椎旁后群肌（竖脊肌和多裂肌）的横截面积;采用星云医学影像后处理平台V9.0测量L4~5椎间隙的腰大肌（椎旁前肌群）的横截面积,分析椎旁肌与骨密度的随着年龄变化的规律和二者的相关性。结果女性的椎旁后群肌的含量（横截面积）在40~60岁明显增多,而男性的随着年龄增长而减少,右侧腰大肌含量随着年龄的增长而降低,而左侧的腰大肌含量在男性40~60岁明显增多,女性40岁以下明显增多。男性的椎旁肌含量随着年龄增长大于女性,骨密度也随着年龄增长而降低,男性骨密度大于女性（男性r=-0.625,P < 0.001;女性r=-0.600,P < 0.001）。腰大肌、椎旁后群肌与骨密度均呈正相关,男性相关性高于女性,右侧高于左侧（男性右侧椎旁后群肌r=0.432,P=0.009;左侧椎旁后群肌r= 0.401,P=0.017;右侧腰大肌r=0.510,P=0.002;左侧腰大肌r=0.447,P=0.007;女性右侧椎旁后群肌r=0.319,P < 0.001;左侧椎旁后群肌r=0.276,P < 0.001;右侧腰大肌r=0.279,P < 0.001;左侧腰大肌r=0.220,P=0.004）。结论椎旁肌随着年龄变化发生改变,男性椎旁肌的含量大于女性,骨密度与年龄呈负相关,腰大肌、椎旁后群肌与骨密度均呈正相关,男性的相关性高于女性,右侧高于左侧,男性的椎旁后群肌与骨密度的相关性低于腰大肌与骨密度的相关性,而女性的椎旁后群肌与骨密度的相关性高于腰大肌与骨密度的相关性。      

Device-assisted muscle strengthening in the rehabilitation of patients after surgically stabilized vertebral fractures

OBJECTIVES: To investigate the effects of a device-assisted muscle strengthening exercise program on the surgically traumatized multifidus musculature and on the intact longissimus and iliocostal muscles and to assess the possible relationship between patients' reported pain symptoms and changes in muscle strength or changes in cross-sectional area (CSA) of the musculature. DESIGN: Open, prospective noncontrolled prepost intervention study. SETTING: University-affiliated center for ambulant physiotherapy. PARTICIPANTS: Fifteen patients who had undergone dorsal osteosynthesis for treatment of thoracolumbar vertebral fracture and who complained of persistent back pain. INTERVENTION: Twelve-week device-assisted training exercise program. MAIN OUTCOME MEASURES: Patients' pain score, muscle strength, and the CSA of the paravertebral musculature determined by magnetic resonance imaging (MRI) were assessed before and after the exercise program. RESULTS: MRI findings revealed no increase in the CSA of the multifidus muscle in any patient (median change, -.27 cm 2 ). All patients, however, exhibited hypertrophy of both the longissimus and iliocostal muscles (median change, 1.39 cm 2 ). Significant increase in muscle strength was observed in 14 of 16 patients (median increase, 56%; range, 0.7%-126.4%). The median overall pain score improved from 19 (range, 7-24) to 16 (range, 5-27). The change in muscle strength and muscle CSA, however, showed no correlation. There was also no correlation between increase in muscle strength and changes in pain scores. CONCLUSIONS: The device-assisted training program resulted in hypertrophy of the iliocostal and longissimus muscles and an increase in muscle strength in patients with surgically stabilized vertebral fractures. About half of the patients reported relief of pain. No correlation was found between hypertrophy, increase in muscle strength, and relief of pain. The surgically damaged multifidus musculature, however, did not show any change in CSA and was not accessible to rehabilitative measures.     

The relationship of carotid three-dimensional ultrasound vessel wall volume with age and sex: comparison to carotid intima-media thickness

The relationship of three-dimensional ultrasound (3DUS)-derived carotid vessel wall volume (VWV) was evaluated with respect to age and sex. B-mode and 3DUS images were acquired for 316 subjects from diverse groups including obese primary prevention, diabetic nephropathy, renal transplant and rheumatoid arthritis populations. The relationship for intima-media thickness (IMT) and VWV with age and sex were determined using Pearson-product-moment correlations. Mean IMT (r = 0.18, p = 0.001) and VWV (r = 0.24, p < 0.01) correlated modestly with age. There were modest correlations in males (IMT, r = 0.19, p = 0.003; VWV, r = 0.34, p < 0.001) and in females for IMT and age (r = 0.30, p = 0.007) but not between 3DUS VWV and age in females (r = 0.10, p = 0.4). Significant associations between plaque and VWV (r = 0.36, p = 0.001) but not IMT suggest different correlations in females that may be attributed to plaque.     

Glycemic control and bone age are independently associated with muscle capillary basement membrane width in diabetic children after puberty

This study was undertaken to examine the possible relationships between muscle capillary basement membrane width (CBMW) and glycemic control, bone age, chronologic age, and duration of diabetes in young patients with insulin-dependent diabetes mellitus (IDDM) during different stages of pubertal development. We studied 49 males and 43 females (age, 7-20 yr) with IDDM for up to 16 yr for whom bone age and glycosylated hemoglobin (HbA1c) data were available at the time of right quadriceps muscle biopsy. Based on pubic hair Tanner stage, subjects were assigned to prepubertal (Tanner I), pubertal (Tanner II and III), and postpubertal (Tanner IV and V) groups. In 30 pubertal and prepubertal subjects, none of the variables studied was significantly correlated with CBMW. This is attributable in part to the small number of subjects in each group. In 62 postpubertal subjects, CBMW was correlated with age (r = .27, P = .03), bone age (r = .43, P = .0005), and postpubertal duration of diabetes (r = .38, P = .003) but not total duration of diabetes. In the postpubertal subjects, CBMW was correlated with HbA1c at the time of biopsy (r = .31, P = .01) but correlated more strongly with the mean of HbA1c values obtained during the 1- and 2-yr periods before biopsy (r = .37, P = .01, and r = .54, P = .03, respectively). An analysis of covariance revealed that the slopes for the regression of loge CBMW on HbA1c differed significantly (P = .02) among the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)