不同病程腰椎间盘突出症患者腰部多裂肌横截面面积研究

目的：研究不同时期腰椎间盘突出患者腰部多裂肌横截面面积（CSA），评估多裂肌萎缩情况。方法55例腰椎间盘突出患者，按发病时间分为急性期15例、亚急性期10例、慢性期30例，使用实时定量超声测量腰4/5水平椎间盘突出累及侧及非累及侧在俯卧休息位下腰部多裂肌CSA。结果男性、女性及总体累及侧多裂肌CSA的急性期与慢性期比较，差异均有统计学意义（t分别=4.15、3.54、4.11，P均＜0.05），女性非累及侧多裂肌CSA急性期与慢性期比较，差异有统计学意义（t=2.40，P＜0.05）。男性与女性腰部累及侧、非累及侧各期多裂肌CSA比较，差异均有统计学意义（t分别=5.72、2.88、2.20；5.70、3.35、2.79，P均＜0.05）。在亚急性期，男性累及侧多裂肌CSA较非累及侧小；在慢性期，男性和女性的累及侧多裂肌CSA均较非累及侧小；且总体累及侧多裂肌CSA也较非累及侧小，差异均有统计学意义（t分别=3.85、2.73、4.66、14.11，P均＜0.05）。在慢性期，女性和男性腰部多裂肌累及侧CSA与非累及侧CSA之间不对称差异值（CSA%）分别为（12.16±10.10）%、（16.45±7.20）%，较急性期同性别组CSA%值均大，差异有统计学意义（t=4.68、2.44，P均＜0.05）。结论定量超声可以用于评估腰部多裂肌形态改变；椎间盘突出病程不足3月，腰部多裂肌萎缩可不明显；反复腰痛大于3个月的患者，多裂肌在双侧横截面面积均减小，以累及侧萎缩较为明显，双侧多裂肌横截面面积呈不对称性表现。

Cross-sectional area of lumbar multifidus muscle in different stages of lumbar disc herniation

Objective To investigate the cross-sectional area （CSA） of lumbar multifidus （LM） muscle changes in dif-ferent stages of lumbar disc herniation. Methods Fifty-five cases of patients with lumbar disc herniation （LDH） were di-vided into acute stage（fifteen cases）, sub-acute stage（ten cases） and chronic stage（thirty cases） according to the time of onset. The CSAs of LM muscle in both the non-affected and affected side in L4/5 level were measured in the rest prone position by rehabilitative ultrasound imaging. Results In the affected side, compared the acute cases and the chronic cases, the CSAs of LM muscle in the male, the female and the overall all showed significant differences （t=4.15, 3.54, 4.11,P〈0.05）. In the non-affected, compared the acute cases and the chronic cases, the CSAs of LM muscle in the female showed significant difference（t=2.40,P〈0.05）. Compared male and female, the differences of the CSAs of LM in the both side of each stage patients were statistic significantly（t=5.72, 2.88, 2.20, 5.70, 3.35, 2.79,P〈0.05）. In the sub-acute stage, the CSA of LM in the affected side in the male was significantly smaller than the non-affected side（t=3.85,P〈0.05） as well as in the male and female in the chronic stage （t=2.73, 4.66,P〈0.05）. The CSA of LM in the affected side in the overall was significantly smaller than the non-affected side （t=14.11,P〈0.05）. In the chronic stage, the CSA% in female and male cases were （12.16±10.10）%and （16.45±7.20）%respectively which were larger than those of them in the acute stage accordingly （t=4.68, 2.44,P〈0.05）. Conclusions Quantitative ultrasound can be used to evaluate the mor-phological change of LM. If course of disease of LDH was less than 3 months, the LM muscle atrophy was not obvious. If lumbago duration time was more than 3 months, the CAS of LM muscle in bilateral were decreased and the affected side atrophy was more obvious. The bilateral CAS of LM muscle showed asymmetry performance.