中度青少年特发性脊柱侧凸胸腰背部浅层与深层椎旁肌超声形态特征

Ultrasonic morphological characteristics of superficial and deep thoracolumbar paraspinal muscles in patients with moderate adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  椎旁肌  竖脊肌  多裂肌  肌骨超声  形态学

英文关键词:Adolescent idiopathic scoliosis  Paraspinal muscles  Erector spinae  Multifidus  Musculoskeletal ultrasound  Morphology

中文摘要:

  【摘要】 目的：探讨中度青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者胸腰背部凸凹侧浅层与深层椎旁肌静息及收缩时的形态结构变化特征及其对侧凸角度影响，分析侧凸角度与椎旁肌形态改变之间的关系。方法：前瞻性纳入本院2020年7月~2023年12月收治的21例Cobb角为20°～45°、胸段为主弯的S型AIS患者（男4例，女17例，年龄13.9±1.6岁）和21例健康对照组（男7例，女14例，年龄14.6±1.4岁），通过肌骨超声采集两组胸腰段椎旁肌形态学数据：AIS患者凸、凹侧（健康对照组为左、右侧）竖脊肌、多裂肌静息状态及最大随意等长收缩时肌肉厚度变化。分析两组间胸腰段浅层及深层椎旁肌的静息厚度、收缩厚度、收缩厚度变化率及椎旁肌总静息厚度与总收缩厚度（竖脊肌+多裂肌）等差异，并分析AIS凸侧、凹侧胸腰段椎旁肌结构特征差异。对胸腰段Cobb角与相应节段的竖脊肌、多裂肌的形态学指标（静息厚度、收缩厚度变化率）进行相关性分析，进一步分析侧凸严重程度对浅层与深层椎旁肌形态学的影响。结果：AIS患者主胸段Cobb角为31.62°±7.68°，腰段Cobb角为19.52°±6.48°。与正常对照组相比，AIS患者胸段凸侧、凹侧椎旁肌的静息厚度、收缩厚度及厚度变化率差异存在统计学意义，患者胸段竖脊肌静息厚度凹侧小于凸侧，多裂肌静息厚度凸侧小于凹侧（P＜0.01），S型AIS患者胸段多裂肌凸侧与凹侧的收缩厚度小于正常人（P＜0.05），而胸段竖脊肌凸侧、凹侧的收缩厚度差异无统计学意义，AIS患者胸段凸侧竖脊肌、凹侧多裂肌收缩厚度变化率明显变小（P＜0.05）。AIS患者胸段（凸、凹侧）椎旁肌总静息厚度（竖脊肌+多裂肌）与对照组相应节段的数值（左、右侧）无明显差异（P＞0.05），且AIS患者胸段椎旁肌总静息厚度凸侧与凹侧之间的差异无统计学意义（P＞0.05），AIS患者胸段（凸侧、凹侧）椎旁肌总收缩厚度（竖脊肌+多裂肌）小于对照组（P＜0.05）。与正常对照组相比，AIS患者腰段凸侧、凹侧多裂肌的静息厚度、收缩厚度及厚度变化率均显著减低（P＜0.05），腰段凹侧竖脊肌收缩厚度变化率小于正常人（P＜0.05）。AIS患者腰段凸侧与凹侧椎旁肌的静息厚度、收缩厚度变化率等指标无明显差异（P＞0.05）。AIS患者腰段（凸侧、凹侧）椎旁肌总静息厚度（竖脊肌+多裂肌）、总收缩厚度（竖脊肌+多裂肌）均小于对照组（P＜0.05）。S型AIS患者主胸段Cobb角与胸段凹侧多裂肌静息厚度、胸段凸侧竖脊肌收缩厚度变化率呈显著负相关关系（r=-0.53/-0.45，P＜0.05），腰段Cobb角与腰段凸凹侧竖脊肌、多裂肌的静息厚度及收缩厚度变化率均无明显相关关系（P＞0.05）。结论：中度S型AIS患者主胸弯凸侧与凹侧椎旁肌是存在不同的肌肉形态学改变，其中凹侧椎旁肌受侧凸畸形的影响更大；腰段双侧深层核心稳定肌收缩功能明显下降。浅层及深层椎旁肌萎缩及收缩力下降模式不同可能是AIS患者脊柱运动障碍和侧凸进展的关键病因。

英文摘要:

  【Abstract】 Objectives: To explore the morphological changes of the superficial and deep thoraolumbar paraspinal muscles on both convex and concave sides during rest and contraction states in patients with moderate adolescent idiopathic scoliosis(AIS), and their effects on scoliosis angle, to analyze the relations between scoliosis angle and the morphological changes of paraspinal muscles. Methods: 21 AIS patients(thoracic Cobb angle 20°-45°, S-shaped with the main curve in thoracic segment, 4 males and 17 females, aged 13.9±1.6 years old) treated in our hospital from July 2020 to December 2023 and 21 healthy subjects(7 males and 14 females, aged 14.6±1.4 years old) were prospectively enrolled. The morphological data of thoracolumbar paraspinal muscles were collected with musculoskeletal ultrasound, including the resting thickness and thickness during maximum voluntary isometric contraction(MVIC) of superficial erector spinae(ES) and multifidus(MF) muscles of AIS patients on both convex and concave sides(left and right sides of healthy controls). The differences in resting thickness, contraction thickness, change rate of contraction thickness, and total resting thickness and total contraction thickness(ES+MF) of superficial and deep thoracolumbar paravertebral muscles between the two groups were analyzed, and the structural characteristics of the thoracolumbar paravertebral muscles on the convex and concave sides of AIS were analyzed. The correlation between Cobb angle in thoracolumbar segment and morphological indexes(resting thickness, contraction thickness change rates) of ES and MF muscles was analyzed, and the influence of scoliosis severity on the morphology of superficial and deep paravertebral muscle was further analyzed. Results: In AIS patients, the mean thoracic Cobb angle were 31.62°±7.68°, and mean lumbar Cobb angle were 19.52°±6.48°. Comparing with healthy controls, patients with AIS were significantly different in resting thickness, contraction thickness and thickness change rates of thoracic paraspinal muscles on both convex and concave sides, and the resting thickness of ES in thoracic segment on concave side was less than that on the convex side, which of MF was less on the convex side than on the concave side(P<0.01). The contraction thickness of thoracic MF muscles on the convex and concave sides in S-type AIS patients was smaller than that in healthy controls(P<0.05), while the contraction thickness of thoracic ES muscles on the convex and concave side wasn′t statistically different from that of healthy con硴?慯湬摳?挠潡湮捤愠癴敨?猠楣摯敮獴?潡晣?瑩桯敮?浴慨楩湣?瑮桥潳牳愠捣楨捡?捧略爠癲敡??愠湯摦?瑅桓攠?捵潳湣捬慥癳攠?灮愠牴慨癥攠牣瑯敮扶牥慸氠?浮畤猠捍汆攠?楮猠?浨潥爠散?慮晣晡敶捥琠敳摩?扥礠?獦挠潴汨楯潲獡楣獩??味桥敧?捥潮湴琠物慮挠瑁楉潓渠?晡畴湩捥瑮楴潳渠?潡晳?瑳桩敧?扩楦汩慣瑡敮牴慬汹?摤敥散灲?捡潳牥敤?獐琼愰戮椰氵椩種椠湔杨?浲略猠捷污敳猠?楯渠?瑩桧敮?汦畩浣扡慮牴?牤敩杦楦潥湲?楮獣?洠慩牮欠整摨汥礠?摯整捡牬攠慲獥敳摴???椠晴晨敩牣敫湮瑥?灳愠瑯瑦攠牴湨獯?潡晣?獣用灣敯牮晶楥捸椠慡汮?愠湣摯?摣敡敶灥?洠異獡捲污敶?慲瑴牥潢灲桡祬?慭湵摳?捬潥湳琨牅慓挫瑍楆氩椠瑢祥?摷敥捥汮椠湁敉?洠慰祡?扩敥?慴?欠敡祮?挠慴畨獥攠?潯晲?獥灳楰湯慮汤?浮潧瘠敳浥敧湭瑥?摴楳猨潬牥摦整爠?慮湤搠?獩捧潨汴椩漠獯楦猠?灯牮潴杲牯敬猠獧楲潯湵?椨湐￣??匰‵瀩愬琠楡敮湤琠獴?ere was no statistically significant difference in the total resting thickness of thoracic paravertebral muscle between the convex and concave sides of AIS patients(P>0.05). The total contraction thickness of thoracic paravertebral muscle(ES+MF) in AIS patients was lower than that in control group(P<0.05). Compared with the control group, the resting thickness, contraction thickness and thickness change rate of lumbar MF muscle on the convex and concave sides in AIS patients were significantly reduced(P<0.05), and the contraction thickness change rate of the lumbar ES muscle on the concave side was less than that of the control group(P<0.05). There were no significant differences in resting thickness and contraction thickness between the convex and concave paravertebral muscles in AIS patients(P>0.05). The total resting thickness(ES+MF) and total contraction thickness(ES+MF) of lumbar(convex and concave) paraspinal muscles in AIS patients were lower than those in control group(P<0.05). There was a significant negative correlation between the Cobb angle of the main thoracic curve and the resting thickness of the thoracic MF muscle on the concave and the change rate of the contraction thickness of the thoracic ES muscle on the convex in S-type AIS patients(r=-0.53/-0.45, P<0.05). There was no significant correlation between the Cobb angle of lumbar segment and the change rates of the resting thickness and contraction thickness of ES and MF muscles on both convex and concave sides(P>0.05). Conclusions: In patients with moderate S-type AIS, there are different muscle morphological changes in the paraspinal muscles on both conve