退行性脊柱侧凸患者椎旁肌退变与脊柱-骨盆参数的关系

Analysis of correlation between paravertebral muscle degeneration and radiological parameters in patients with adult degenerative scoliosis

中文关键词:  退行性脊柱侧凸  椎旁肌  矢状位平衡

英文关键词:Adult degenerative scoliosis  Paravertebral muscle  Sagittal balance

中文摘要:

  【摘要】 目的：分析退行性脊柱侧凸（adult degenerative scoliosis，ADS）患者椎旁肌（多裂肌、竖脊肌）MRI影像退变程度与脊柱-骨盆参数之间的关系，为ADS患者矢状位失平衡评估提供新的线索。方法：回顾性分析在我院就诊的女性ADS患者52例，年龄55～65岁，收集患者人口统计学资料，分别测量患者腰椎MRI上L1~S1椎间盘层面椎旁肌（多裂肌、竖脊肌）横截面积（cross-sectional area，CSA）、脂肪化比例（fat saturation fraction，FSF），并在患者脊柱全长X线片上测量冠状位和矢状位的影像学参数，包括冠状位Cobb角、矢状位垂直偏距（sagittal vertical axis，SVA）、胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）、骨盆倾斜角（pelvic tilt，PT）、骨盆入射角（pelvic incidence，PI）、骶骨倾斜角（sacral slope，SS）、PI-LL，对椎旁肌L1~S1各层面FSF行单因素方差分析并进行LSD事后多重比较，利用Pearson相关分析比较椎旁肌退变程度和脊柱-骨盆参数之间的关系。结果：L1~S1各层面FSF有显著性差异（P<0.01），L5/S1层面椎旁肌FSF明显大于其他层面（P<0.05）。冠状位Cobb角与L1/2、L2/3、L3/4、L4/5椎间盘层面CSA呈负相关（r=-0.358、-0.367、-0.329、-0.283，P<0.05）。椎旁肌FSF与PT在L1~S1各层面呈正相关（r=0.487、0.394、0.354、0.356、0.355，P<0.05），而与SS呈负相关（r=-0.494、-0.440、-0.373、-0.301、-0.300，P<0.05）。椎旁肌FSF与LL在L1/2、L2/3层面呈负相关（r= -0.398、-0.328，P<0.05）。椎旁肌总体FSF（TFSF）与PT呈正相关（r=0.395，P<0.01），与LL呈负相关（r=-0.345，P<0.05）。L1~S1各层面椎旁肌CSA、FSF与SVA、PI、TK的Pearson相关分析结果无统计学意义（P>0.05）。BMI与L1~S1各层面椎旁肌CSA呈正相关（P<0.05），而与椎旁肌各层面FSF的Pearson相关分析结果无统计学意义（P>0.05）。结论：在ADS患者中，椎旁肌FSF与PT有明显的正相关性，提示椎旁肌的退变可能参与了脊柱退变和代偿机制的过程，椎旁肌FSF可能反映了ADS患者矢状位失平衡的严重程度。

英文摘要:

  【Abstract】 Objectives: To analyze the correlation between degeneration of paravertebral muscles(multifidus and erector spinalis) and the radiological parameters of coronal and sagittal planes in patients with adult degenerative scoliosis(ADS), so as to provide new clues for sagittal imbalance evaluation of ADS patients. Methods: 52 female patients with ADS, aged 55-65 years, were retrospectively collected. Their demographic data were recorded. The cross-sectional area(CSA) and fat saturation fraction(FSF) of paravertebral muscles (multifidus and erector spinalis) at the L1-S1 intervertebral disc level on lumbar magnetic resonance images were measured. The radiological parameters [coronal Cobb angle; sagittal: sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), pelvic tilt(PT), pelvic incidence(PI), sacral slope(SS), PI-LL] were measured. One-way ANOVA was used to analyze FSF at L1-S1 levels of paraspinal muscles, and multiple post-LSD comparisons were made. Pearson correlation analysis was used to compare the relationship between paraspinal muscle degeneration and radiological parameters. Results: There were significant differences in FSF among L1-S1 levels(P<0.01). The FSF of paraspinal muscles at L5/S1 level was significantly higher than that at other levels(P<0.05). Coronal Cobb angle was negatively correlated with CSA at L1/2, L2/3, L3/4, L4/5 levels (r=-0.358, -0.367, -0.329, -0.283, P<0.05). The FSF of paraspinal muscles was positively correlated with PT at all levels of L1-S1(r=0.487, 0.394, 0.354, 0.356, 0.355, P<0.05), but negatively correlated with SS(r= -0.494, -0.440, -0.373, -0.301, -0.300, P<0.05). There was a negative correlation between FSF and LL at L1/2, L2/3 level(r=-0.398, -0.328, P<0.05). Total FSF(TFSF) was positively correlated with PT (r=0.395, P<0.01) and negatively correlated with LL(r=-0.345, P<0.05). There was no statistical significance in Pearson correlation analysis among CSA, FSF and SVA, PI and TK at all levels(P>0.05). BMI was positively correlated with CSA of paravertebral muscles at L1-S1 levels(P<0.05), but there was no statistical significance in Pearson correlation analysis between BMI and FSF(P>0.05). Conclusions: FSF of paravertebral muscles is positively correlated with PT in patients with ADS. Paravertebral muscle degeneration might be involved in the process of spinal degeneration and compensatory mechanism. FSF could potentially be used as an indicator to evaluate the severity of sagittal imbalance in ADS patients.