成人退行性脊柱侧凸患者椎旁肌和腰大肌退变的不对称性及其与脊柱-骨盆冠状位参数的关系

Asymmetric degeneration of paravertebral muscle and psoas muscle in patients with adult degenerative scoliosis and its relationship with coronal spinopelvic parameters

中文关键词:  成人退行性脊柱侧凸  椎旁肌  腰大肌  冠状位失平衡

英文关键词:Adult degenerative scoliosis  Paravertebral muscle  Psoas muscle  Coronal imbalance

中文摘要:

  【摘要】 目的：分析成人退行性脊柱侧凸（adult degenerative scoliosis，ADS）患者椎旁肌（多裂肌、竖脊肌）和腰大肌退变的不对称性及其与脊柱-骨盆冠状位参数之间的关系，为ADS患者冠状位失平衡的评估和预测提供新的思路。方法：回顾性分析96例ADS患者，测量并计算患者腰椎MRI顶椎层面椎旁肌和腰大肌的横截面积（cross-sectional area，CSA）、脂肪化比例（fat saturation fraction，FSF）、凹侧与凸侧横截面积之比（ratio of CSAconcave to CSAconvex，rCSA）、凹侧与凸侧脂肪化比例之比（ratio of FSFconcave to FSFconvex，rFSF），并在脊柱全长X线片上测量冠状位影像学参数，包括冠状位Cobb角（coronal Cobb angle，CA）和冠状面平衡距离（coronal balance distance，CBD）。根据C7铅垂线（C7PL）与骶骨中垂线（CSVL）的相对位置，将22例CBD≥30mm的患者分为两组：A组（C7PL在凸侧边，13例）和B组（C7PL在凹侧边，9例）。采用配对样本t检验分析顶椎层面凹凸两侧椎旁肌和腰大肌CSA和FSF的差异、Pearson相关分析肌肉影像学参数与脊柱-骨盆冠状位参数之间的相关性。结果：在顶椎层面，多裂肌、竖脊肌、腰大肌、椎旁肌凹侧CSA均显著大于凸侧（P<0.05），多裂肌凹侧FSF显著大于凸侧（P<0.01），竖脊肌凸侧FSF显著大于凹侧（P<0.05），腰大肌、椎旁肌两侧FSF无统计学差异（P>0.05）。CA与多裂肌凸侧CSA、竖脊肌和椎旁肌双侧CSA呈负相关（r=-0.233、-0.346、-0.211、-0.387、-0.232，P<0.05），与多裂肌凹侧FSF、rCSA和椎旁肌rCSA呈正相关（r=0.360、0.424、0.259，P<0.05）。A组CBD与各个肌肉的影像学参数均无相关性（P>0.05）。B组CBD与竖脊肌凹侧CSA，腰大肌凹侧FSF，多裂肌、竖脊肌、腰大肌和椎旁肌rCSA，腰大肌rFSF呈正相关（r=0.720、0.768、0.720、0.752、0.738、0.721、0.893，P<0.05）。结论：ADS患者椎旁肌和腰大肌影像学参数与脊柱-骨盆冠状位参数有明显的相关性，其中多裂肌rCSA与CA的相关性最强，在CBD超过30mm且C7PL在凹侧边的ADS患者中腰大肌rFSF与CBD的相关性最强，表明椎旁肌和腰大肌能体现ADS患者在冠状位失衡的严重程度。

英文摘要:

  【Abstract】 Objectives: To analyze the asymmetric degeneration of paravertebral muscle and psoas muscle and its relationship with the radiological spinopelvic parameters in coronal plane in patients with adult degenerative scoliosis(ADS), so as to provide a new idea for the evaluation and prediction of coronal imbalance in patients with ADS. Methods: A retrospective analysis of 96 patients with ADS was performed. The muscle values at the apex level of the curvature, including cross-sectional area(CSA), fat saturation fraction(FSF), ratio of CSAconcave to CSAconvex(rCSA), ratio of FSFconcave to FSFconvex(rFSF) were measured on lumbar magnetic resonance imaging. The spinopelvic parameters, including coronal Cobb angle(CA) and coronal balance distance(CBD) were measured on standing radiograph of the entire spine. According to the relative position of C7PL and CSVL, patients with CBD≥30mm were divided into two groups: group A(C7PL on the convex side) and group B(C7PL on the concave side). Paired-sample t-test was used to analyze the difference between the values of muscles on concave and convex side. Pearson correlation was used to analyze the correlation between the asymmetric degeneration of the muscles and the coronal spinopelvic parameters. Results: At the apex level of the curvature, CSA of the multifidus muscle, erector spinae, psoas muscle, and paravertebral muscle on the concave side were significantly larger than those on the convex side(P<0.05). FSFconcave of the multifidus muscle was significantly larger than FSFconvex(P<0.01). FSFconvex of the erector spinae was significantly larger than FSFconcave(P<0.05). There was no significant difference between FSF of the psoas muscle and the paravertebral muscle on both sides(P>0.05). CA was negatively correlated with CSA convex of the multifidus muscle, bilateral CSA of the erector spinae and the paraspinal muscle(r=-0.233, -0.346, -0.211, -0.387, -0.232, P<0.05) and positively correlated with FSFconcave of the multifidus muscle, rCSA of multifidus muscle and paravertebral muscle(r=0.360, 0.424, 0.259, P<0.05). There was no correlation between CBD in group A(13 patients) and the values of each muscle(P>0.05). CBD in group B(9 patients) was positively correlated with CSAconcave of the erector spinae, FSFconcave of the psoas muscle, rCSA of the multifidus muscle, the erector spinae, the psoas muscle and the paravertebral muscle, rFSF of the psoas muscle(r=0.720, 0.768, 0.720, 0.752, 0.738, 0.721, 0.893, P<0.05). Conclusions: There is a significant correlation between the values of paravertebral and psoas muscle in the ADS patients and the spinopelvic coronal parameters. The rCSA of the multifidus muscle has the strongest correlation with CA, and the correlation between rFSF of the psoas muscle and CBD in patients with CBD≥30mm and C7PL on the concave side is the strongest. The paravertebral muscle and psoas muscle could reflect the degree of coronal imbalance of ADS patients.