成人退行性脊柱侧凸患者椎旁肌肉退变与顶椎旋转的关系

Relationship between degeneration of paravertebral muscles and rotation of apical vertebrae in patients with adult degenerative scoliosis

中文关键词:  成人退行性脊柱侧凸  多裂肌  竖脊肌  腰大肌  顶椎旋转

英文关键词:Adult degenerative scoliosis  Multifidus  Erector spinae  Psoas muscle  Rotation of apical vertebrae

中文摘要:

  【摘要】 目的：分析成人退行性脊柱侧凸（adult degenerative scoliosis，ADS）患者多裂肌、竖脊肌和腰大肌的退变与顶椎旋转的关系。方法：收集2017年1月～2019年7月在我院门诊就诊的ADS患者的临床资料，在顶椎层面MRI影像上测量并计算患者多裂肌、竖脊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（rCSA）、凹侧与凸侧脂肪化比例之比（rFSF）和顶椎旋转度（apical vertebra rotation，AVR）。采用配对样本t检验分析顶椎层面凹凸两侧多裂肌、竖脊肌和腰大肌CSA和FSF的差异，Pearson 相关分析分析肌肉影像学参数与AVR之间的相关性。结果：共纳入96例ADS患者，男18例，女78例；年龄64.64±7.18岁；腰椎前凸角20.19°±17.61°；Cobb角24.70°±10.41°；AVR 10.94°±6.47°，旋转方向均偏向侧凸凸侧。在顶椎层面，多裂肌、竖脊肌、腰大肌凹侧CSA均显著性大于凸侧（P<0.05），多裂肌凹侧FSF显著性大于凸侧（P<0.01），竖脊肌凸侧FSF显著性大于凹侧（P<0.05），腰大肌两侧FSF差异无统计学意义（P>0.05）。AVR与多裂肌凸侧CSA、腰大肌凸侧FSF呈显著性负相关（r=-0.225、-0.292，P<0.05），与多裂肌rCSA、竖脊肌rFSF呈显著性正相关（r=0.396、0.215，P<0.05）。结论：ADS患者脊柱侧凸顶椎两侧多裂肌、竖脊肌和腰大肌的退变与AVR显著相关，多裂肌、竖脊肌的退变可能参与顶椎的旋转。

英文摘要:

  【Abstract】 Objectives: To analyze the relationship between the degeneration of multifidus, erector spinae and psoas muscle and the rotation of apical vertebrae in patients with adult degenerative scoliosis(ADS). Methods: The clinical data of patients with ADS treated in our hospital from January 2017 to July 2019 was collected. The parameters of muscles at the level of the apex of the curvature, including cross-sectional area(CSA), fat saturation fraction(FSF), ratio of CSAconcave to CSAconvex(rCSA), ratio of FSFconcave to FSFconvex(rFSF) and apical vertebra rotation(AVR) were measured on lumbar magnetic resonance imaging(MRI). Paired-sample t-test was used to analyze the differences between the values of muscles on concave and convex sides. Pearson correlation was used to analyze the correlation between the values of the muscles and AVR. Results: A total of 96 patients(18 males and 78 females) were included, with an average age of 64.64±7.18 years old; lumbar lordosis angle 20.19°±17.61°; Cobb angle 24.70°±10.41°; AVR 10.94°± 6.47°, all directions of rotation toward the convex side of scoliosis. At the level of the apex of the curvature, CSAconcave of multifidus muscle, erector spinae and psoas muscle were significantly larger than CSAconvex (P<0.05). FSFconcave of multifidus muscle was significantly larger than FSFconvex(P<0.01). FSFconvex of erector spinae was significantly larger than FSFconcave(P<0.05). There was no significant difference between FSF on both sides of psoas muscle(P>0.05). AVR was negatively correlated with CSAconvex of multifidus muscle and FSFconvex of psoas muscle(r=-0.225, -0.292, P<0.05) and positively correlated with rCSA of multifidus muscle, rFSF of erector spinae(r=0.396, 0.215, P<0.05). Conclusions: There is a significant correlation between the parameters of multifidus,erector spinae and the psoas muscle and AVR in ADS patients. The degeneration of the multifidus muscle and the erector spinae may be involved in the rotation of the vertebrae.