慢性非特异性腰痛患者腰椎椎旁肌脂肪浸润比与腰椎-骨盆参数的相关性

Relationship between paraspinal muscle fat infiltration ratio and lumbar-pelvic parameters in patients with chronic non-specific low back pain

中文关键词:  慢性非特异性腰痛  脂肪浸润比  腰椎-骨盆参数

英文关键词:Chronic non-specific low back pain  Fat infiltration ratio  Lumbar-pelvic parameters

中文摘要:

  【摘要】 目的：比较双侧和单侧慢性非特异性腰痛（chronic non-specific low back pain，CNLBP）患者不同节段腰椎椎旁肌脂肪浸润比和腰椎-骨盆参数，并探讨两者间的关系。方法：纳入28例双侧CNLBP患者（A组）、20例单侧CNBLP患者（B组）和20例非腰痛志愿者（C组）。在腰椎MRI上获取L3/4、L4/5、L5/S1三个节段椎旁肌的脂肪浸润比（FIR）和脂肪浸润比的不对称性（FIRasy），在站立位X线片上测量腰椎-骨盆参数：冠状面骨盆倾斜角（pelvic obliquity，PO）、腰椎前凸角（lumbar lordosis，LL）、骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic titl，PT）和骶骨倾斜角（sacral slope，SS）。观察三组腰椎椎旁肌FIR表现，比较CNLBP患者与对照组椎旁肌FIR的差异和单、双侧CNLBP患者腰椎-骨盆参数的差异；用Pearson相关性分析CNLBP患者椎旁肌FIR与腰椎-骨盆参数的相关性。结果：三组年龄、性别比和体重指数（BMI）无显著性差异（P>0.05），具有可比性。A组L4/5、L5/S1左右两侧腰大肌FIR、L4/5左右两侧竖脊肌FIR有统计学差异（P<0.05）；B组痛侧与非痛侧FIR比较无统计学差异（P>0.05）；相较于C组，A、B组多裂肌FIR更高（P<0.05）。A组与B组的PO、LL、PI、PT、SS均无统计学差异（P>0.05）。A组LL与L3/4左侧腰大肌的FIR、L5/S1腰大肌的FIRasy存在负相关（r=-0.460、 -0.425，P<0.05），与L3/4多裂肌的FIRasy存在正相关（r=0.459，P<0.05）；SS与L3/4左侧腰大肌的FIR存在负相关（r=-0.496，P<0.05）。B组PI、PT与L5/S1腰大肌的FIRasy均呈正相关（r=0.490、0.516，P<0.05）；LL、SS与L4/5竖脊肌的FIRasy均呈正相关（r=0.503、0.523，P<0.05）。结论：CNLBP患者的多裂肌表现出更高的脂肪浸润，单侧和双侧CNLBP患者腰椎旁肌FIR的对称性表现差异和不对称的脂肪化（左右两侧腰椎旁肌FIR的差值）与腰椎-骨盆矢状面参数具有显著相关性。

英文摘要:

  【Abstract】 Objectives: To compare and explore the relationship between the lumbar paraspinal muscle fatty infiltration ratio(FIR) and lumbar-pelvic parameters of unilateral and bilateral chronic non-specific low back pain(CNLBP). Methods: A total of 28 patients with bilateral CNLBP(group A), 20 patients with unilateral CNLBP(group B), and 20 volunteers without low back pain(group C) were included. The FIR and FIR asymmetry(FIRasy) of paraspinal muscles in L3/4, L4/5 and L5/S1 segments were measured on lumbar MRI. Lumbar-pelvic parameters were measured on standing radiographs, including coronal pelvic obliquity(PO), lumbar lordosis(LL), pelvic incidence(PI), pelvic tilt(PT) and sacral tilt(SS). The muscle FIRs in patients with unilateral and bilateral CNLBP were observed, and the differences of FIRs between CNLBP and control group were compared. Meanwhile the differences of lumbar-pelvic parameters between two groups with CNLBP were also compared. The correlation between FIR and lumbar-pelvic parameters was analyzed by Pearson correlation. Results: There was no significant difference in age, gender ratio and body mass index(BMI) among the three groups(P>0.05). In group A, there were significant differences in the FIR of psoas major(PM) muscle on the left and right sides of L4/5, L5/S1 and FIR of L4/5 erector spines(ES)(P<0.05). In group B, the FIRs between painful and non-painful sides were not significantly different(P>0.05). Compared with group C, the FIR of multifidus(MF) in group A and B was higher(P<0.05). There was no significant difference in PO, LL, PI, PT, SS between group A and group B(P>0.05). In group A, LL was negatively correlated with FIR of L3/4 left PM and FIRasy of L5/S1 PM(r=-0.460, -0.425, P<0.05), and positively correlated with FIRasy of L3/4 MF(r=0.459, P<0.05); SS was negatively correlated with FIR of L3/4 left PM(r=-0.496, P<0.05). In group B, PI and PT were positively correlated with FIRasy of L5/S1 PM(r=0.490, 0.516, P<0.05); LL and SS were positively correlated with FIRasy of L4/5 ES(r=0.503, 0.523, P<0.05). Conclusions: CNLBP patients showed higher fatty infiltration in multifidus muscle. The FIR symmetry of lumbar paraspinal muscles was different in unilateral and bilateral CNLBP patients. And there was a certain correlation between the asymmetrical fatty of lumbar paraspinal muscles and the lumbar-pelvic findings in the sagittal plane.