表面肌电分析在特发性脊柱侧凸椎旁肌病变研究中的应用进展

Application progress of surface electromyography analysis in the study of paraspinal muscle diseases in patients with idiopathic scoliosis

中文关键词:  脊柱感染  穿刺活检  阳性率  影响因素

英文关键词:Spinal infections  Percutaneous biopsy  Positive rate  Influencing factors

中文摘要:

  特发性脊柱侧凸是一种发生在冠状面、矢状面和横断面的三维脊柱畸形，表现形式多种多样,会引起患者外形改变，导致疼痛、活动受限等症状，甚至丧失行动能力，为家庭、社会带来沉重的经济负担。这种脊柱畸形既会导致患者静态功能改变，如外形改变、平衡障碍；也会导致动态功能改变，如姿势、步态异常。特发性脊柱侧凸的发生发展是多因素综合作用的结果，但已有研究提出椎旁肌病变所导致的肌肉不平衡是其中重要因素。因此，准确评价椎旁肌功能变化，对于脊柱侧凸疾病的防治有着重要意义。国内外学者对椎旁肌进行了大量研究，方法包括肌肉组织活检、生化指标检测、影像学分析等。然而，相关文献对于椎旁肌病变是脊柱侧凸的致病因素还是侧凸所导致的继发改变尚无一致定论，需进一步研究以明确脊柱侧凸椎旁肌的病变机制。肌电信号作为人体神经肌肉活动的反应，其特征代表了肌肉功能状态的变化，可用于分析椎旁肌与脊柱侧凸疾病的相关性。表面肌电（surface electromyography, sEMG）是指将表面电极粘贴于目标肌肉的皮肤上，在神经肌肉的调控下收集一系列生物电信号，进而分析肌肉活动的兴奋性特征。表面肌电分析手段主要有时域分析和频域分析，时域分析是以积分肌电值（iEMG）、均方根值（RMS）等对动作过程中主要用力肌群、肌肉贡献率、肌肉之间的协调方式进行研究；频域分析是以中位频率（MF）、平均功率频率（MPF）等用于研究肌肉疲劳。表面肌电分析为我们进一步解释特发性脊柱侧凸椎旁肌病变提供了全新的视角，其作为能够直观反应肌肉功能状态的监测手段，有巨大的应用潜力，且相较于以上提及的其他研究手段，具有花费小、无侵入性及放射性、受试者接受度高等优势，该技术有望成为特发性脊柱侧凸疾病诊断、评估和治疗的重要工具。目前，国内外尚无关于表面肌电技术在特发性脊柱侧凸疾病中应用的总结性文献。本综述通过查阅国内外特发性脊柱侧弯疾病椎旁肌病变研究方面表面肌电分析技术应用的相关文献，总结其肌电信号特征，阐述了该技术在特发性脊柱侧凸基础研究和临床工作中的应用现状，并为进一步开展相关研究提供参考。

英文摘要:

  【Abstract】 Objectives: To calculate the positive bacterial culture rate of X-ray fluoroscopy-guided percutaneous biopsy in primary spinal infections and analyze the factors influencing the positive cultures. Methods: A total of 179 patients with primary spinal infections who underwent fluoroscopy-guided percutaneous biopsy in the Division of Spine Surgery of Nanfang Hospital and Orthopedics Department of Nanfang Hospital Zengcheng Branch from August 2018 to August 2021 were retrospectively reviewed, including 110 males and 69 females, aged 54.63±13.70 years old. Cases were divided into culture-positive group(n=100) and culture-negative group(n=79) based on culture results. The culture positive rate was calculated, and the factors including demographics, antibiotics intervention, clinical manifestation, laboratory examination, imaging data, biopsy procedure, blood culture, and histopathology examination were analyzed to determine the culture positive-related influencing facors by Logistic regression analysis. Results: The culture positive rate of biopsy was 56%. A total of 119 strains of 36 species of microorganisms were cultured from 100 puncture culture positive specimens, among which 81 strains(81%) were single microorganisms. The common microorganisms were Mycobacterium tuberculosis(n=24), Staphylococcus epidermis(n=16), Staphylococcus aureus(n=12), Escherichia coli(n=8), and Brucella(n=8). Logistic regression analysis showed that the level of CRP, biopsy site, biopsy level had no effect on the positive results of biopsy culture, while hypertension(OR 0.139, 95%CI: 0.038-0.500, P=0.003), antibiotics intervention(OR 0.221, 95%CI: 0.063-0.784, P=0.019), and paravertebral abscess(OR 8.495, 95%CI:1.623-44.479, P=0.011) were the influencing factors for positive biopsy cultures. Conclusions: The overall positive bacterial culture rate of fluoroscopy-guided percutaneous puncture biopsy in primary spinal infections is 56%, and hypertension, antibiotics intervention, and paravertebral abscess are the factors influencing the biopsy culture results.