椎旁肌退变与L5/S1峡部裂性腰椎滑脱程度的关系

The relationship between paraspinal muscle degeneration and L5/S1 isthmic spondylolisthesis

中文关键词:  峡部裂性腰椎滑脱  椎旁肌  脂肪浸润  横截面积

英文关键词:Isthmic spondylolisthesis  Paraspinal muscle  Fatty infiltration  Cross-sectional area

中文摘要:

  【摘要】 目的：探究椎旁肌退变与L5/S1峡部裂性腰椎滑脱程度的关系。方法：回顾性分析2020年1月1日~2023年12月31日郑州大学第一附属医院骨科收治的108例L5/S1双侧峡部裂患者的临床资料，其中女62例，男46例，年龄26~86（52.8±10.4）岁，所有患者腰椎侧位及动力位X线、腰椎CT和腰椎MRI等影像学资料完整。根据是否伴有滑脱及Meyerding分度将患者分为无滑脱组（28例）、Ⅰ度滑脱组（46例）和Ⅱ度滑脱组（34例）。在腰椎轴位MRI的L5下终板层面测量椎体横截面积（V CSA）、竖脊肌横截面积（ES CSA）、多裂肌横截面积（MF CSA）以及关节突关节角度（FJA），并计算平均关节突关节角度（mFJA）、多裂肌相对横截面积（MF rCSA）、竖脊肌相对横截面积（ES rCSA）、多裂肌脂肪浸润率（MF FIR）及竖脊肌脂肪浸润率（ES FIR）。比较三组间年龄、性别、体质指数（BMI）、病程、V CSA、mFJA、MF CSA、ES CSA、MF rCSA、ES rCSA、MF FIR以及ES FIR之间的差异，并使用有序Logistics回归分析年龄、性别、病程、BMI、mFJA、MF rCSA、ES rCSA、MF FIR、ES FIR等参数与峡部裂性腰椎滑脱程度的关系。结果：各组间年龄、体重、BMI、V CSA、mFJA无统计学差异（P>0.05）。无滑脱组女性患者（29%）占比显著低于Ⅰ度滑脱组（61%）和Ⅱ度滑脱组（76%）（P<0.05）；无滑脱组的身高（1.68±0.06m）相较于Ⅰ度滑脱组（1.64±0.75m）和Ⅱ度滑脱组（1.63±0.54m）更高（P<0.05），病程相较于Ⅰ度滑脱组和Ⅱ度滑脱组更短（P<0.05）。三组间MF CSA、MF rCSA以及ES FIR差异均无统计学意义（P>0.05），Ⅱ度滑脱组的ES CSA和ES rCSA（3183.2±1196.38mm2和2.14±1.11）显著高于Ⅰ度滑脱组（2579.28±896.56mm2和1.65±0.65）及无滑脱组（2401.40±742.98mm2和1.56±0.58）（P<0.05）；Ⅱ度滑脱组的MF FIR（40.70±14.05）%显著高于Ⅰ度滑脱组（30.39±12.98）%及无滑脱组（26.69±9.96）%（P<0.05）；Ⅰ度滑脱组与无滑脱组间ES CSA、ES rCSA和MF FIR差异无统计学意义（P>0.05）；有序Logistics回归分析结果显示，女性（OR=2.81，95%CI：1.120~7.062，P=0.028）及MF FIR增加（OR=1.044，95%CI：1.003~1.088，P=0.034）是峡部裂性腰椎滑脱程度加重的独立危险因素（P<0.05）。结论：滑脱程度较重的双侧峡部裂患者多裂肌脂肪浸润更严重，并且出现了竖脊肌的肥大，女性及MF FIR增加是峡部裂性腰椎滑脱程度加重的独立危险因素。

英文摘要:

  【Abstract】 Objectives: To investigate the relationship between paraspinal muscle degeneration and isthmic spondylolisthesis in L5/S1. Methods: The clinical data of 108 patients with L5/S1 bilateral isthmic spondylolysis admitted and treated at the Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University from January 1, 2020 to December 31, 2023 were retrospectively analyzed. There were 62 females and 46 males, aged 26-86(52.8±10.4) years. All the patients had complete imaging data, including lateral and dynamic lumbar X-ray, lumbar CT and lumbar MRI. According to the presence or absence of spondylolisthesis and Meyerding grading, the patients were divided into non-spondylolisthesis group(28 cases), grade Ⅰ spondylolisthesis group(46 cases) and grade Ⅱ spondylolisthesis group(34 cases). Vertebral body cross-sectional area(V CSA), erector spinae muscle cross-sectional area(ES CSA), multifidus muscle cross-sectional area(MF CSA), and facet joint angle(FJA) were measured at the inferior vertebral endplate of L5 vertebral body on the axial view of lumbar spine MRI. And the mean FJA(mFJA), relative MF CSA(MF rCSA), relative ES CSA(ES rCSA), fat infiltration rate of multifidus muscle(MF FIR) and fat infiltration rate of erector spinae muscle(ES FIR) were calculated. The differences in age, gender, body mass index(BMI), disease duration, V CSA, mFJA, MF CSA, ES CSA, MF rCSA, ES rCSA, MF FIR and ES FIR between the three groups were compared. Ordinal logistics regression was used to analyze the relationship between age, gender, disease duration, BMI, mFJA, MF rCSA, ES rCSA, MF FIR, ES FIR and the isthmic spondylolisthesis. Results: There were no statistical differences in age, body weight, BMI, V CSA, and mFJA between the three groups(P>0.05). The proportion of female patients in the non-spondylolisthesis group(29%) was significantly lower than that in grade Ⅰ spondylolisthesis group(61%) and grade Ⅱ spondylolisthesis group(76%)(P<0.05). The height of non-spondylolisthesis group(1.68±0.06m) was higher than that of grade Ⅰ spondylolisthesis group(1.64±0.75m) and grade Ⅱ spondylolisthesis group(1.63±0.54m)(P<0.05), and the disease duration in the non-spondylolisthesis group was shorter than that of grade Ⅰ spondylolisthesis group and grade Ⅱ spondylolisthesis group(P<0.05). There was no significant difference in MF CSA, MF rCSA and ES FIR between the three groups(P>0.05). ES CSA and ES rCSA in grade Ⅱ spondylolisthesis group(3183.2±1196.38mm2 and 2.14±1.11) were significantly greater than that in grade Ⅰ spondylolisthesis group(2579.28±896.56mm2 and 1.65±0.65) and non-spondylolisthesis group(2401.40±742.98mm2 and 1.56±0.58)(P<0.05). The MF FIR of grade Ⅱ spondylolisthesis group(40.70±14.05)% was significantly higher than that of grade Ⅰ spondylolisthesis group(30.39±12.98)% and non-spondylolisthesis group(26.69±9.96)%(P<0.05). There were no significant differences in ES CSA, ES rCSA and MF FIR between grade Ⅰ spondylolisthesis group and non-spondylolisthesis group(P>0.05). Ordinal logistics regression analysis showed that female(OR=2.81; 95%CI: 1.120-7.062; P=0.028) and increased MF FIR(OR=1.044; 95%CI: 1.003-1.088; P=0.034) were the independent risk factors for the progression of isthmic spondylolisthesis(P<0.05). Conclusions: Patients with a higher degree of isthmic spondylolisthesis have more severe fat infiltration of multifidus muscle and hypertrophy of erector spinae muscle. Female and increased MF FIR are independent risk factors for the progression of isthmic spondylolisthesis.