脊柱

腰椎管狭窄患者腰多裂肌影像学改变与临床相关性

    介绍：脊柱旁肌肉的脂肪浸润（Fatty infiltration，FI）已证实与慢性腰背痛相关。对于椎管狭窄患者，脊柱旁肌肉的容量与临床症状的相关性已经被证实。本研究重在研究腰椎管狭窄患者腰多裂肌影像学改变、功能改变与临床相关性

    方法：70例L45椎管狭窄患者，无机械性背痛或节段性不稳被入组。记录并分析年龄，性别，BMI，累及节段数，症状持续时间。评估L45椎间水平位MRI。在L45水平，多裂肌脂肪浸润适用T1加权MRI评估。相对的多裂肌水平位区域（Relative cross-sectional area，RCSA）定义为多裂肌与同侧腰大肌的比。使用JOA评分评估功能表现。

    结果：当性别为男性时，有更大的RCSA，年龄大于60岁与更多的FI相关联(p<0.01)。FI和RCSA与BMI，累及节段数，症状持续时间都无关联。FI越大，JOA评分中得运动障碍和膀胱功能越差(p<0.05)。RCSA越小，JOA评分中于东障碍，平躺时翻身，淋雨，身体前倾和膀胱功能越差(p<0.05)。

    结论与讨论：腰多裂肌的FI与患者慢性下腰背痛存在相关性。但与功能表现的相关性没有建立。在本研究中RCSA首次得到描述，它独立于不同的BMI和影像学形态。本研究结果对于腰椎管狭窄患者存在不同的生活治疗和预后提供有用的信息和解释。

 

INTRODUCTION

Fatty infiltration (FI) of paraspinal muscles has been correlated to chronic back pain in severity. The clinical role of paraspinal muscle volume in patients with spinal stenosis has yet been clarified. This study focused on the clinical correlations of image changes of multifidus lumborum to functional performance in patients with lumbar stenosis.
METHODS

Seventy patients diagnosed as lumbar stenosis at L4-5 level without mechanical back pain or segmental instability were included. Age, sex, body mass index (BMI), number of level involved, and symptom duration were recorded and analyzed. Cross-section MRI images of L4-5 intervertebral level were evaluated. FI of multifidus lumborum was evaluated using T1-weighted MRI images. Relative cross-sectional area (RCSA) of multifidus lumborum was defined as the ratio of multifidus to ipsilateral psoas muscle at L4-5 level. Functional performance was evaluated with Japanese Orthopedic Association score (JOA score).
RESULTS

Age more than 60 was correlated with more FI (p<0.01) while male gender was correlated with larger RCSA (p<0.01). FI and RCSA were neither correlated with BMI, number of level involved, nor symptom duration. More FI was correlated with poorer JOA score in motor disturbance and urinary bladder function (p<0.05). Smaller RCSA was correlated with poorer JOA score in motor disturbance, turn-over when lying, taking shower, leaning forward, and urinary bladder function (p<0.05).
DISCUSSION AND CONCLUSIONFI

in multifidus lumborum has been correlated with patients with chronic low back pain, but its correlation with functional performance has not been established. RCSA was first described in this study and was independent to different BMI and image modalities. The result of this study may provide useful information for explanation of different life quality and treatment outcome in patients with lumbar stenosis.