目的 探讨退变性腰椎滑脱患者多裂肌萎缩程度与腰椎滑脱程度和Oswestry功能障碍指数（ODI）的相关性。方法 回顾性评估了上海市第一人民医院2017年2月—2019年12月收治的62例退变性腰椎滑脱患者,所有患者均拍摄腰椎正侧位X线片和腰椎MRI检查,使用图像处理软件Image Pro Plus计算滑脱节段和滑脱相邻节段的双侧多裂肌总横断面积和多裂肌净横截面积,计算两者比值以评估多裂肌萎缩程度,（数值越小表明多裂肌萎缩程度越重）。结果 退变性腰椎滑脱患者退变节段多裂肌萎缩程度比相邻正常节段增加5.5%,差异有统计学意义（t=2.826, P=0.008）;退变性腰椎滑脱患者Ⅱ度滑脱多裂肌萎缩程度比Ⅰ度滑脱增加6.9%,差异有统计学意义（t=2.236, P=0.027）;退变性腰椎滑脱患者ODI评分平均为（42.7±3.6）%,退变性腰椎滑脱患者多裂肌萎缩程度与ODI评分存在正相关。结论 多裂肌退变程度可能参与了退变性腰椎滑脱的进程,退变性腰椎滑脱患者多裂肌萎缩程度与腰椎滑脱程度和腰椎功能障碍存在正相关。
Objective To investigate the correlations of multifidus atrophy extert with lumbar spondylolisthesis extert and Oswestry Disability Index （ODI） in degenerative lumbar spondylolisthesis patients. Methods A total of 62 patients with lumbar degenerative spondylolisthesis were retrospectively analyzed in Shanghai General Hospital from February 2017 to December 2019. Each patient underwent lumbar X-ray and lumbar MRI examinations. Image Pro Plus software was used to calculate the ratio of fat-free multifidus muscle cross sectional area to total multifidus muscle cross sectional area in slipped segments and non-slipped segments, and a smaller ratio indicated more severe atrophy. Results The ratio of fat-free multifidus muscle cross sectional area to total multifidus muscle cross sectional area in degenerative segments was 5.5% higher than the value in non-degenerative segments of the degenerative lumber spondylolisthesis patients （t=2.826, P=0.008）. The ratio in Ⅱ degree spondylolisthesis segments was 6.8% higher than that in Ⅰ degree spondylolisthesis segments （t=2.236, P=0.027）. The mean ODI of the selected participants was （42.7±3.6）%. The degree of multifidus atrophy was positively correlated with the ODI value. Conclusion Degenerative multifidus muscle may be involved in the development of degenerative lumbar spondylolisthesis. The degree of multifidus atrophy is correlated with the degree of spondylolisthesis and lumber dysfunction.
[1] Gille O, Bouloussa H, Mazas S, et al.A new classification system for degenerative spondylolisthesis of the lumbar spine[J]. Eur Spine J, 2017,26(12):3096-3105.
[2] 李毅嵩,王庆敏,吴志君,等.微创及传统开放手术治疗腰椎退行性疾病临床比较[J].外科研究与新技术,2017,6(4):253-255.
[3] 周林杰,杨民,郑伟伟,等.退变性腰椎滑脱中腰椎-骨盆结构参数的特点分析[J].中国骨伤,2020,33(9):862-866.
[4] Chang Y, Zhou F, Fei L, et al.The effect of preoperative degenerative spondylolisthesis on postoperative outcomes of degenerative lumbar spinal stenosis: a single-center cohort study protocol[J]. Medicine (Baltimore), 2020,99(45):e22355.
[5] 刘华柳. 经皮椎体成形术治疗骨质疏松性椎体压缩骨折的疗效和安全性评价[J].外科研究与新技术,2019,8(4):223-226.
[6] Shahidi B, Hubbard JC, Gibbons MC, et al.Lumbar multifidus muscle degenerates in individuals with chronic degenerative lumbar spine pathology[J]. J Orthop Res, 2017,35(12):2700-2706.
[7] Ogon I, Takebayashi T, Takashima H, et al.Quantitative analysis concerning atrophy and fat infiltration of the multifidus muscle with magnetic resonance spectroscopy in chronic low back pain[J]. Spine Surg Relat Res, 2019,3(2):163-170.
[8] 迟鹏飞,王征,吴兵,等.成人退行性脊柱侧凸患者椎旁肌和腰大肌退变的不对称性及其与脊柱-骨盆冠状位参数的关系[J].中国脊柱脊髓杂志,2020,30(1):1-7.
[9] 王超兰,朱天民.腰椎术后骶髂关节源性下腰痛发病机制及临床治疗[J].外科研究与新技术,2018,7(1):61-64.
[10] 韩耕愚,姜宇,李危石.不同影像学参数在评估腰部椎旁肌退变中应用的研究进展[J].中国脊柱脊髓杂志,2020,30(6):566-571.
[11] 戴凯峰,黄永础,蔡雅丽,等.MRI技术在腰椎间盘突出症中对脊柱多裂肌的定量分析[J].岭南现代临床外科,2020,20(1):62-66.
[12] Kalichman L, Klindukhov A, Li L, et al.Indices of paraspinal muscles degeneration: reliability and association with facet joint osteoarthritis: feasibility study[J]. Clin Spine Surg, 2016,29(9):465-470.
[13] 张剑刚,丁文元,申勇,等.解剖学因素在退变性腰椎滑脱发生中的意义[J].中国脊柱脊髓杂志,2012,22(5):443-447.
[14] 谭永胜. Mulligan动态关节松动术联合肌肉能量技术在神经根型颈椎病治疗中的应用[J].外科研究与新技术,2020,9(2):78-81.
[15] 程大为,葛鹏,申才良,等.磁共振成像下退变性腰椎滑脱不同节段多裂肌改变的研究[J].中国矫形外科杂志,2016,24(13):1164-1169.
[16] Hodges P, Holm AK, Hansson T, et al.Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury[J]. Spine (Phila Pa 1976), 2006,31(25):2926-2933.
[17] 刘芳,敖丽娟.核心肌稳定性训练对腰痛康复治疗的意义[J].中国康复医学杂志,2017,32(2):231-234.
[18] Khalifa AH, Stubig T, Meier O, et al.Dynamic stabilization for degenerative diseases in the lumbar spine: 2 years results[J]. Orthop Rev (Pavia), 2018,10(1):7534.
