退变性腰椎侧凸两侧椎旁肌的影像学差异及其临床意义

摘要

目的 观察退变性腰椎侧凸两侧椎旁肌的影像学变化,分析其影响因素及临床意义.方法 采用回顾性研究的方法,选取2004年4月至2011年8月66例退变性腰椎侧凸患者为研究对象(侧凸组),确诊为腰椎管狭窄症并且资料齐全的66例患者为腰椎管狭窄组,于我院体检的资料齐全的健康者66例为对照组；三组间性别、年龄、体质量指数匹配.应用Image J软件测量3组MRIT2WI上L1～S1椎间盘水平两侧椎旁肌横截面积和脂肪浸润百分比.所测数据应用配对t检验进行统计学分析.结果 侧凸组有双侧神经根症状的患者中,凸侧和凹侧多裂肌脂肪浸润百分比在L1～2、L2-3、L3～4、L4 ～5、L5～S1水平分别为18％±4％、21％±4％、27％±4％、34％±6％、42％±10％和25％±8％、30％±7％、35％±7％、40％±10％、44％±8％,两者差异有统计学意义(t=7.95、9.30、5.35、2.78、2.38,P＜0.05)；凸侧和凹侧最长肌脂肪浸润百分比在L3～4、L4～5水平分别为25％±9％、28％±8％和27％±9％、31％±9％,两者差异有统计学意义(t=2.52和3.48,P＜0.05)；两侧多裂肌和最长肌横截面积之间差异无统计学意义(P＞0.05).侧凸组有单侧神经根症状的患者中,凸侧和凹侧多裂肌脂肪浸润百分比在L1～2、L2～3、L3～4、L4～5、L5～S1水平分别为18％±5％、23％±5％、29％±5％、34％±6％、42％±9％和23％±6％、30％±7％、36％±7％、41％±10％、45％±8％,两者差异有统计学意义(t =6.67、7.96、6.43、3.86、2.15,P＜0.05)；两侧多裂肌横截面积、两侧最长肌横截面积及其脂肪浸润百分比之间差异无统计学意义(P＞0.05).结论 退变性腰椎侧凸两侧椎旁肌存在不对称性退变,凹侧大于凸侧；脊柱畸形和神经根压迫可能是引起椎旁肌不对称性退变的重要因素；椎旁肌不对称性退变对判断脊柱侧凸的进展具有潜在的临床意义.%Objectives To investigate the radiological change of bilateral paravertebral muscles in degenerative lumbar scoliosis (DLS) and analyze its clinical significance.Methods As a retrospective study,66 patients with DLS and 66 patients with lumbar spinal stenosis were retrospectively enrolled from April 2004 to August 2011 as scoliosis group and lumbar spinal stenosis group,meanwhile 66 health persons with no lumbar spinal stenosis were selected as control group.No significant differences were found in the gender,age and body mass index among the three groups.The cross-sectional area(CSA) and percentage of fat infiltration area (FIA) of the bilateral paravertebral muscles at the L1-S1 levels were measured using T2-weighted axial MRI and Image J software.The measured data were analyzed with a paired t-test.Results In the DLS with bilateral symptom group,the mean percentage of FIA of the multifidus muscle on the convex side were 18％ ±4％,21％ ±4％,27％ ±4％,34％ ±6％,42％ ± 10％ and on the concave side were 25％ ±8％,30％ ±7％,35％ ±7％,40％ ± 10％,44％ ±8％ at L1-2,L2-3,L3-4,L4-5 and L5-S1 levels,which showed significant differences between the convex side and the concave side (t =7.95,9.30,5.35,2.78,2.38,P ＜0.05) ;the mean percentage of FIA of the longissimus muscle on the convex side were 25％ ±9％,28％ ±8％ and on the concave side were 27％ ± 9％,31％ ± 9％ at L3-4,L4-5 levels,which showed significant differences between the convex side and the concave side(t =2.52,3.48,P ＜ 0.05).There were no significant differences in the CSA of both muscles between the concave and convex sides (P ＞ 0.05).In the DLS with unilateral symptom group,the mean percentage of FIA of the multifidus muscle on the convex side were 18％ ±5％,23％ ±5％,29％ ±5％,34％ ±6％,42％ ±9％ and on the concave side were 23％ ±6％,30％ ±7％,36％ ±7％,41％ ± 10％,45％ ± 8％ at L1-2,L2-3,L3-4,L4-5 and L5-S1 levels,which showed significant differences between the convex side and the concave side (t =6.67,7.96,6.43,3.86,2.15,P ＜ 0.05).There were on significant differences in the CSA of both muscles,and in the percentage of FIA of the longissimus between the concave and convex sides (P ＞ 0.05).Conclusions There exist asymmetric degeneration in paravertebral muscle in DLS,which have potential clinical importance on the evaluation of curve progression,and muscle degeneration is more often seen in the concave side.Spinal deformity and radiculopathy may contribute to the paravertebral muscle degeneration.