椎旁肌横截面积变化可导致退行性腰椎滑脱

摘要

背景：近年来，关节突关节形态在退变性腰椎滑脱症发病中所起的作用是讨论的焦点，但多集中于关节角及骨关节炎 CT 表现的研究。有研究表明椎旁肌横截面积的变化被认为可能是退行性腰椎滑脱的病理学诊断的重要标志，但既往的研究由于样本量偏小、研究对象的年龄较小以及测量等诸多问题限制了其结论的准确性。　　目的：观察退变性腰椎滑脱两侧椎旁肌的MRI影像学变化。　　方法：采用回顾性研究方法，选取退行性腰椎滑脱的患者80例作为腰椎滑脱组，选取健康者80例作为对照组。应用Image J软件测量两组MRI T2加权像上L 3-5椎体下终板水平两侧竖脊肌和腰大肌的横截面积，并计算相关数据的比值。　　结果与结论：与对照组相比，腰椎滑脱组同侧并同水平椎旁肌的横截面积比值增高(P<0.05)，同水平左右腰大肌横截面积的均值减小(P <0.05)，同水平左右竖棘肌横截面积的均值差异均无显著性意义(P >0.05)。结果说明，椎旁肌横截面积的变化可导致退行性腰椎滑脱，可考虑其作为退行性腰椎滑脱的诊断标准。%BACKGROUND:Recently, the effects of lumbar facet joint morphology on the onset of degenerative lumbar spondylolisthesis have been a discussion point. However, the discussion mainly concerned CT manifestations of joint angle and osteoarthritis. Studies have shown that the changes in cross-sectional area of paraspinal muscle were considered as the essential marker for the pathological diagnosis of degenerative lumbar spondylolisthesis. However, previous studies limited the accuracy of the conclusion due to smal sample size, young age, and measurement. OBJECTIVE:To observe changes in MRI images of bilateral paraspinal muscles after degenerative lumbar spondylolisthesis. METHODS:This study adopted the method of retrospective study, selected 80 cases of degenerative lumbar spondylolisthesis as lumbar spondylolisthesis group, and 80 healthy persons as control group. Image J software was utilized to measure cross-sectional areas of bilateral erector spinae and psoas major muscle on the L 3-5 vertebral endplate levels using T2-weighted MRI in both groups. The ratio of relevant data was calculated. RESULTS AND CONCLUSION:Compared with the control group, the ratio of cross-sectional area of paraspinal muscle was increased on the same side and the same level in the lumbar spondylolisthesis group (P<0.05), and the mean value of cross-sectional area of bilateral psoas major muscle was decreased on the same level (P<0.05). No significant difference in the mean value of cross-sectional area of left and right erector spinae was detected on the same level (P>0.05). Results indicated that the changes in cross-sectional area of paraspinal muscle could induce degenerative lumbar spondylolisthesis, and could be considered as a diagnostic standard for degenerative lumbar spondylolisthesis.