退变性腰椎滑脱患者腰部多裂肌退变与腰背痛的相关性研究

摘要

目的 分析退变性腰椎滑脱患者腰椎多裂肌退变程度与其视觉模拟疼痛评分(visual analogue score,VAS)以及Oswestry功能障碍指数(Oswestry disability index,ODI)的相关性.方法 回顾性分析64例患者,男性24例,女性40例;年龄45～84岁,平均(63.02±10.59)岁.通过腰椎MRI测量患者两侧多裂肌平均横截面积与第5腰椎椎体横截面积比值,通过多裂肌内脂肪浸润面积比例将患者分为0、1、2、3共四级,将0、1级患者分为A组,2、3级为B组,并对两组间VAS及ODI评分进行比较,对多裂肌萎缩程度 、脂肪浸润分级与VAS、ODI评分进行相关性分析.结果 64例患者多裂肌萎缩值平均为(0.78±0.05).多裂肌脂肪浸润分级为:0级6例,1级11例,2级20例,3级27例.所有患者VAS评分平均(5.3±1.4)分,ODI评分平均(47.1±13.5)％.A组VAS评分平均(4.7±1.9)分,ODI评分平均(33.7±8.6)％.B组VAS评分平均(5.8±1.4)分,ODI评分平均(53.2±9.3)％.A组VAS评分低于B组(P=0.016),A组ODI评分也低于B组(P=0.009).多裂肌萎缩值与VAS及ODI评分具有负相关性(r=-0.43,P=0.024;r=-0.49,P=0.004),而脂肪浸润分级与VAS及ODI评分具有正相关性(r=0.53,P=0.019;r=0.44,P=0.015).结论 退变性腰椎滑脱患者多裂肌退变程度与腰背痛程度存在相关性.严重的多裂肌退变程度预示着更严重的腰背痛及功能障碍.%Objective To analysis the correlation between lumbar multifidus muscle degeneration and Visual Ana-logue Score(VAS) ,Oswestry disability index(ODI) in degenerative lumbar spondylolisthesis patients .Methods A total of 64 patients(24 males ,40 females) with a mean age of (63 .02 ± 10 .59) years(range ,45 ～ 84 years) was included in this retrospective study .The mean cross-sectional area of lumbar multifidus muscle on both sides and the cross-sectional area of the fifth lumbar vertebra were measured on the MRI imaging and then the ratio was calculated .The severity of the fatty infiltration was also evaluated by MRI and 4 different degrees(grade 0 ,1 ,2 ,3)were determined .Patients were divided into two groups :group A(grade 0 or 1) and group B(grade 1 or 2) .The VAS and ODI were cornpared between two groups .The correlations between the atrophy ,fatty infiltration of multifidus muscle and VAS ,ODI were analyzed . Results The mean ratio of multifidus muscle atrophy of all 64 cases was (0 .78 ± 0 .05) .The fatty infiltration of grade 0 ,1 ,2 and 3 in multifidus muscle were observed in 6 ,11 ,20 and 27 patients respectively .The mean VAS and ODI of all patients was (5 .3 ± 1 .4) and (47 .1 ± 13 .5)％ .Patients in group A had significantly lower VAS and ODI than those in group A (P = 0 .016 and 0 .009) .There was negative correlation between the ratio of multifidus muscle atrophy and VAS ,ODI(r = - 0 .43 ,P = 0 .024 ;r = - 0 .49 ,P = 0 .004) .Meanwhile ,positive correlation was observed between the fat-ty infiltration and VAS ,ODI(r = 0 .53 ,P = 0 .019 ;r = 0 .44 ,P = 0 .015) .Conclusion There is a correlation between the severity of lumbar multifidus muscle degeneration and low back pain in patients with degenerative lumbar spondylolis -thesis .The more severe of lumbar multifidus muscle degeneration indicates more severe low back pain and disability .