单侧腰椎间盘突出症患者多裂肌退变的MRI指标与临床指标的相关性

关键词：腰椎间盘突出症  多裂肌退变  磁共振成像指标  临床指标  相关性

Keywords:lumbar disc herniation  multifidus degeneration  MRI indicators  clinical features  correlation

摘要：

      摘要 目的：分析单侧腰椎间盘突出症患者多裂肌退变的磁共振成像（magnetic resonance imaging，MRI）指标与临床指标的相关性。 方法：回顾分析我院2018年1月至2021年12月收治的临床资料完整的单侧腰椎间盘突出症患者，共筛选出符合条件的患者86例。根据腰椎间盘突出节段和数量分成3组：A组27例为单纯L4/5椎间盘突出组，B组30例为单纯L5/S1椎间盘突出组，C组29例为多节段腰椎间盘突出组，所有患者均进行腰椎MRI平扫检查，测量指标包括L4/5、L5/S1水平多裂肌健侧和患侧总横截面积比值、双侧多裂肌肌肉萎缩程度和脂肪浸润比例，从病历资料中获取腰椎间盘突出患者腰部视觉模拟评分（visual analogue scale，VAS）、Oswestry残疾指数（oswestry disability index，ODI）等临床指标，采用Spearman相关性分析L4/5、L5/S1水平多裂肌健侧和患侧总横截面积比值以及双侧肌肉萎缩程度、脂肪浸润比例等指标与临床指标的相关性。 结果：各组间年龄、性别和体质指数比较，无显著性差异（P＞0.05）；三组的多裂肌健侧和患侧总横截面积比值与VAS评分均呈正相关（P＜0.05），与ODI评分无相关性（P＞0.05）；双侧多裂肌肌肉萎缩程度、脂肪浸润比例与ODI评分呈正相关（P＜0.05），与VAS评分无关（P＞0.05）。 结论：在单侧腰椎间盘突出症患者中，多裂肌左右横截面积不对称程度与腰部疼痛相关，而双侧多裂肌肌肉萎缩程度与脂肪浸润比例与ODI评分相关。

Abstract:

      Abstract Objective： To analyze the correlation between MRI indicators and clinical features of multifidus degeneration in patients with unilateral lumbar disc herniation. Method： Eighty-six eligible patients with unilateral lumbar disc herniation admitted to our hospital from January 2018 to December 2021 with complete clinical data were retrospectively analyzed and divided into three groups according to the level and number of lumbar disc herniation： 27 patients in group A were treated with L4/5 disc herniation only， 30 patients in group B were treated with L5/S1 disc herniation only， and 29 patients with multi-level lumbar disc herniation in group C. All patients underwent lumbar MRI scans， and the measurements included the ratio of the total cross-sectional area of the unaffected and affected sides of the multifidus muscle at L4/5 and L5/S1 levels， the degree of bilateral multifidus muscle atrophy， and the proportion of fatty infiltration. The lumbar visual analogue scale （VAS）， Oswestry disability index （ODI） and other clinical features of patients with lumbar disc herniation were obtained from the medical records， and Spearman correlation was used to analyze the correlation between the ratio of the total cross-sectional area of the unaffected and affected sides of the multifidus muscle at L4/5 and L5/S1 levels and the proportion of fatty infiltration. Result： There was no significant difference in age， gender and body mass index （BMI） between the groups （P>0.05）； the total cross-sectional area ratio of the unaffected and affected sides of the multifidus muscle in the three groups was positively correlated with the VAS score （P<0.05） and not correlated with the ODI score （P>0.05）； the degree of bilateral multifidus muscle atrophy and the proportion of fatty infiltration were positively correlated with the ODI score （P<0.05） and not correlated with the VAS score （P>0.05）. Conclusion： In patients with unilateral lumbar disc herniation， the degree of asymmetry in the left and right cross-sectional areas of the multifidus muscle was associated with lumbar pain， whereas the degree of bilateral multifidus muscle atrophy and the proportion of fatty infiltration were associated with ODI scores.