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| 腰椎间盘突出症与椎旁肌CT形态学改变的相关性研究 |
| Relationship between lumbar disc herniation and morphological changes of paraspinal muscle based on CT |
| 投稿时间：2025-03-20 修订日期：2025-08-15 |
| DOI： |
| 中文关键词: 腰椎间盘突出症，椎旁肌，QCT，脂肪浸润，横截面积 |
| 英文关键词: lumbar disc herniation, paraspinal muscle，Quantitative computed tomography，fat infiltration，cross-sectional area |
| 基金项目:2022 年济宁市重点研发计划项目（2022YXNS030） |
| 作者 | 单位 | 邮编 | | 刘艳杰 | 济宁医学院附属医院 | 272200 | | 陈月芹* | 济宁医学院附属医院 | 272200 |
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| 中文摘要: |
| 摘要：目的 探讨椎旁肌形态学改变与腰椎间盘突出症（LDH）的相关性，为LDH的预防和治疗提供依据。方法 选取LDH患者118例作为观察组。以同期无LDH者59例作为对照组。两组性别、年龄、BMI相匹配。使用QCT后处理软件测量骨密度（vBMD）、皮下脂肪面积及内脏脂肪面积。Slice-O-Matic软件分别测量所有受试者L4/5、L5/SI水平双侧椎旁肌[腰大肌、多裂肌、竖脊肌（PS、MF、ES）]纯肌肉横截面积、纯脂肪横截面积、同水平椎间盘横截面积，计算椎旁肌脂肪浸润程度。结果 观察组PS、MF、ES的rCSA和rFCSA，以及椎体vBMD与对照组比较，差异均有统计学意义（P＜0.05）。观察组MFFCSA明显小于对照组，而MFFI明显大于对照组，差异有统计学意义（P＜0.01）。二元logistic回归分析结果显示MFrFCSA（OR=0.002，95%CI：0.000～0.085）、MFFI（OR=1.145，95%CI：1.061～1.236）是预测LDH的独立危险因素。ROC曲线预测LDH的AUC值为0.773(95%CI：0.704-0.832)，灵敏度81.36%，特异度62.71%。结论 LDH患者椎旁肌形态有不同程度退变，其中MFrFCSA和MFFI，可以作为预测LDH发生的独立影响因素，该模型具有较好的诊断效能。 |
| 英文摘要: |
| Abstract：Objective To investigate the correlation between morphological changes of paraspinal muscle and lumbar lumbar disc herniation(LDH).To provide the evidence for the prevention and treatment of LDH. Methods 118 patients with LDH were selected as the observation group. 59 patients without LDH were selected as the control group.No significant differences were found in the gender，age and BMI between the two groups. Bone mineral density (vBMD), subcutaneous fat area and visceral fat area were measured using QCT post-processing software. Slice-O-Matic software was used to measure the pure muscle cross-sectional area（FCSA） and pure fat cross-sectional area of bilateral paraspinal muscles (psoas，multifidus muscle, erector spinae), cross-sectional area of the intervertebral disc at L4/5 and L5/SI levels.And calculated the degree of fat infiltration in the paraspinal muscles(FI).Results There were significant differences in the rCSA, rFCSA of the paraspinal muscles (PS, MF, ES), and the vertebral vBMD between groups (P<0.05). This study also found that the MFFCSA in the observation group was significantly smaller than that in the control group, while the MFFI was significantly larger(P<0.05).Logistic regression analysis showed that MFFI（OR=1.145，95%CI：1.061～1.236）、MFrFCSA（OR=0.002，95%CI：0.000～0.085）were independent risk factors for predicting LDH (P<0.05). The AUC value of ROC curve predicting LDH was 0.773(95%CI:0.704-0.832), with sensitivity 81.36% and specificity 62.71%.Conclusion There are different degrees of paraspinal muscle degeneration in LDH patients.Among them, MFrFCSA and MFFI are independent influencing factors for predicting LDH, and this model has a good diagnostic efficacy. |
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