椎旁肌CT形态学改变与腰椎间盘突出症的关系

刘艳杰; 高缇; 赵鲁平; 孔维惠; 迟啸宇; 陈月芹

文章摘要

刘艳杰,高缇,赵鲁平,孔维惠,迟啸宇,陈月芹.椎旁肌CT形态学改变与腰椎间盘突出症的关系[J].济宁医学院学报,2025,48(5):411-416

椎旁肌CT形态学改变与腰椎间盘突出症的关系

The relationship between morphological changes of paraspinal muscles based on CT and lumbar disc herniation

投稿时间：2025-03-20

DOI：10.3969/j.issn.1000-9760.2025.05.006

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	E-mail
刘艳杰	济宁医学院附属医院影像科, 济宁 272000 济宁市心脑血管重点实验室, 济宁 272000
高缇	济宁医学院附属医院影像科, 济宁 272000 济宁市心脑血管重点实验室, 济宁 272000
赵鲁平	济宁医学院附属医院影像科, 济宁 272000 济宁市心脑血管重点实验室, 济宁 272000
孔维惠	济宁医学院附属医院影像科, 济宁 272000 济宁市心脑血管重点实验室, 济宁 272000
迟啸宇	济宁医学院附属医院(临床医学院), 济宁 272000
陈月芹	济宁医学院附属医院影像科, 济宁 272000 济宁市心脑血管重点实验室, 济宁 272000	chenyueqin010@163.com

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中文摘要:

目的探讨椎旁肌形态学改变与腰椎间盘突出症(LDH)的关系，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80例作为对照组。两组性别、年龄、BMI均无显著性差异(P＞0.05)。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(PS)、多裂肌(MF)、竖脊肌(ES)]、纯肌肉横截面积(cross-sectional area, CSA)、纯脂肪CSA、同水平椎间盘CSA，计算椎旁肌脂肪浸润程度。结果观察组PSrCSA [0.99(0.78, 1.22)]、MFrCSA(0.72±0.19)、ESrCSA[0.87(0.68, 1.05)]和PSrFCSA(1.02±0.33)、MFrFCSA(0.64±0.17)、ESrFCSA(0.79±0.25)均低于对照组[1.12(0.93, 1.41)、0.85±0.20、0.97(0.84, 1.20)、1.17±0.37、0.79±0.20、0.93±0.30，P＜0.05]。观察组骨量异常者[69(58.47%)]多于对照组[35(43.75%)，P＜0.05]。观察组MFFCSA(12.79±2.76)小于对照组(14.01±2.89，P＜0.05)，而MFFI[12.02(5.48, 14.72)]大于对照组[4.96(2.23, 10.89)，P＜0.05]。二元logistic回归分析结果显示MFFCSA(OR=1.210，95%CI：1.015~1.441)、MFrFCSA(OR=0.007，95%CI：0.001~0.086)、MFFI(OR=1.137，95%CI：1.062~1.216)是预测LDH的独立影响因素。MFFCSA、MFrFCSA、MFFI预测LDH的AUC分别为0.636、0.710、0.727；MFFCSA、MFrFCSA联合MFFI的AUC为0.756(95%CI：0.686-0.826)。结论 LDH患者椎旁肌形态有不同程度退变，其中MFFCSA、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:

Objective To investigate the relationship between morphological changes of paraspinal muscle and 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. 80 patients without LDH were selected as the control group. No significant differences were found in the gender, age and BMI between the two groups (P > 0.05). Volumetric bone mineral density (vBMD), subcutaneous fat area and visceral fat area were measured using QCT post-processing software. Slice-O-Matic software was employed to measure the cross-sectional areas (CSAs) of bilateral paravertebral muscles [psoas major (PS), multifidus (MF), and erector spinae (ES)], pure muscle CSA, pure fat CSA, and intervertebral disc CSA at the L4/5 and L5/S1 levels in all subjects. The degree of fat infiltration in the paravertebral muscles was calculated. Results PSrCSA [0.99(0.78, 1.22)], MFrCSA(0.72±0.19), ESrCSA[0.87(0.68, 1.05)], and PSrFCSA (1.02±0.33), MFrFCSA (0.64±0.17), ESrFCSA (0.79±0.25) were lower in the observation group than the control group[1.12(0.93, 1.41)、0.85±0.20、0.97(0.84, 1.20)、1.17±0.37、0.79±0.20、0.93±0.30, P < 0.05].There were more bone abnormalities in the observation group [69(58.47%)] than in the control group [35(43.75%), P < 0.05].MFFCSA (12.79±2.76) was significantly smaller in the observation group than in the control group (14.01±2.89, P < 0.05), whereas MFFI [12.02(5.48, 14.72)] was significantly larger than in the control group [4.96(2.23, 10.89), P < 0.05].Logistic regression analysis showed that MFFCSA(OR=1.210, 95%CI: 1.015~1.441)、MFrFCSA(OR=0.007, 95%CI: 0.001~0.086)and MFFI(OR=1.137, 95%CI: 1.062~1.216)were independent factors for predicting LDH (P < 0.05). The areas under the curve of MFFCSA、MFrFCSA and MFFI for predicting LDH were 0.636、0. 710 and 0. 727, respectively; The AUC of the MFFCSA、MFrFCSA in combination with MFFI was 0. 756(95%CI: 0.686~0.826). Conclusion There are different degrees of paraspinal muscle degeneration in LDH patients. Among them, MFFCSA、MFrFCSA and MFFI are independent influencing factors for predicting LDH, and this model has a good diagnostic efficacy.

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