2021 年第 3 期 第 16 卷

退变性脊柱后凸畸形患者腰部肌肉退变与脊柱骨盆参数的相关性分析

Correlation analysis between lumbar back muscle degeneration and spinal-pelvic parameters in patients with degenerative spinal kyphosis

作者：王伟炎夏威威刘海鹰

英文作者：Wang Weiyan Xia Weiwei Liu Haiying

单位：北京大学人民医院脊柱外科，北京100044

英文单位：Department of Spinal Surgery Peking University People′s Hospital Beijing 100044 China

关键词：退变性脊柱后凸畸形；腰背肌肉退变；矢状位失衡；数字影像分析

英文关键词：Degenerativespinalkyphosis;Lumbarbackmuscledegeneration;Sagittalimbalance;Digitalimaginganalysis

• 摘要：

• 目的 观察退变性脊柱后凸畸形（DSK）患者腰椎相应节段多裂肌、竖脊肌和腰大肌的脂肪浸润情况，并分析肌肉退变与脊柱骨盆参数的相关性。方法 回顾性分析2018年1月至2019年12月北京大学人民医院收治的132例DSK患者的影像学资料。定量测量与L1/2～L5/S1的5个节段下位终板相对应的多裂肌、竖脊肌和腰大肌的脂肪浸润百分比及肌肉相对横截面积（RCSA）。分析肌肉退变与矢状面偏移距离（SVA）、胸椎后凸角（TK）、胸腰后凸角（TLK）、腰椎前凸角（LL）、骨盆入射角（PI）、骶骨倾斜角（SS）及骨盆倾斜角（PT）的相关性。结果 多裂肌和竖脊肌在L3/4、L4/5、L5/S1节段脂肪浸润百分比均高于L1/2和L2/3节段（均P<0.05）。腰大肌在L4/5和L5/S1节段脂肪浸润百分比均低于L1/2、L2/3和L3/4节段（均P<0.05）。多裂肌和腰大肌的RCSA在L1/2～L5/S1节段逐渐升高，竖脊肌的RCSA在L1/2～L5/S1节段逐渐降低。多裂肌在L1/2节段的RCSA与SVA存在负相关性（r=-0.391，P=0.027），L3/4节段的RCSA与TK存在负相关性（r=-0.364，P=0.040），与LL存在正相关性（r=0.381，P=0.031），L4/5节段的RCSA与TLK存在负相关性（r=-0.336，P=0.048），与LL存在正相关性（r=0.402，P=0.022），L5/S1节段的RCSA与TLK存在负相关性（r=-0.432，P=0.014）；竖脊肌在L3/4节段的RCSA与PI存在正相关性（r=0.350，P=0.049），L4/5节段的RCSA与LL（r=0.451，P=0.010）和SS（r=0.440，P=0.012）存在正相关性。结论 DSK患者多裂肌、竖脊肌在下腰椎的脂肪浸润百分比高于上腰椎，而腰大肌上腰椎水平脂肪浸润百分比高于下腰椎水平。多裂肌下腰椎水平有助于维持腰椎曲度，竖脊肌下腰椎水平主要影响骨盆参数，二者对于维持脊柱骨盆的矢状位平衡具有差异。

• Objective To observe the fat infiltration of multifidus(MF), erector spinae(ES) and psoas(PS) at corresponding lumbar segments in patients with degenerative spinal kyphosis(DSK), and to analyze the correlation between muscle degeneration and spinal-pelvic parameters. Methods The imaging data of 132 patients with DSK admitted to Peking University People′s Hospital from January 2018 to December 2019 were retrospectively analyzed. The fat infiltration percentage(FI%) and relative cross-sectional area of muscle(RCSA) were quantitatively measured for MF, ES and PS at inferior endplates of 5 segments from L1/2 to L5/S1. The correlations were analyzed between muscle degeneration and the sagittal vertical axis(SVA), thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), lumbar lordosis(LL), pelvic incidence(PI), sacral slope(SS) and pelvic tilt(PT). Results The FI% of MF and ES at L3/4, L4/5 and L5/S1 segments were higher than those at L1/2 and L2/3segments(all P<0.05). The FI% of PS at L4/5 and L5/S1 segments were lower than those at L1/2, L2/3 and L3/4segments(all P<0.05). The RCSA of MF and PS from L1/2 to L5/S1 segments gradually increased, whereas the RCSA of ES from L1/2 to L5/S1 segments gradually decreased. The RCSA of MF at the L1/2 segment was negatively correlated SVA (r=-0.391, P=0.027), the RCSA at L3/4segment was negatively correlated with TK(r=-0.364, P=0.040) and positively correlated with LL(r=0.381, P=0.031), the RCSA at L4/5 segment was negatively correlated with TLK(r=-0.336, P=0.048) and positively correlated with LL(r=0.402, P=0.022),and the RCSA at L5/S1 segment was negatively correlated with TLK(r=-0.432, P=0.014). The RCSA of ES at L3/4segment was positively correlated with PI(r=0.350, P=0.049),and the RCSA at L4/5 segment was positively correlated with LL(r=0.451, P=0.010) and SS(r=0.440, P=0.012). Conclusions FI% of MF and ES at lower lumbar level are higher than those at upper lumbar level, but FI% of PS at upper lumbar level is higher than that at lower lumbar level. MF is helpful to maintain the curvature of lumbar vertebrae. ES mainly affects the pelvic parameters. There are differences between them in maintaining the sagittal balance of spine and pelvis.