目的 探讨腰椎间盘突出症（lumbar disc herniation,LDH）患者椎旁肌横截面积（cross-sectional area,CSA）平衡性、对称性以及椎旁肌质子密度脂肪分数（proton density fat fraction,PDFF）变化特征,分析性别、年龄、突出节段及椎间盘重吸收程度对上述指标的影响,为LDH非手术治疗疗效评估提供影像学依据。方法 选取2021年4月—2023年7月四川省骨科医院收治的128例L4/5或L5/S1的LDH患者作为研究对象,均接受非手术治疗方案,并随访1年。治疗前后均接受腰椎磁共振（magnetic resonance imaging,MRI）常规T2加权成像序列矢状位及迭代水脂分离定量技术序列轴位扫描,通过Image J软件测量椎旁肌包括多裂肌（multifidus,MF）、竖脊肌（erector spinae,ES）、腰大肌（psoas major,PS）的脂肪百分比（fat fraction,FF）、CSA 及PDFF。根据1年随访时椎间盘重吸收程度分为重吸收组（n=82）和无重吸收组（n=46）,比较不同性别、年龄阶段（<35岁、35~49岁、>49岁）、突出节段（L4/5组n=70、L5/S1组n=58）患者的椎旁肌指标差异。结果 L4/5、L5/S1 节段患侧及健侧的女性多裂肌FF均显著高于男性;无重吸收组MF、ES、PS的PDFF均显著高于重吸收组;重吸收组随访时L4/5患健侧、L5/S1患侧CSA较治疗前显著增加,无重吸收组治疗前后CSA无显著变化;年龄差异：<35岁、35~49岁、>49岁三个年龄阶段中,无重吸收组MF、ES、PS的PDFF均显著高于重吸收组>49岁患者椎旁肌PDFF整体更高;治疗前及随访时,L5/S1节段组患侧MF、ES的PDFF均显著高于L4/5节段组,而患侧MF、ES的CSA显著低于L4/5节段组,两组PS的PDFF及CSA无显著差异。结论 在LDH患者中,女性多裂肌脂肪浸润更重;>49岁或L5/S1节段突出者脂肪含量更高,且后者CSA更小。椎旁肌PDFF降低与CSA增大或预示椎间盘重吸收,可作为非手术治疗疗效的潜在影像学指标。
Abstract
Objective To analyze the change characteristics of cross-sectional area (CSA) balance, symmetry and proton density fat fraction (PDFF) of paravertebral muscle in patients with lumbar disc herniation (LDH), and to analyze the effects of gender, age, protruding segments and intervertebral disc reabsorption on the above indexes to provide imaging evidence for curative effect evaluation of non-surgical treatment in LDH. Methods A total of 128 patients with LDH of L4/5 or L5/S1 admitted to Sichuan Province Orthopedic Hospital were enrolled as the research objects between April 2021 and July 2023. All were given a non-surgical treatment regimen and followed up for 1 year. Before and after treatment, all underwent routine T2WI sequence under sagittal view and IDEAL-IQ sequence under axial view in lumbar magnetic resonance imaging (MRI). The fat fraction (FF), CSA and PDFF of the paravertebral muscles[multifidus (MF), erector spinae (ES), psoas major (PS) ]were measured by Image J software. According to the intervertebral disc reabsorption degree after 1 year of follow-up, patients were divided into reabsorption group (n=82) and non-reabsorption group (n=46). The differences in paravertebral muscle indexes among patients with different genders, age groups (<35 years, 35-49 years, >49 years) and protruding segments (n=70 for group L4/5, n=58 for group L5/S1) were compared. Results FF values of MF on affected and healthy sides of L4/5 and L5/S1 segments in females were significantly higher than those in males. PDFF of MF, ES and PS in non-reabsorption group were significantly higher than those in reabsorption group. During follow-up, CSA on affected and healthy sides of L4/5 and affected side of L5/S1 were significantly increased in reabsorption group compared with those before treatment, but there was no significant change in CSA before and after treatment in non-reabsorption group. Age differences: in the three age groups (<35 years, 35-49 years, >49 years), PDFF of MF, ES and PS in non-reabsorption group were significantly higher than those in reabsorption group, and PDFF of paravertebral muscles was overall higher in patients aged >49 years. Before treatment and during follow-up, PDFF of MF and ES on affected side in L5/S1 segment group were significantly higher than those in L4/5 segment group, while CSA of MF and ES on affected side were significantly lower than those in L4/5 segment group, but there was no significant difference in PDFF and CSA of PS between the two groups. Conclusion In LDH patients, fat infiltration of MF is more severe in females. The fat content is higher in those aged >49 years or L5/S1 segment protruding, and CSA is lower in the latter. The decrease of PDFF and increase of CSA in paravertebral muscles may indicate intervertebral disc resorption, which can be applied as potential imaging indexes to evaluate the curative effect of non-surgical treatment.
关键词
腰椎间盘突出症 /
椎旁肌 /
横截面积 /
质子密度脂肪分数 /
平衡性、对称性
Key words
lumbar disc herniation /
paravertebral muscle /
cross-sectional area /
proton density fat fraction /
balance, symmetry
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基金
四川省中医药管理局科学技术研究项目“基于“IDEAL-IQ定量MR技术”探讨中医药治疗破裂型椎间盘突出重吸收程度与椎旁肌肉脂肪含量的相关性研究”（2021MS053）; 四川省干部保健科研项目“关于突出腰椎间盘重吸收相关因素的前瞻性研究”（川干研ZH2023-601）; 四川省中央引导地方科技发展专项项目“基于三维有限元分析的腰椎间盘突出症建模、发病机制与非手术治疗疗效评价的研究”（2022ZYD105）
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