摘要
目的:探讨椎旁肌三维形态学参数(椎旁肌相对容积、椎旁肌脂肪浸润)与双节段经椎间孔腰椎椎间融合术(TLIF)治疗腰椎管狭窄症患者术后功能改善之间的相关性。方法:回顾性分析2018年1月至2020年5月接受双节段TLIF手术的146例腰椎管狭窄症患者的术前临床资料,根据术后2年随访时的腰椎功能改善程度分为预后较好组和预后较差组,比较分析两组患者的一般资料和影像学资料,三维重建椎旁肌以评估椎旁肌的相对容积(肌肉数量)及脂肪浸润率(肌肉质量)。结果:预后不同的两组在性别、年龄、体重指数、骨密度、手术时间及术中出血量方面差异无统计学意义。与预后较好组比较,预后较差组患者多裂肌、竖脊肌的相对容积较小[(5.36±1.10)cm^(3)vs.(4.28±1.05)cm^(3),P=0.025;(15.90±3.18)cm^(3)vs.(12.70±2.85)cm^(3),P=0.019)],多裂肌、竖脊肌的脂肪浸润程度较高[(19.8±6.1)%vs.(25.2±5.0)%,P=0.009;(17.5±4.9)%vs.(24.4±5.9)%,P=0.001],差异有统计学意义。多裂肌相对容积与Oswestry功能障碍指数(ODI)改善率呈正相关(r=0.445,P=0.038);多裂肌、竖脊肌脂肪浸润率均与ODI改善率呈负相关(r=-0.452,P=0.035;r=-0.482,P=0.023)。结论:椎旁肌相对容积减小及脂肪浸润程度增加与腰椎管狭窄症TLIF手术预后不良相关。
Objective:To investigate the correlation between three-dimensional morphological parameters of paravertebral muscles(relative volume and fatty infiltration)and functional improvement after two-segment transforaminal lumbar interbody fusion(TLIF)in the treatment of lumbar stenosis.Methods:The preoperative clinical data of 146 patients who had undergone two-segment TLIF for lumbar spinal stenosis from January 2018 to May 2020 were retrospectively analyzed.They were divided into a better prognosis group and a relatively poor prognosis group according to the functional outcomes at the two-year postoperative follow-up.The general characteristics and imaging data of the two groups were compared and analyzed.The three-dimensional reconstruction of the paravertebral muscles was performed to assess the relative volume(muscle quantity)and fatty infiltration(muscle quality).Results:No statistically significant differences between the two groups were noted in terms of gender,age,body mass index,bone mineral density,operative time,and intraoperative bleeding.Compared with the better prognosis group,the relative volume of the multifidus and erector spinae were smaller in the relatively poor prognosis group([5.36±1.10]cm^(3)vs.[4.28±1.05]cm^(3),P=0.025;[15.90±3.18]cm^(3)vs.[12.70±2.85]cm^(3),P=0.019),and the fat infiltration in the multifidus and erector spinae were higher([19.8±6.1]%vs.[25.2±5.0]%,P=0.009;[17.5±4.9]%vs.[24.4±5.9]%,P=0.001),with statistically significant differences.The relative volume of the multifidus was positively related with the improvement of ODI(r=0.445,P=0.038).The fat infiltration of both the multifidus and erector spinae was negatively related with the improvement of ODI(r=-0.452,P=0.035;r=-0.482,P=0.023).Conclusions:The reduced relative volume of the paravertebral muscles and increased fatty infiltration are associated with a poor prognosis of TLIF in the treatment of lumbar spinal stenosis.
作者
赵书杰
李寅
范啸
刘浩
殷国勇
黄振飞
ZHAO Shujie;LI Yin;FAN Xiao;LIU Hao;YIN Guoyong;HUANG Zhenfei(Jiangsu Institute of Functional Reconstruction and Rehabilitation,Nanjing 210029;Department of Orthopaedics,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029;Department of Neurosurgery,The First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)
出处
《中华骨与关节外科杂志》
2022年第12期921-926,共6页
Chinese Journal of Bone and Joint Surgery
基金
国家自然科学基金(82030069)
国家自然科学基金(82102570)
南京医科大学第一附属医院青年基金培育计划(PY2021012)
关键词
腰椎管狭窄症
椎旁肌
三维形态学参数
手术预后
Lumbar Spinal Stenosis
Paravertebral Muscle
Three-dimensional Morphological Parameter
Surgical Prognosis
