腰椎多裂肌核磁共振影像学改变在成人腰椎退变中分析

发布时间：2018-05-18 12:32

本文选题：多裂肌 + 腰背痛　；参考：《山东大学》2014年硕士论文

【摘要】：背景：腰腿痛已成为现代社会严重影响社会生产力,大量消耗医疗资源的社会性顽疾。关于腰腿痛的原因也被众多专家、学者广泛研究,发现腰痛症影响因素不仅存在腰椎间盘退变、腰椎不稳等病理因素,而且还包括遗传因素、年龄、性别、职业、及社会心理等众多因素,关于腰痛的治疗手段从康复理疗、药物治疗到手术处理,都涉及到全面评估疾病重要影响因素,才能获得更佳疗效。在大量研究发现脊柱退变性疾病主要是其稳定性紊乱导致,那么除了骨骼、韧带以外的椎旁肌在脊柱稳定中的作用,也就显得弥足重要,其中多裂肌是椎旁肌群中肌束最大,且位置靠近脊柱最内侧的肌肉,肌纤维特点为短而韧,通过力学原理探索证实多裂肌在维持腰椎矢状面和冠状面平衡稳定中起到重要作用。目前许多关于多裂肌退变与脊柱疾病相关研究文献显示,研究存在样本量偏小、规模较小等因素,因此会影响研究结果,易产生偏倚。目的：通过进一步研究有腰腿痛症状患者多裂肌MRI影像学改变,发现其中规律,并探讨临床价值。方法：选取在影像科2011年1月-2013年12月期间所有行腰椎MRI检查者中年龄18周岁以上并含18周岁,然后按照男女性别不同分两组,每组分别自18岁始,年龄每递增10岁分为一亚组,共分：18岁-27岁组、28岁-37岁组、38岁-47岁组、48岁-57岁组、58岁-67岁组、68岁-77岁组、78岁以上组七个亚组,共14个亚组,每研究组由随机抽取的20人组成,男性140人、女性140人,本研究共含280人。结果：1、男性组均比对应年龄女性组多裂肌厚度大；2、多裂肌脂肪浸润程度与年龄增长呈正相关关系；3、多裂肌横断面面积在男性58岁以前、女性48岁以前无明显统计学差异性改变,但在男性58岁以后、女性48岁以后肌纤维萎缩、多裂肌横断面积缩小以及肌组织脂肪浸润情况改变出现年龄相关性加剧。4、多裂肌至棘突中线最长距离成正态分布,相同节段男女间无显著性差异,各年龄段之间也无显著差异。结论：腰椎多裂肌退变现象女性比男性出现的早,其退变主要MRI影像特征为：1、肌纤维萎缩,对应影像表现为肌束变细、形态缩小、轮廓萎缩；2、肌纤维组织脂肪浸润,表现为肌间隙点状、线状、羽状或网格状改变。多裂肌至棘突中线的最长距离符合正态分布,在下腰椎该距离较远,随着腰椎节段的上升间距逐渐缩小,在上腰椎相对靠近棘突中线,此为临床手术治疗提供解剖学依据。
[Abstract]:Background: lumbago and leg pain has become a social obstinate disease which seriously affects social productivity and consumes a large amount of medical resources in modern society. The causes of low back pain have also been extensively studied by many experts and scholars. It has been found that there are not only pathological factors such as lumbar disc degeneration, lumbar instability and so on, but also genetic factors, age, sex, occupation, etc. The treatment of low back pain, from rehabilitation physiotherapy, drug treatment to surgical treatment, all involve comprehensive evaluation of the important factors affecting the disease, in order to obtain a better curative effect. In a large number of studies, it has been found that degenerative diseases of the spine are mainly caused by its disorder of stability. Besides bones and ligaments, the role of the paravertebral muscles in the stability of the spine appears to be important, and the polybifida muscle is the largest muscle bundle in the paravertebral muscle group. The muscle is located near the innermost side of the spine, and the muscle fiber is short and tough. It is proved that the polyfissure muscle plays an important role in maintaining the balance and stability of the sagittal and coronal planes of the lumbar vertebrae. At present, many literatures on the relationship between polybifida degeneration and spinal diseases show that there are some factors in the study, such as small sample size and small scale, which will affect the research results and easily produce bias. Objective: to study the MRI imaging changes of polyfissure muscle in patients with lumbago and leg pain, to find out the regularity and to explore the clinical value. Methods: from January 2011 to December 2013, all the patients who underwent lumbar vertebrae MRI examination were divided into two groups according to the sex of men and women, from the age of 18 years old to the age of 18 years, each group started from the age of 18 years. Each increase in age by 10 years was divided into one subgroup, divided into seven subgroups, including 14 subgroups, aged from 68 to 77 years old and over 78 years old, divided into 7 subgroups, including 14 subgroups, composed of 20 randomly selected persons in the age group of 18 to 27 years of age and the age group of 28 years to 37 years of age and the age group of 48 years to 57 years old, age group between 58 years old to 67 years old group, age group of 58 years to 67 years old group, group of 68 years old to 77 years old group, There were 140 males and 140 females. Results in the male group, the thickness of the polyfissure muscle was 2% larger than that in the corresponding age group. There was a positive correlation between the degree of fat infiltration of the polyfissure muscle and the age increase. The cross-sectional area of the polyfissure muscle was not significantly changed before the male was 58 years old and the female was 48 years old. However, after 58 years of age in men and 48 years in women, muscle fiber atrophy, cross-sectional area of polyfissure muscle and fatty infiltration of muscle tissue were increased in age correlation. The longest distance between the polyfissure muscle and the middle line of spinous process was normal distribution. There was no significant difference between men and women in the same segment, and there was no significant difference between different age groups. Conclusion: the degenerative phenomenon of lumbar polyfissure in women is earlier than that in men. The main MRI imaging features of the degeneration are: 1: 1, muscle fiber atrophy. The corresponding imaging features are muscle bundle thinning, shape shrinking, contour atrophy 2, muscle fiber tissue fat infiltration. The results showed that the muscle space was punctate, linear, pinnately or reticulate. The longest distance from the polyfissure muscle to the middle line of the spinous process accords with the normal distribution, and the distance between the lower lumbar vertebrae and the middle line of the spinous process accords with the normal distribution. With the ascending distance of the lumbar vertebrae gradually reduced, the upper lumbar vertebrae is relatively close to the central line of the spinous process, which provides anatomic basis for clinical surgical treatment.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R681.5;R445.2

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