腰椎多裂肌改变与关节突关节炎相关性探究

发布时间：2018-06-12 19:59

本文选题：腰椎 + 多裂　；参考：《上海交通大学》2015年博士论文

【摘要】：研究设计:横断面观察研究目的:比较有关节突关节炎(FJOA)的病人和无FJOA的病人的腰椎多裂肌MRI测量的影像学指标,包括肌肉大小、脂肪化程度及双侧多裂肌不对称程度的区别。背景:腰椎多裂肌是腰椎后柱重要的支撑结构。大量文献报道腰椎多裂肌对局部腰椎病变十分敏感,可以作为提示相关病变的指标,包括退行性椎间盘病或腰椎间盘突出,退行性腰椎滑脱和腰椎神经根病等。然而,目前还鲜有关于多裂肌退变和FJOA关系的报道。材料与方法:我们对3562个年龄在25至65岁之间的在2011年1月到2014年12月期间在上海市仁济医院健康体检中心接受腰椎MRI检查的病人的影像学资料进行了回顾性的筛选。共有551个病人符合入组要求。我们收集了L3-L4、L4-L5及L5-S1节段的横断面T2像MRI图像。根据不同节段将研究对象分为有FJOA组和无FJOA组。我们用Image J软件测量了不同节段腰椎多裂肌的总截面积(total cross-sectional area,TCSA),单纯肌肉截面积(functional cross-sectional area,FCSA),脂肪化程度也就是肌肉脂肪比例(muscle-fat index,MFI)以及双侧多裂肌不对称的百分比例。我们还测量了关节突关节相对于矢状位的倾斜角(facet orientation,FO),并将其与多裂肌的特点进行了相关分析。结果:多裂肌的体积大小和脂肪化程度都明显受年龄的影响,但年龄对双侧多裂肌不对称性的影响并不大。单因素分析结果显示,与对照组相比,有FJOA的病人年龄较大,FCSA值较小,MFI值较大,三个腰椎节段结果一致(p0.001)。多因素分析结果显示,只有年龄和MFI才是在三个节段均与FJOA独立相关的因素(p0.001),而FCSA只在L4-L5节段与FJOA独立相关(p=0.005)。性别与TCSA并不是FJOA的独立相关因素。双侧多裂肌FCSA大小的不对称性也是FJOA的独立相关因素,但仅限于L5-S1节段(p=0.009),而且双侧多裂肌的不对称性似乎与双侧关节突不对称退变并无明显关系。此外,我们发现FO越小的人,多裂肌TCSA和FCSA的值越小,提示多裂肌薄弱可能是FO较小的人容易发生退变性腰椎滑脱相关原因之一。结论:腰椎多裂肌脂肪化加重是FJOA发病的独立相关因素,不受年龄及性别差异的影响。双侧多裂肌大小的不对称增大时L5-S1节段FJOA的独立相关因素。腰椎FJOA不应单纯被视作小关节突关节软骨本身的退变,而是关节及周围组织包括椎旁肌在内的整体的退变。本研究进一步支持了这个观点。
[Abstract]:Study Design: Cross-sectional study objective: to compare the MRI measurements of lumbar polyfissure muscle between patients with arthritic arthritis (FJOA) and those without FJOA, including the difference of muscle size, degree of fat loss and degree of asymmetry of bilateral polyfissure muscle. Background: lumbar polyfissure muscle is an important supporting structure of lumbar posterior column. A large number of literatures have reported that the lumbar polyfissure muscle is very sensitive to local lumbar spondylopathy, which can be used as an indicator to indicate the related lesions, including degenerative disc disease or lumbar disc herniation, degenerative lumbar spondylolisthesis and lumbar radiculopathy and so on. However, there are few reports about the relationship between polyfissure degeneration and FJOA. Materials and methods: we retrospectively screened the imaging data of 3 562 patients aged 25 to 65 who underwent lumbar MRI examination in Shanghai Renji Hospital Health examination Center from January 2011 to December 2014. A total of 551 patients were admitted to the group. We collected T _ 2 images of L _ 3-L _ 4 and L _ 4-L _ 5 and L _ 5-S _ 1 segments. According to different segments, the subjects were divided into FJOA group and no FJOA group. We measured the total cross-sectional area of the different segments of lumbar vertebrae polyfissure muscle and the percentage of bilateral polyfissure muscle asymmetry by using the image-J software. We also measured the total area of total cross-sectional area of the different segments of the lumbar vertebrae polyfissure muscle and the total area of the muscle cross-sectional muscle, the muscle fat ratio muscle-fat index (MFI) and the percentage of the muscle fat ratio muscle-fat index (MFI). We also measured the facet orientation of the facet in relation to the sagittal position of the articular facet, and analyzed its correlation with the characteristics of the polyfissure muscle. Results: the volume size and fatty degree of polyfissure muscle were obviously affected by age, but age had little effect on the asymmetry of bilateral polyfissure muscle. Univariate analysis showed that the older patients with FJOA had higher FCSA and higher MFI values than those in the control group, and the results of the three lumbar vertebrae segments were consistent with that of the control group (P 0.001). Multivariate analysis showed that only age and MFI were independent factors associated with FJOA in all three segments, while FCSA was only associated with FJOA in L4-L5 segment (p0.005). Sex and TCSA are not independent factors of FJOA. The asymmetry of the size of FCSA in bilateral polyfissure muscle is also an independent factor of FJOA, but it is limited to L5-S1 segment p0.009, and the asymmetry of bilateral polyfissure muscle does not seem to be related to bilateral asymmetrical degeneration of the articular process. In addition, we found that the smaller the FO, the smaller the values of TCSA and FCSA of the polyphagus muscle, suggesting that the weakness of the polyfissure muscle may be one of the related causes of degenerative lumbar spondylolisthesis in the patients with smaller FO. Conclusion: the fatty exacerbation of lumbar polyfissure muscle is an independent related factor of FJOA, and is not affected by age and sex. The independent factors of FJOA in L _ 5-S _ 1 segment with asymmetrical enlargement of bilateral polyfissure muscle. Lumbar FJOA should not be considered as degeneration of facet articular cartilage itself, but as a whole degeneration of joints and surrounding tissues, including paravertebral muscles. This study further supports this view.
【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R687.3

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