脊髓型颈椎病患者颈椎旁肌退变评估及与矢状位参数的相关性分析

摘要
图/表
参考文献
相关文章 (11)

全文: PDF (2946 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的通过颈椎MRI评估脊髓型颈椎病(cervical spondylotic myelopathy，CSM)患者的颈椎旁肌影像学形态，并探索其对颈椎矢状位平衡(cervical sagittal balance，CSB)和颈椎活动度的影响。方法选取2019年1月至2022年1月陆军第八十三集团军医院骨科收治的30例脊髓型颈椎病患者和同时段行健康体检的42例健康人群为研究对象，分别作为观察组和对照组。观察组男21例，女9例；年龄30~78岁，平均(59.9±12.2)岁。对照组男23例，女19例；年龄33~76岁，平均(55.7±10.1)岁。基于两组人群的颈椎MRI，借助Image J软件分别测量颈椎多裂肌(multifidus，MF)、颈椎半棘肌(semispinalis cervicis，Scer)、头半棘肌(semispinalis capitis，Scap)、头夹肌(splenius capitis，SPL)和颈长肌(longus colli，LC)的肌肉横截面积(cross sectional area，CSA)、有效横截面积(effective cross sectional area，ECSA)、相对横截面积(relative cross sectional area，RCSA)和脂肪浸润度(fat infiltration，FI)，并在两组人群中分别选取15例重复测量进行方法学研究。基于观察组患者标准颈椎正侧位和过伸过屈位X线片，测量CSB参数和颈椎活动度。采用同类相关系数(intralcass correlation coefficient，ICC)双侧随机模型评价Image J软件测量颈椎旁肌退变水平的一致性，通过两样本t检验对比两组人群颈椎旁肌退变水平，通过Pearson相关系数评估观察组颈椎旁肌退变对颈椎相关影像学指标的影响。结果观察组和对照组颈椎椎旁肌CSA及颈椎旁肌FI测量的组间和组内ICC总范围为0.771～0.956。观察组MF、Scap、SPL的CSA、RCSA相比对照组明显升高(P＜0.05)，而ECSA与对照组相比差异无统计学意义(P＞0.05)；观察组LC、Scer的CSA、RCSA及ECSA平均值与对照组相比差异无统计学意义(P＞0.05)；观察组MF、Scer、Scap、SPL、LC的FI平均值相对于对照组均明显升高(P＜0.05)。SPL的ECSA与颈椎屈曲角呈显著负相关(P＜0.05)，其余颈椎旁肌群与颈椎矢状位参数无明显相关性。LC的CSA、ECSA与颈椎前凸角呈显著负相关(P＜0.05)，LC的CSA、ECSA与颈椎过伸角及屈伸角呈显著负相关(P＜0.05)，LC的FI与颈椎C_2~7矢状面轴向距离呈显著正相关(P＜0.05)。结论基于颈椎MRI的Image J软件测量法可有效反映颈椎旁肌的影像学形态。脊髓型颈椎病患者的颈椎旁肌退变主要表现为颈椎旁肌群肥大增生和脂肪化改变，其中以Scap和SPL的退变最为显著。LC的退变与颈椎矢状位的失平衡和过伸活动度受限密切相关。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	苏威
	杨森
	杜习起
	张珂
	马小贝
	梁秋冬

关键词 ：脊髓型颈椎病, 颈椎旁肌, 矢状位参数

Abstract：

Objective To evaluate the imaging status of the paraspinal muscle in patients with cervical spondylotic myelopathy(CSM) and explore the effects on cervical sagittal balance and cervical range of motion with cervical MRI.Methods Thirty patients with cervical spondylotic myelopathy admitted to the Department of Orthopedics of the 83rd Group Military Hospital of the Army from January 2019 to January 2022 and 42 healthy people who underwent physical examination at the same time were selected as the observation group and the control group.In the observation group，there were 21 males and 9 females.The average age was (59.9±12.2) years，ranging from 30 to 78 years.In the control group，there were 23 males and 19 females.The average age was (55.7±10.1) years，ranging from 33 to 76 years.Based on the cervical MRI of the two groups of people，the cervical multifidus(MF)，cervical semispinalis cervicis(Scer) and cervical semispinalis capitis(Scap) were measured by Image J software，respectively.Cross sectional area(CSA) of Scap，splenius capitis(SPL)，and longus colli(LC) muscles，Effective crosssectional area(ECSA)，Relative cross-sectional area(RCSA) and fat infiltration(FI).15 cases of repeated measurement in two groups were selected for methodological research.Cervical sagittal balance parameters and cervical motion were measured based on standard cervical spine anterolateral and hyperextension and flexion X-ray films of patients in the observation group.A bilateral random model with intralcass correlation coefficient(ICC) was used to evaluate the consistency of Image J’s measurement of the level of paracyclinal muscle degeneration.The two-sample t test was used to compare the level of paracyclinal muscle degeneration between the two groups.Pearson correlation coefficient was used to evaluate the influence of cervical paracyclinal muscle degeneration on cervical imaging indexes in the observation group.Results The total range of intergroup and intragroup ICC measured by CSA and FI of cervical paravertebral muscle in observation group and control group was 0.771~0.956.The mean values of CSA and RCSA of multifidus muscle，semitinous capitis muscle and capicular pinus muscle in the observation group were significantly higher than those in the control group(P＜0.05)，but there was no significant difference in the average value of ECSA compared with the control group(P＞0.05).There was no significant difference in CSA，RCSA and ECSA between the observation group and the control group(P＞0.05).Compared with the control group，the average FI of multifidus muscle，cervical semispectinus muscle，cephalic semispectinus muscle and cervical longus muscle in the observation group were significantly higher(P＜0.05).ECSA of pinus capitis muscle was negatively correlated with cervical flexion angle(P＜0.05).There was no significant correlation between the other cervical paraspinal muscles and the sagittal parameters of the cervical spine.There was a significant negative correlation between CSA，ECSA and cervical lordosis angle(P＜0.05)，CSA and ECSA were significantly negatively correlated with cervical hyperextension angle and flexion extension angle(P＜0.05).The cervical longus muscle FI was significantly positively correlated with C_2~7 SVA of cervical spine(P＜0.05).Conclusion The Image J software measurement method based on cervical MRI can effectively reflect the imaging function of the paracyclinal muscles.The degeneration of the paracyclinal muscles in patients with cervical spondylotic myelopathy is mainly manifested by hypertrophy and fatty changes of the paracyclinal muscles，in which the degeneration of the capitis hemispinosus and the capitis clipper muscles is the most significant.The degeneration of the longus cervical muscle is closely related to sagittal disequilibrium of the cervical spine and limited hyperextension range of motion.

Key words： cervical spondylotic myelopathy cervical paraspinal muscles sagittal parameters

通讯作者: 梁秋冬

作者简介: 苏威(1989－ )，男，主治医师，陆军第八十三集团军医院骨科，869845584@qq.com

引用本文:

苏威，杨森，杜习起，张珂，马小贝，梁秋冬. 脊髓型颈椎病患者颈椎旁肌退变评估及与矢状位参数的相关性分析[J]. 实用骨科杂志, 2023, 29(7): 577-.
Su Wei，Yang Sen，Du Xiqi，Zhang Ke，Ma Xiaobei，Liang Qiudong. Evaluation of Cervical Paraspinal Muscle Degeneration and Its Correlation with Sagittal Parameters in Patients with Cervical Canal Stenosis. sygkzz, 2023, 29(7): 577-.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I7/577

［1］关晓明，马迅.脊髓型颈椎病手术入路及减压融合方式的选择策略［J］.中华骨科杂志，2019(23)：1478-1484.
［2］张意琪，吉岩忠，程丽.浅析颈部肌群与颈椎病的关系［J］.中外医学研究，2011，9(10)：114-116.
［3］Elliott J，Jull G，Noteboom JT，et al.MRI study of the cross sectional area for the cervical extensor musculature in patients with persistent whiplash associated disorders(WAD)［J］.Man Ther，2008，13(3)：258-265.
［4］韩耕愚，姜宇，李危石.不同影像学参数在评估腰部椎旁肌退变中应用的研究进展［J］.中国脊柱脊髓杂志，2020，30(6)：566-571.
［5］Fortin M，Gibbons LE，Videman T，et al.Do variations in paraspinal muscle morphology and composition predict low back pain in men?［J］.Scand J Med Sci Sports，2015，25(6)：880-887.
［6］徐野夫，王锋，吴小涛.颈椎矢状位平衡参数的研究进展［J］.中国矫形外科杂志，2020，28(5)：425-429.
［7］Asai Y，Tsutsui S，Oka H，et al.Sagittal spino-pelvic alignment in adults：The wakayama spine study［J］.PLoS ONE，2017，12(6)：e0178697.
［8］丁浚哲，鲁世保，孔超，等.退变性腰椎侧凸椎旁肌群不对称退变临床意义［J］.中华骨科杂志，2019，39(18)：1133-1141.
［9］He K，Head J，Mouchtouris N，et al.The implications of paraspinal muscle atrophy in low back pain，thoracolumbar pathology，and clinical outcomes after spine surgery：A review of the literature［J］.Global Spine Journal，2020，10(5)：657-666.
［10］杨森，武文杰，鲁燕芬，等.MRI成像Dixon-VIBE序列定量评估退变性腰椎侧凸患者椎旁肌退变程度的可行性［J］.中华实用诊断与治疗杂志，2020，34(1)：72-76.
［11］Kalichman L，Carmeli E，Been E.The association between imaging parameters of the paraspinal muscles，spinal degeneration，and low back pain［J］.BioMed research international，2017(2017)：1-14.
［12］张元成，敖俊.腰椎退行性疾病中椎旁肌退变的影像学研究进展［J］.局解手术学杂志，2021，30(9)：829-833.
［13］Fortin M，Omidyeganeh M，Battié MC，et al.Evaluation of an automated thresholding algorithm for the quantification of paraspinal muscle composition from MRI images［J］.Biomed Eng Online，2017，16(1)：61.
［14］Zhao YX，Huang MQ，Serrano Sosa M，et al.Fatty infiltration of paraspinal muscles is associated with bone mineral density of the lumbar spine［J］.Archives of osteoporosis，2019，14(1)：99.
［15］Koji T，Jessica C，Michael S，et al.The evaluation of lumbar paraspinal muscle quantity and quality using the goutallier classification and lumbar indentation value［J］.Eur Spine J，2018，27(5)：1005-1012.
［16］Maryse F，Nikola W，Octavian D，et al.Relationship between cervical muscle morphology evaluated by MRI，cervical muscle strength and functional outcomes in patients with degenerative cervical myelopathy［J］.Musculoskeletal Science and Practice，2018(38)：1-7.
［17］Tamai K，Grisdela P，Romanu J，et al.The impact of cervical spinal muscle degeneration on cervical sagittal balance and spinal degenerative disorders［J］.Clin Spine Surg，2019，32(4)：E206-E213.
［18］Yagi M，Hosogane N，Watanabe K，et al.The paravertebral muscle and psoas for the maintenance of global spinal alignment in patient with degenerative lumbar scoliosis［J］.Spine J，2016，16(4)：451-458.
［19］De LV，Van den Oord M，Keser I，et al.MRI study of the morphometry of the cervical musculature in F-16 pilots［J］.Aviat Space Environ Med，2009，80(8)：727-731.
［20］Mayoux-Benhamou MA，Revel M，Vallée C，et al.Longus colli has a postural function on cervical curvature［J］.Surg Radiol Anat，1994，16(4)：367-371.
［21］Buyukturan B，Guclu-Gunduz A，Buyukturan O，et al.Cervical stability training with and without core stability training for patients with cervical disc herniation：A randomized，singleblind study.［J］.European journal of pain(London，England)，2017，21(10)：1678-1687.
［22］Okada E，Matsumoto M，Ichihara D，et al.cross sectional area of posterior extensor muscles of the cervical spine in asymptomatic subjects：a 10-year longitudinal magnetic resonance imaging study.［J］.Eur Spine J，2011，20(9)：1567-1573.
［23］Gu YF，Wang C，Hu JQ，et al.Association between the cervical extensor musculature and the demographic features，symptoms and sagittal balance in patients with multilevel cervical spondylotic myelopathy［J］.World neurosurgery，2023(169)：e40-e50.