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中华损伤与修复杂志(电子版) ›› 2025, Vol. 20 ›› Issue (03) : 185 -191. doi: 10.3877/cma.j.issn.1673-9450.2025.03.001

论著

老年女性腰椎管狭窄症患者不同层面椎旁肌质量与脊柱骨盆参数的相关性分析
吴文凯1, 段芳芳2, 王玲3,4, 杨桂鹤1, 李楚齐1, 郎昭1, 肖斌1, 何达1, 刘亚军1,4,()   
  1. 1. 100035 国家骨科医学中心 首都医科大学附属北京积水潭医院脊柱外科
    2. 100035 国家骨科医学中心 首都医科大学附属北京积水潭医院临床流行病学研究中心
    3. 100035 国家骨科医学中心 首都医科大学附属北京积水潭医院放射科
    4. 100035 北京市创伤骨科研究所 积水潭肌少症研究中心
  • 收稿日期:2025-02-05 出版日期:2025-06-01
  • 通信作者: 刘亚军
  • 基金资助:
    北京市医院管理中心临床医学发展专项经费(ZLRK202309)北京市卫生健康委员会第五批北京市属医学科研院所公益发展改革试点项目(京医研2023-8)首都医学科学创新中心项目(CX23YZ12)

Analysis on the correlation between paraspinal muscle quality at different levels and spinal pelvic parameters in elderly women with lumbar spinal stenosis

Wenkai Wu1, Fangfang Duan2, Ling Wang3,4, Guihe Yang1, Chuqi Li1, Zhao Lang1, Bin Xiao1, Da He1, Yajun Liu1,4,()   

  1. 1. National Center for Orthopedics,Department of Spine Surgery,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China
    2. Clinical Epidemiology Research Center,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China
    3. Department of Radiology,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China
    4. Beijing Research Institute of Traumatology and Orthopaedics,Jishuitan Sarcopenia Research Center,Beijing 100035,China
  • Received:2025-02-05 Published:2025-06-01
  • Corresponding author: Yajun Liu
引用本文:

吴文凯, 段芳芳, 王玲, 杨桂鹤, 李楚齐, 郎昭, 肖斌, 何达, 刘亚军. 老年女性腰椎管狭窄症患者不同层面椎旁肌质量与脊柱骨盆参数的相关性分析[J/OL]. 中华损伤与修复杂志(电子版), 2025, 20(03): 185-191.

Wenkai Wu, Fangfang Duan, Ling Wang, Guihe Yang, Chuqi Li, Zhao Lang, Bin Xiao, Da He, Yajun Liu. Analysis on the correlation between paraspinal muscle quality at different levels and spinal pelvic parameters in elderly women with lumbar spinal stenosis[J/OL]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2025, 20(03): 185-191.

目的

评估老年女性腰椎管狭窄症患者不同层面椎旁肌横截面积、肌肉密度和肌肉脂肪比例与脊柱骨盆参数的相关性。

方法

回顾性分析2021年11月至2023年4月于首都医科大学附属北京积水潭医院脊柱外科收治的老年女性腰椎管狭窄症患者的临床和影像学资料。在术前站立位腰椎侧位X线片中测量胸腰段脊柱后凸角度(TLK)、腰椎前凸角(LL)、骶骨倾斜角(SS)、骨盆入射角(PI)和骨盆倾斜角(PT),在腰椎MRI中评估椎间盘退变和椎管狭窄程度,在腰椎定量CT扫描(QCT)中测量T12、L3、L5水平椎旁肌面积(PSMA),肌肉密度和椎旁肌脂肪比例(FF)。使用Spearmen相关性分析和多元线性回归模型分析不同层面椎旁肌肉参数与脊柱骨盆角度的相关性。

结果

本研究共纳入老年女性腰椎管狭窄症患者96例,患者平均年龄67.50±4.72岁。相关性分析显示,T12、L3、L5层面PSMA、肌肉密度和L5层面椎旁肌FF与LL和SS相关(P<0.05)。校正相关协变量后,T12层面PSMA与LL和SS的关联有统计学意义(β=-0.740、0.529,P<0.05),L3和L5层面PSMD与LL的关联有统计学意义(β=0.608、0.494,P<0.05)。

结论

老年女性腰椎管狭窄症患者的椎旁肌横截面积、肌肉密度和脂肪比例与脊柱骨盆角度有关。其中T12层面椎旁肌横截面积下降是LL和SS代偿的独立影响因素,而L3和L5层面椎旁肌密度下降是LL变小的独立影响因素。在脊柱退行性疾病的诊疗中应关注胸腰段椎旁肌肉量减少患者的潜在矢状面失平衡风险,在早期脊柱退行性疾病患者的保守治疗中应强调下腰椎椎旁肌和胸椎后伸肌的运动锻炼,以预防或减缓腰椎曲度退变和矢状位失平衡的发生。

Objective

To evaluate the correlation between paraspinal muscle cross sectional area,muscle density,and fat fraction at different levels with spinal pelvic parameters in elderly women with lumbar spinal stenosis.

Methods

A retrospective analysis was conducted of the clinical and imaging data of elderly female patients with lumbar spinal stenosis who were hospitalized in the Department of Spine Surgery at Beijing Jishuitan Hospital, Capital Medical University from November 2021 to April 2023.Thoracolumbar kyphosis angle(TLK),lumbar lordosis(LL),sacral slope(SS),pelvic incidence(PI),and pelvic tilt(PT) were measured on preoperative standing lateral lumbar spine X-ray images.The intervertebral disc degeneration and spinal canal stenosis were assessed on MRI images.The paraspinal muscle area(PSMA),muscle density,and fat fraction(FF) at the T12,L3,and L5 levels were measured on quantitative computed tomography(QCT).Spearman correlation analysis and multiple linear regression models were used to analyze the correlation between paraspinal muscle parameters at different levels and spinal pelvic angles.

Results

A total of 96 elderly women with lumbar spinal stenosis were included,with age of 67.50±4.72 years.Correlation analysis showed significant associations between PSMA,PSMD at T12,L3,and L5 levels,and FF at the L5 level with LL and SS(P<0.05).After adjustment for confounding variables,PSMA at the T12 level remained significantly associated with LL and SS(β=-0.740 and 0.529,P<0.05).PSMD at the L3 and L5 levels were significantly associated with LL(β=0.608 and 0.494,P<0.05).

Conclusion

The study finds that paraspinal muscle cross sectional area, muscle density, and fat fraction are associated with spinopelvic parameters in elderly female patients with lumbar spinal stenosis.Specifically, a decreased PSMA at the T12 level is identified as an independent factor for LL and SS compensation, whereas reduced muscle density at the L3 and L5 levels are independent factors for LL reduction.These findings highlight the need to address the potential risk of sagittal imbalance in patients with reduced thoracolumbar paraspinal muscle mass when diagnosing and treating spinal degenerative diseases.Additionally, in the conservative management of early-stage spinal degeneration,targeted strengthening of the lower lumbar paraspinal muscles and thoracic posterior extensors should be emphasized to help prevent or slow down lumbar curvature regression and the onset of sagittal imbalance.

图1 胸腰段脊柱后凸角度、脊柱骨盆参数和椎旁肌肉参数的测量方法。A示患者站立位腰椎侧位X线片,红色虚线表示在CT中的椎旁肌测量层面(T12、L3、L5水平),绿色线表示胸腰段TLK,黄色线表示脊柱骨盆参数LL、SS、PI和PT的测量方法。B-D示患者腰椎CT椎旁肌测量图(分别为T12、L3和L5层面),红色虚线区域面积为椎旁肌总面积,绿色填充区域面积为根据阈值(-30~150 HU)自动选取的PSMA
表1 患者基本信息、椎旁肌肉参数和脊柱骨盆角度的Spearman相关性分析
表2 LL影响因素的多元线性回归分析
表3 SS影响因素的多元线性回归分析
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