本文選題：腰椎 + 多裂��； 參考：《上海交通大學(xué)》2015年博士論文

【摘要】：研究設(shè)計(jì):橫斷面觀察研究目的:比較有關(guān)節(jié)突關(guān)節(jié)炎(FJOA)的病人和無(wú)FJOA的病人的腰椎多裂肌MRI測(cè)量的影像學(xué)指標(biāo),包括肌肉大小、脂肪化程度及雙側(cè)多裂肌不對(duì)稱(chēng)程度的區(qū)別。背景:腰椎多裂肌是腰椎后柱重要的支撐結(jié)構(gòu)。大量文獻(xiàn)報(bào)道腰椎多裂肌對(duì)局部腰椎病變十分敏感,可以作為提示相關(guān)病變的指標(biāo),包括退行性椎間盤(pán)病或腰椎間盤(pán)突出,退行性腰椎滑脫和腰椎神經(jīng)根病等。然而,目前還鮮有關(guān)于多裂肌退變和FJOA關(guān)系的報(bào)道。材料與方法:我們對(duì)3562個(gè)年齡在25至65歲之間的在2011年1月到2014年12月期間在上海市仁濟(jì)醫(yī)院健康體檢中心接受腰椎MRI檢查的病人的影像學(xué)資料進(jìn)行了回顧性的篩選。共有551個(gè)病人符合入組要求。我們收集了L3-L4、L4-L5及L5-S1節(jié)段的橫斷面T2像MRI圖像。根據(jù)不同節(jié)段將研究對(duì)象分為有FJOA組和無(wú)FJOA組。我們用Image J軟件測(cè)量了不同節(jié)段腰椎多裂肌的總截面積(total cross-sectional area,TCSA),單純肌肉截面積(functional cross-sectional area,FCSA),脂肪化程度也就是肌肉脂肪比例(muscle-fat index,MFI)以及雙側(cè)多裂肌不對(duì)稱(chēng)的百分比例。我們還測(cè)量了關(guān)節(jié)突關(guān)節(jié)相對(duì)于矢狀位的傾斜角(facet orientation,FO),并將其與多裂肌的特點(diǎn)進(jìn)行了相關(guān)分析。結(jié)果:多裂肌的體積大小和脂肪化程度都明顯受年齡的影響,但年齡對(duì)雙側(cè)多裂肌不對(duì)稱(chēng)性的影響并不大。單因素分析結(jié)果顯示,與對(duì)照組相比,有FJOA的病人年齡較大,FCSA值較小,MFI值較大,三個(gè)腰椎節(jié)段結(jié)果一致(p0.001)。多因素分析結(jié)果顯示,只有年齡和MFI才是在三個(gè)節(jié)段均與FJOA獨(dú)立相關(guān)的因素(p0.001),而FCSA只在L4-L5節(jié)段與FJOA獨(dú)立相關(guān)(p=0.005)。性別與TCSA并不是FJOA的獨(dú)立相關(guān)因素。雙側(cè)多裂肌FCSA大小的不對(duì)稱(chēng)性也是FJOA的獨(dú)立相關(guān)因素,但僅限于L5-S1節(jié)段(p=0.009),而且雙側(cè)多裂肌的不對(duì)稱(chēng)性似乎與雙側(cè)關(guān)節(jié)突不對(duì)稱(chēng)退變并無(wú)明顯關(guān)系。此外,我們發(fā)現(xiàn)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較小的人容易發(fā)生退變性腰椎滑脫相關(guān)原因之一。結(jié)論:腰椎多裂肌脂肪化加重是FJOA發(fā)病的獨(dú)立相關(guān)因素,不受年齡及性別差異的影響。雙側(cè)多裂肌大小的不對(duì)稱(chēng)增大時(shí)L5-S1節(jié)段FJOA的獨(dú)立相關(guān)因素。腰椎FJOA不應(yīng)單純被視作小關(guān)節(jié)突關(guān)節(jié)軟骨本身的退變,而是關(guān)節(jié)及周?chē)M織包括椎旁肌在內(nèi)的整體的退變。本研究進(jìn)一步支持了這個(gè)觀點(diǎn)。
[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.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R687.3

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