Kamaz Müzeyyen, Kireşi Demet, Oğuz Hasan, Emlik Dilek, Levendoğlu Funda
Department of Physical Medicine and Rehabilitation, Selçuk University School of Medicine, Konya, Turkey.
Diagn Interv Radiol. 2007 Sep;13(3):144-8.
The objective of this study was to determine the cross-sectional area changes of the paraspinal, isolated multifidus, quadratus lumborum, psoas, and the gluteus maximus muscles with CT in patients with chronic low back pain.
In this study, we evaluated 36 patients with chronic low back pain and 34 healthy volunteers. The mean age of the patients was 43.2 +/- 6.9 years (range, 30- 58 years) and the mean age of control group was 44.4 +/- 6.9 years (range, 31-61 years). We defined pain that lasts more then one year as chronic pain. Female patients were selected for standardization. All patients were housewives. None of the patients or controls engaged in physical activity other than routine housework. We used a visual analog scale and the Oswestry Pain Questionnaire for clinical evaluation. We made CT cross-sections of the paraspinal muscles at the upper and lower endplates of L4, and of the gluteus maximus at the head of the interfoveal level.
In the patient group the multifidus, psoas, and quadratus lumborum cross-sectional areas were smaller than in the control group, and the P values were P = 0.002, P = 0.042, and P = 0.047, respectively, at the L4 endplate. At the L4 endplate level, cross-sectional areas of the multifidus and paravertebral muscles in the patient group were smaller than in the control group, and the difference was statistically significant (P = 0.001, P = 0.010, respectively). We did not find any significant difference between the patient and the control groups in gluteus maximus cross-sectional area.
Chronic low back pain caused atrophy of the paraspinal, isolated multifidus, quadratus lumborum, psoas, and the gluteus maximus muscles to varying degrees, which was most prominent in the multifidus. Atrophy was noted in all of the studied muscles, except the gluteus maximus. The reliability of CT in measuring the cross-sectional areas of the back muscles was acceptable.
本研究的目的是通过CT确定慢性下腰痛患者椎旁肌、孤立的多裂肌、腰方肌、腰大肌和臀大肌的横截面积变化。
在本研究中，我们评估了36例慢性下腰痛患者和34名健康志愿者。患者的平均年龄为43.2±6.9岁（范围30 - 58岁），对照组的平均年龄为44.4±6.9岁（范围31 - 61岁）。我们将持续超过一年的疼痛定义为慢性疼痛。为实现标准化选取女性患者。所有患者均为家庭主妇。除日常家务外，患者和对照组均未从事体育活动。我们使用视觉模拟量表和奥斯威斯功能障碍指数问卷进行临床评估。我们在L4上下终板水平对椎旁肌进行CT扫描，并在髋臼间水平头部对臀大肌进行CT扫描。
在患者组中，多裂肌、腰大肌和腰方肌的横截面积小于对照组，在L4终板水平，P值分别为P = 0.002、P = 0.042和P = 0.047。在L4终板水平，患者组多裂肌和椎旁肌的横截面积小于对照组，差异具有统计学意义（分别为P = 0.001、P = 0.010）。我们未发现患者组和对照组在臀大肌横截面积上有任何显著差异。
慢性下腰痛导致椎旁肌、孤立的多裂肌、腰方肌、腰大肌和臀大肌不同程度萎缩，其中多裂肌最为明显。除臀大肌外，所有研究的肌肉均出现萎缩。CT测量背部肌肉横截面积的可靠性是可以接受的。
