Fernández-de-las-Peñas César, Albert-Sanchís Joan C, Buil Miguel, Benitez Jose C, Alburquerque-Sendín Francisco
Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
J Orthop Sports Phys Ther. 2008 Apr;38(4):175-80. doi: 10.2519/jospt.2008.2598.
Case-control study.
To analyze the differences in muscle size and shape of cervical multifidus between patients with bilateral chronic neck pain and healthy subjects.
Researchers have demonstrated atrophy of lumbar multifidus in patients presenting with low back pain; however, there are only few published reports on cervical multifidus muscle size in individuals with chronic neck pain.
Bilateral ultrasound images of multifidus muscle from the third to sixth cervical vertebrae (C3 to C6) were taken in 20 women with bilateral chronic neck pain and 20 healthy women. Cross-sectional area (CSA [cm2]) and muscle shape ratio (ratio between lateral [Lat] and anterior-posterior [AP] dimensions, [Lat/AP]) were measured without knowledge of group assignment. Two separate 3-way (4 x 2 x 2) mixed-model analyses of variance (ANOVAs) with cervical level (C3 to C6) and side (right, left) as within-subject factors and group (patient, control) as the between-subject factor, were used to evaluate differences in CSA and muscle shape ratio between groups, sides, and cervical levels.
The ANOVA for CSA indicated a significant effect for cervical level (F = 6.81, P<.001) and group (F = 20.27, P<.001), but not for side (F = 1.26, P = .36). There were no significant interactions among the variables (P>.5). Post hoc analysis showed that the CSA of the C3 multifidus was smaller than the CSA of the C4 (P = .025), C5 (P<.001) or C6 (P<.01) multifidus. There was no significant difference between C4, C5, and C6 multifidus CSA (P>.05). The patients with neck pain had a smaller CSA of the cervical multifidus at all levels compared to controls (P<.001). The ANOVA for muscle shape ratio indicated a significant effect for level (F = 7.84, P<.001) and group (F = 12.501, P<.001), but not for side (F = 0.654, P = .58). There was a significant interaction between level and group (F = 3.651, P = .01). Patients had a wider ovoid shape (greater values in muscle shape ratio) of the C3 (P<.001) and C6 (P<.01) cervical multifidus compared to controls. Further, the C4 multifidus had a smaller shape ratio compared to C6 (P<.001), but was not significantly different than the shape ratio of the C3 and C5 (P>.05) multifidus.
Females with bilateral chronic neck pain had generalized smaller CSA of the cervical multifidus muscles compared to healthy females.
病例对照研究。
分析双侧慢性颈部疼痛患者与健康受试者之间颈多裂肌的肌肉大小和形状差异。
研究人员已证实在患有下背部疼痛的患者中腰多裂肌萎缩；然而，关于慢性颈部疼痛个体的颈多裂肌大小仅有少数已发表的报告。
对20名双侧慢性颈部疼痛女性和20名健康女性拍摄第三至第六颈椎（C3至C6）水平的双侧多裂肌超声图像。在不知道分组情况的前提下测量横截面积（CSA[cm²]）和肌肉形状比（外侧[Lat]与前后[AP]维度之比，[Lat/AP]）。使用两个独立的三因素（4×2×2）混合模型方差分析（ANOVA），以颈椎水平（C3至C6）和侧别（右侧、左侧）作为受试者内因素，组（患者、对照）作为受试者间因素，来评估组间、侧别间和颈椎水平间CSA和肌肉形状比的差异。
CSA的ANOVA显示颈椎水平有显著影响（F = 6.81，P<.001）和组有显著影响（F = 20.27，P<.001），但侧别无显著影响（F = 1.26，P = .36）。变量间无显著交互作用（P>.5）。事后分析表明，C3多裂肌的CSA小于C4（P = .025）、C5（P<.001）或C6（P<.01）多裂肌的CSA。C4、C5和C6多裂肌的CSA之间无显著差异（P>.05）。与对照组相比，颈部疼痛患者各水平的颈多裂肌CSA均较小（P<.001）。肌肉形状比的ANOVA显示水平有显著影响（F = 7.84，P<.001）和组有显著影响（F = 12.501，P<.001），但侧别无显著影响（F = 0.654，P = .58）。水平和组之间存在显著交互作用（F = 3.651，P = .01）。与对照组相比，患者C3（P<.001）和C6（P<.01）颈多裂肌的椭圆形更宽（肌肉形状比的值更大）。此外，C4多裂肌的形状比与C6相比更小（P<.001），但与C3和C5多裂肌的形状比无显著差异（P>.05）。
与健康女性相比，双侧慢性颈部疼痛的女性颈多裂肌的CSA普遍较小。
