Kulig Kornelia, Scheid Alison R, Beauregard Robin, Popovich John M, Beneck George J, Colletti Patrick M
Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California 90089, USA.
Am J Phys Med Rehabil. 2009 May;88(5):355-61. doi: 10.1097/phm.0b013e31819c506d.
The purpose of this study was 2-fold: (1) to analyze the degree and the location of lumbar multifidus asymmetry among patients scheduled for L4-L5 microdiscectomy, and (2) to determine the amount of asymmetry recognizable by a radiologist on magnetic resonance imaging.
Bilateral multifidi cross-sectional areas were measured on magnetic resonance axial images of 20 patients scheduled to undergo L4-L5 microdiscectomy. The sides were compared and the location and amount of asymmetry (%)determined. The axial slices were assigned to two different categories based on their anatomical proximity to the L4-L5 disc (Disc(Ref)) and to the fascicles of the lumbar multifidus attaching to the spinous process of L5 (Muscle(Ref)). The maximal percent difference in cross-sectional area was compared between these categories. A radiologist rated the degree of asymmetry visually. These ratings were compared slice by slice to the computed percent difference in the cross-sectional area.
Mean differences in multifidus cross-sectional area were 11.5 +/- 5.6% in the Disc(Ref) and 15.8 +/- 9.5% in the Muscle(Ref) categories and were statistically significant (P = 0.03). The radiologist recognized asymmetry when the quantitative difference was at least 12.6%. This level of asymmetry was identified in the Muscle(Ref) category in 45% of cases and in Disc(Ref) in 30% of cases.
Nearly half of the cases scheduled for lumbar microdiscetomy exhibited asymmetry of at least 12.6% in the lumbar multifidus innervated by the L5 nerve root, which is located below the level of the injured disc. A trained radiologist can readily identify this multifidus asymmetry.
本研究有两个目的：（1）分析计划接受L4-L5微创椎间盘切除术患者的腰多裂肌不对称程度及位置，（2）确定放射科医生在磁共振成像上可识别的不对称量。
在20例计划接受L4-L5微创椎间盘切除术患者的磁共振轴位图像上测量双侧多裂肌的横截面积。比较两侧并确定不对称的位置和量（%）。根据轴位切片与L4-L5椎间盘（椎间盘（参考））以及附着于L5棘突的腰多裂肌束（肌肉（参考））的解剖接近程度，将其分为两个不同类别。比较这些类别之间横截面积的最大百分比差异。一名放射科医生通过视觉评估不对称程度。将这些评估逐片与计算出的横截面积百分比差异进行比较。
在椎间盘（参考）类别中，多裂肌横截面积的平均差异为11.5±5.6%，在肌肉（参考）类别中为15.8±9.5%，差异具有统计学意义（P = 0.03）。当定量差异至少为12.6%时，放射科医生可识别出不对称。在45%的病例中，肌肉（参考）类别出现这种不对称水平，在30%的病例中，椎间盘（参考）类别出现这种不对称水平。
计划接受腰椎微创椎间盘切除术的病例中，近一半在由L5神经根支配的腰多裂肌中表现出至少12.6%的不对称，该神经根位于受损椎间盘水平以下。训练有素的放射科医生能够轻易识别这种多裂肌不对称。
