Crawford Rebecca J, Elliott James M, Volken Thomas
Institute for Health Sciences, School of Health Professions, Zurich University of Applied Sciences, Technikumstrasse 81, 8401, Winterthur, Switzerland.
Faculty of Health Sciences, Curtin University, Perth, Australia.
Eur Spine J. 2017 Dec;26(12):3059-3067. doi: 10.1007/s00586-017-5212-6. Epub 2017 Jul 11.
Fatty infiltration (FI) is a feature of degenerating muscle that predominates in the low lumbar spine, associates with pain, and is confounded by age, spinal degeneration, and curvature. We determined rates for decline of lumbar muscle quality according to ethnicity, muscle, and spinal level in asymptomatic subjects.
Cross-sectional simulation study assessing aggregated data; 650 Asians aged 20-89 years versus 80 Caucasians aged 20-62 years. Change in lumbar multifidus, erector spinae (ES), and psoas fat content were computed using synthetic data and Monte Carlo simulations. General linear regression models and multivariate adaptive regression splines enabled estimation of yearly decline rates [with 95% confidence intervals (CI)].
ES at L1-5 (total) shows steeply reduced density (rate; CI) for Asians in older (>53.3 years) adulthood (-0.32; -0.27 to -0.36/year). For Asians, multifidus (-0.18; -0.15 to -0.20/year) and psoas (-0.04; -0.03 to -0.06/year) also decline, while ES in younger ≤53.3 years) adults does not (0.06; 0.01-0.12/year). Caucasian multifidus declines (increasing FI % rate; CI) insignificantly faster (L1-5; 0.23; 0.10-0.36%/year) than ES (0.13; 0.04-0.22%/year). Multifidus decline does not differ between ethnicities. ES in older Asians generally declines fastest across ethnicities and muscles, and particularly in the low lumbar levels. Low lumbar levels show higher rates of decline in Asians, with mixed level-dependencies apparent in Caucasians.
Decline in lumbar muscle composition may differ between ethnicities and muscles. ES and low lumbar levels appear increasingly susceptible in Asians. Longitudinal studies examining rate of change to muscle composition may provide distinction between spinal conditions.
脂肪浸润（FI）是退变肌肉的一个特征，在腰椎下部最为明显，与疼痛相关，且受年龄、脊柱退变和脊柱曲度的影响。我们确定了无症状受试者中根据种族、肌肉和脊柱节段划分的腰椎肌肉质量下降率。
横断面模拟研究，评估汇总数据；650名20 - 89岁的亚洲人与80名20 - 62岁的高加索人。使用合成数据和蒙特卡罗模拟计算腰大肌、竖脊肌（ES）和腰大肌脂肪含量的变化。通用线性回归模型和多元自适应回归样条用于估计年下降率[95%置信区间（CI）]。
L1 - 5（总计）的ES在亚洲老年（>53.3岁）成年人中显示密度急剧下降（速率；CI）（-0.32；-0.27至-0.36/年）。对于亚洲人，多裂肌（-0.18；-0.15至-0.20/年）和腰大肌（-0.04；-0.03至-0.06/年）也会下降，而在年龄较小（≤53.3岁）的成年人中ES则不会（0.06；0.01 - 0.12/年）。高加索人的多裂肌下降（FI百分比增加速率；CI）比ES（0.13；0.04 - 0.22%/年）略快（L1 - 5；0.23；0.10 - 0.36%/年），但不显著。多裂肌下降在不同种族之间没有差异。老年亚洲人的ES在所有种族和肌肉中通常下降最快，尤其是在腰椎下部节段。亚洲人腰椎下部节段的下降率更高，而高加索人则表现出不同节段的混合依赖性。
腰椎肌肉组成的下降在不同种族和肌肉之间可能存在差异。亚洲人的ES和腰椎下部节段似乎越来越易受影响。研究肌肉组成变化率的纵向研究可能有助于区分脊柱疾病。
