Tanida Shimei, Fujibayashi Shunsuke, Otsuki Bungo, Masamoto Kazutaka, Matsuda Shuichi
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Orthop Sci. 2017 Nov;22(6):1001-1008. doi: 10.1016/j.jos.2017.08.002. Epub 2017 Aug 24.
In some people, the psoas major rises laterally or anteriorly at the L4/5 disc level and detaches from the most posterior aspect of the disc despite the absence of transitional vertebrae; this is called the "rising psoas sign." There are no reports of the relationship between spinopelvic parameters and rising psoas sign. The objective of this study was to investigate the relationship between spinopelvic parameters and deviations in the location and shape of psoas major muscle at the L4/5 disc level.
We investigated the preoperative location and shape of both psoas major muscles in 64 patients treated with lateral lumbar interbody fusion. Spinopelvic parameters were measured on X-ray films. The morphology of psoas major at the L4/5 disc level was investigated with magnetic resonance images. The morphological measurements were normalized by the anteroposterior diameter of the center of the L4 vertebral body, which was measured by computed tomography. The rising psoas sign was classified into 2 types: bilateral or unilateral.
The pelvic incidence (PI) was significantly larger for the bilateral type than the others (normal and unilateral types) (60.2 ± 11.0 vs. 46.7 ± 8.7, p < 0.001). The PI correlated significantly with the normalized anteroposterior diameter of the pelvis (R = 0.66, p < 0.001). The receiver-operator characteristic curve showed an optimal cutoff value of PI = 54, with 75% sensitivity and 78.5% specificity. The coronal L1-4 Cobb angle was significantly larger in the unilateral type than the others (normal and bilateral types) (p < 0.0001). In the unilateral type, the Cobb angle in the recumbent position correlated significantly with the normalized distance of the lateral deviation of psoas major (R = 0.60, p = 0.0085).
The rising psoas sign was related to a higher PI and lumbar scoliosis. It was firstly elucidated that the spinopelvic alignment and morphology influence the deviation of the course of the psoas major muscle.
A retrospective morphological study.
在一些人身上，腰大肌在L4/5椎间盘水平向外侧或前方上升，尽管没有过渡椎骨，但却从椎间盘的最后方附着处分离；这被称为“腰大肌上升征”。目前尚无关于脊柱骨盆参数与腰大肌上升征之间关系的报道。本研究的目的是探讨脊柱骨盆参数与L4/5椎间盘水平腰大肌位置和形态偏差之间的关系。
我们对64例行腰椎外侧椎间融合术的患者术前双侧腰大肌的位置和形态进行了研究。在X线片上测量脊柱骨盆参数。通过磁共振成像研究L4/5椎间盘水平腰大肌的形态。形态学测量值通过计算机断层扫描测量的L4椎体中心前后径进行标准化。腰大肌上升征分为2种类型：双侧型或单侧型。
双侧型的骨盆入射角（PI）显著大于其他类型（正常型和单侧型）（60.2±11.0 vs. 46.7±8.7，p<0.001）。PI与骨盆标准化前后径显著相关（R=0.66，p<0.001）。受试者工作特征曲线显示PI的最佳截断值为54，敏感性为75%，特异性为78.5%。单侧型的冠状面L1-4 Cobb角显著大于其他类型（正常型和双侧型）（p<0.0001）。在单侧型中，仰卧位时的Cobb角与腰大肌外侧偏移的标准化距离显著相关（R=0.60，p=0.0085）。
腰大肌上升征与较高的PI和腰椎侧弯有关。首次阐明了脊柱骨盆排列和形态会影响腰大肌走行的偏差。
一项回顾性形态学研究。
