Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China.
China National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China.
J Orthop Surg Res. 2023 Feb 15;18(1):111. doi: 10.1186/s13018-023-03596-w.
This study was performed to quantify the morphological characteristics of the psoas major muscle in patients with symptomatic multilevel degenerative lumbar spinal stenosis (SMLSS) and assess the correlations of these morphological characteristics with function and clinical symptoms.
One hundred fourteen patients diagnosed with SMLSS (≥ 3 segments) were included. The patients' presenting symptoms were assessed with the Oswestry Disability Index (ODI), and visual analogue scale (VAS) scores were recorded. The morphology of the psoas major was evaluated at the L3/4 intervertebral disc level in three ways: by measuring (i) the psoas muscle mass index (PMI); (ii) the mean muscle attenuation (Hounsfield units, HU); and (iii) the morphologic change of the psoas major (mean ratios of the short axis to the long axis of the bilateral psoas major).
Men had a higher PMI than women (p = 0.001). Patients with severe disability had a significantly lower PMI (p = 0.002) and muscle attenuation (p = 0.001). The PMI and muscle attenuation were significantly higher in the patients with no or mild back pain (both p < 0.001). In the univariable and multivariable analyses, a greater HU value was associated with a higher functional status as assessed by the ODI (p = 0.002), and a higher PMI was associated with less severe back pain as measured by the VAS score (p < 0.001).
This study showed that muscle attenuation of psoas major positively correlated with the functional status and PMI negatively correlated with low back pain severity in patients diagnosed with SMLSS. Future prospective studies are needed to evaluate whether improvement in such muscle parameters through physiotherapy programs can alleviate the clinical symptoms and improve the functional status of patients with SMLSS.
本研究旨在量化症状性多节段退行性腰椎管狭窄症（SMLSS）患者腰大肌的形态学特征，并评估这些形态学特征与功能和临床症状的相关性。
纳入 114 例诊断为 SMLSS（≥3 个节段）的患者。使用 Oswestry 残疾指数（ODI）评估患者的表现症状，并记录视觉模拟评分（VAS）。通过以下三种方法评估腰大肌形态：（i）测量腰大肌质量指数（PMI）；（ii）测量平均肌肉衰减值（亨氏单位，HU）；（iii）测量腰大肌形态变化（双侧腰大肌短轴与长轴的平均比值）。
男性的 PMI 高于女性（p=0.001）。严重残疾患者的 PMI（p=0.002）和肌肉衰减值（p=0.001）明显较低。无或轻度腰痛患者的 PMI 和肌肉衰减值明显较高（均 p<0.001）。在单变量和多变量分析中，HU 值较高与 ODI 评估的功能状态较高相关（p=0.002），而 PMI 较高与 VAS 评分测量的腰痛较轻相关（p<0.001）。
本研究表明，腰大肌肌肉衰减值与功能状态呈正相关，PMI 与腰痛严重程度呈负相关，在诊断为 SMLSS 的患者中。需要进一步开展前瞻性研究，以评估通过物理治疗方案改善这些肌肉参数是否能减轻临床症状并改善 SMLSS 患者的功能状态。
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