Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America.
Metabolic Bone Service, Hospital for Special Surgery, New York, NY, United States of America.
Bone. 2024 Dec;189:117259. doi: 10.1016/j.bone.2024.117259. Epub 2024 Sep 18.
Prior studies demonstrate that muscle and bone health are integrally related, and both independently impact orthopedic surgery outcomes. However, relationships between bone density, in vivo microarchitecture, and muscle area have not been previously investigated in orthopedic surgery patients. This study assessed associations between psoas cross sectional area (CSA), bone mineral density (BMD), and microstructure in a cohort undergoing spine fusion. Pre-operatively, bilateral psoas CSA was measured on axial lumbar spine CT in the L3-L4 disc space. To adjust for body size, Psoas Muscle Index (PMI) was calculated (CSA divided by the square of patient height). High resolution peripheral quantitative CT (HR-pQCT, XtremeCT2) assessed volumetric BMD (vBMD), cortical (Ct) and trabecular (Tb) microarchitecture at the distal radius and tibia. Areal BMD (aBMD) was measured by DXA at the lumbar spine (LS), total hip (TH), femoral neck (FN), and the 1/3 radius (1/3R). Pearson correlations related psoas CSA and bone imaging parameters before and after correcting for height and weight. Among 88 patients included, mean age was 63 ± 12 years, BMI was 28 ± 7 kg/m, 47 (53 %) were female. Larger psoas CSA was associated with higher vBMD, greater Ct thickness and better Tb microarchitecture (higher Tb number and lower Tb separation) at the tibia and radius. Larger psoas CSA was also associated with greater aBMD at TH and FN bilaterally and 1/3R (r 0.33 to 0.61; p < 0.002 for all comparisons). Psoas CSA was not associated with aBMD at the LS. Similar results were observed when relating PMI, and adjusting for age, height and weight to HR-pQCT and DXA measurements. Investigation of subgroups by sex demonstrated that relationships were similar magnitude among women but not the men. Patients who underwent primary compared to revision spine surgery had similar associations. Our results demonstrate a link between psoas muscle size and peripheral bone microarchitecture among patients undergoing posterior lumbar spinal fusion. Given the importance of both muscle and skeletal integrity to the success of spine surgery, further study regarding the associations between measurements of psoas muscle, bone microarchitecture, and surgical outcomes is warranted.
先前的研究表明，肌肉和骨骼健康是密切相关的，两者都独立影响骨科手术的结果。然而，在骨科手术患者中，骨密度、体内微结构和肌肉面积之间的关系尚未得到研究。本研究评估了接受脊柱融合术的患者的腰大肌横截面积（CSA）、骨密度（BMD）和微观结构之间的关联。在术前，在 L3-L4 椎间盘水平的轴向腰椎 CT 上测量双侧腰大肌 CSA。为了调整体型，计算了腰大肌肌肉指数（PMI）（CSA 除以患者身高的平方）。高分辨率外周定量 CT（HR-pQCT，XtremeCT2）评估了桡骨远端和胫骨的容积 BMD（vBMD）、皮质（Ct）和小梁（Tb）微观结构。腰椎（LS）、全髋关节（TH）、股骨颈（FN）和 1/3 半径（1/3R）的 DXA 测量了面积 BMD（aBMD）。Pearson 相关关系校正身高和体重前后的腰大肌 CSA 和骨骼成像参数。在 88 名纳入的患者中，平均年龄为 63±12 岁，BMI 为 28±7kg/m，47 名（53%）为女性。较大的腰大肌 CSA 与胫骨和桡骨的更高 vBMD、更大的 Ct 厚度和更好的 Tb 微观结构（更高的 Tb 数量和更低的 Tb 分离）相关。较大的腰大肌 CSA 还与双侧 TH 和 FN 以及 1/3R 的更大 aBMD 相关（r 0.33 至 0.61；所有比较均 p<0.002）。腰大肌 CSA 与 LS 的 aBMD 无关。当将 PMI 与 HR-pQCT 和 DXA 测量值相关联，并调整年龄、身高和体重时，观察到类似的结果。按性别对亚组进行的研究表明，女性的相关性相似，但男性则不然。与接受翻修脊柱手术的患者相比，接受初次脊柱手术的患者具有相似的相关性。我们的研究结果表明，在接受后路腰椎脊柱融合术的患者中，腰大肌大小与外周骨微观结构之间存在联系。鉴于肌肉和骨骼完整性对脊柱手术成功的重要性，需要进一步研究腰大肌肌肉、骨微观结构和手术结果之间的关联。
