Wang Bingwen, Xu Lifei, Teng Peng, Nie Lin, Yue Hongwei
Department of Orthopedics, National Regional Medical Center, Dezhou People's Hospital, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China.
Department of Clinical Laboratory, Lianyungang Maternal and Child Health Hospital, Affiliated Hospital of Kangda College of Southern Medical University, Lianyungang, China.
Front Surg. 2024 Nov 12;11:1323939. doi: 10.3389/fsurg.2024.1323939. eCollection 2024.
This study aimed to investigate the effect of lumbar multifidus muscle (MF) degeneration on upper lumbar disc herniation (ULDH).
This study used 3.0T magnetic resonance imaging (MRI) T2 axial weighted images to retrospectively analyze 93 ULDH patients and 111 healthy participants. Sixty-five pairs of participants were included in this study using propensity score matching (PSM). Cross-sectional area, fat infiltration area, anteroposterior diameter (APD), lateral diameter (LD), cross-sectional area of the bilateral multifidus muscles at the corresponding level, intervertebral disc area at the corresponding section, and visual analog scale (VAS) score for low back pain (LBP). For inter-group comparisons, we used the -test, analysis of variance (ANOVA), Mann-Whitney test, Kruskal-Wallis test, chi-square test, or Fisher's exact test, according to the type of data. We used Pearson correlation analysis to study the correlation between the VAS score and related indicators, and established a predictive model for upper lumbar disc herniation using the receive operative characteristic (ROC) curve analysis method. Finally, univariate and multivariate logistic regression analyses were performed to establish a predictive model for the risk of high lumbar disc herniation.
We compared the fat areas at the lumbar vertebral levels L1/2, L2/3, and L3/4, as well as the left lateral diameter (LD) (MF), L1/2 left lumbar multifidus muscle index (LMFI), and L1/2 total fat infiltration cross-section area (TFCSA), and found significant differences between the case and control groups ( < 0.001). Furthermore, we observed a significant positive correlation ( < 0.05) between the VAS scores and multiple muscle indicators. Additionally, we developed ROC prediction models to assess the risk of lumbar intervertebral disc protrusion at the L1/2, L2/3, and L3/4 levels, with the results identifying L1/2 TFCSA, L2/3 TFCSA, and L3/4 relative psoas major muscle cross-section area (rPMCSA) as the most predictive indicators. Finally, univariate and multivariate logistic regression analyses showed that the L1/2 rPMCSA, L2/3 TFCSA were significantly associated with the risk of lumbar intervertebral disc protrusion in both models.
Degeneration of the MF is significantly correlated with the occurrence of ULDH, and the larger the area of fat infiltration in the MF, the more obvious the lower back pain in ULDH patients. In addition, TFCSA can serve as an indicator of the occurrence of ULDH.
本研究旨在探讨腰多裂肌（MF）退变对上腰椎间盘突出症（ULDH）的影响。
本研究采用3.0T磁共振成像（MRI）T2轴位加权图像，回顾性分析93例ULDH患者和111例健康参与者。采用倾向评分匹配（PSM）纳入65对参与者。测量相应节段双侧多裂肌的横截面积、脂肪浸润面积、前后径（APD）、左右径（LD）、相应节段椎间盘面积以及下腰痛视觉模拟量表（VAS）评分。对于组间比较，根据数据类型，我们使用t检验、方差分析（ANOVA）、Mann-Whitney检验、Kruskal-Wallis检验、卡方检验或Fisher精确检验。我们使用Pearson相关分析研究VAS评分与相关指标之间的相关性，并使用接受手术特征（ROC）曲线分析方法建立上腰椎间盘突出症的预测模型。最后，进行单因素和多因素逻辑回归分析，建立高位腰椎间盘突出症风险的预测模型。
我们比较了L1/2、L2/3和L3/4腰椎水平的脂肪面积，以及左侧左右径（LD）（MF）、L1/2左侧腰多裂肌指数（LMFI）和L1/2总脂肪浸润横截面积（TFCSA），发现病例组和对照组之间存在显著差异（P<0.001）。此外，我们观察到VAS评分与多个肌肉指标之间存在显著正相关（P<0.05）。此外，我们开发了ROC预测模型，以评估L1/2、L2/3和L3/4水平腰椎间盘突出的风险，结果确定L1/2 TFCSA、L2/3 TFCSA和L3/4相对腰大肌横截面积（rPMCSA）为最具预测性的指标。最后，单因素和多因素逻辑回归分析表明，在两个模型中，L1/2 rPMCSA、L2/3 TFCSA与腰椎间盘突出风险显著相关。
MF退变与ULDH的发生显著相关，MF中脂肪浸润面积越大，ULDH患者下腰痛越明显。此外，TFCSA可作为ULDH发生的一个指标。
