仰卧位及俯卧过屈位MRI对正常人多裂肌形态变化的研究
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摘要
目的研究仰卧位及俯卧过屈位MRI对正常人多裂肌的形态变化。方法随机选取健康志愿者42例,男16例,女26例,年龄22～67岁,平均(39.1±12.2)岁;应用美国GE DISCOVERY MR 750 3.0 T磁共振扫描仪,行仰卧位及俯卧过屈位配对检查,俯卧过屈位为患者俯卧于MR检查床上,腹部垫以表面呈弧形的软垫,高度为25 cm,造成腰椎过屈状态。两种体位MRI检查要求扫描的腰椎间盘层面、层数及层厚一致;应用Image J软件进行图像分析,测量参数为:①多裂肌总横截面积(TCSA);②仰卧位与俯卧过屈位多裂肌TCSA差值(S-P)。结果各个节段多裂肌TCSA存在差异,自上至下逐渐增大;各个节段TCSA俯卧过屈位较TCSA仰卧位多裂肌形态减小,TCSA俯卧过屈位、TCSA仰卧位与俯卧过屈位差值自上至下也逐渐增大,差异具有统计学意义(P=0.000)。结论仰卧位及俯卧过屈位配对MRI检查动态评估正常人多裂肌形态变化对研究腰椎间盘突出症(LDH)的病因及发病机制具有重要意义。
Objective To investigate the morphological changes of normal lumbar multifidus muscle(LMM)in the dynamic evaluation with supine vs. prone flexion MRI. Methods 42 healthy volunteers(16 male and 26 female)between the ages of 22 and 67 years were enrolled in this study. All healthy volunteers underwent supine and prone flexion paired lumbar MRI, including sagittal T_1WI, T_2WI and axial T_2WI sequences. LMM morphological parameters were obtained using the Image J software, including the total cross-sectional area( TCSA)and muscle morphological change between supine and prone flexion positions(S-P). Results TCSA of LMM increased gradually from L3/4 to L5/S1. TCSA with prone flexion position of LMM was less than TCSA with supine position from L3/4 to L5/S1(P = 0.000). Conclusions The morphological changes of normal lumbar multifidus muscle in the dynamic evaluation with supine vs. prone flexion MRI was important for exploring the etiology and pathogenesis of LDH.
Objective To investigate the morphological changes of normal lumbar multifidus muscle(LMM)in the dynamic evaluation with supine vs. prone flexion MRI. Methods 42 healthy volunteers(16 male and 26 female)between the ages of 22 and 67 years were enrolled in this study. All healthy volunteers underwent supine and prone flexion paired lumbar MRI, including sagittal T_1WI, T_2WI and axial T_2WI sequences. LMM morphological parameters were obtained using the Image J software, including the total cross-sectional area( TCSA)and muscle morphological change between supine and prone flexion positions(S-P). Results TCSA of LMM increased gradually from L3/4 to L5/S1. TCSA with prone flexion position of LMM was less than TCSA with supine position from L3/4 to L5/S1(P = 0.000). Conclusions The morphological changes of normal lumbar multifidus muscle in the dynamic evaluation with supine vs. prone flexion MRI was important for exploring the etiology and pathogenesis of LDH.
引文
[1]中华医学会放射学分会介入学组.腰椎间盘突出症的介入和微创治疗操作规范的专家共识[J].中华放射学杂志,2014,48(1):10-12.
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[6]范顺武,胡志军,方向前.腰椎后路手术中脊旁肌保护的相关思考[J].中华骨科杂志,2011,31(4):400-407.
[7]Hoh DJ,Wang MY,Ritland SL.Anatomic features of the paramedian muscle-splitting approaches to the lumbar spine[J].Neurosurgery,2010,66(3 Suppl Operative):13-24;discussion:24-5.
[8]Macintosh JE,Valencia F,Bogduk N,et al.The morphology of the human lumbar multifidus[J].Clin Biomech(Bristol,Avon),1986,1(4):196-204.
[9]Crossman K,Mahon M,Watson PJ,et al.Chronic low back pain-associated paraspinal muscle dysfunction is not the result of a constitutionally determined“adverse”fiber-type composition[J].Spine(Phila Pa 1976),2004,29(6):628-634.
[10]O’Sullivan PB,Grahamslaw KM,Kendell M,et al.The effect of different standing and sitting postures on trunk muscle activity in a pain-free population[J].Spine(Phila Pa 1976),2002,27(11):1238-1244.
[11]Freeman MD,Woodham MA,Woodham AW.The role of the lumbar multifidus in chronic low back pain:a review[J].PM R,2010,2(2):142-146.
[12]陈兴灿,潘建虎,俞一曼.仰卧及俯卧过屈位CT对腰椎间盘突出症的初步临床应用[J].中国医学影像技术,2003,19(4):468-470.
[13]陈兴灿,刘淼,何东,等.仰卧位和俯卧过屈位CT、MRI对腰椎间盘突出症显示的比较研究[J].中华放射学杂志,2011,45(1):65-68.
[2]王国基,王国军,彭健民,等.腰椎间盘突出症致病因素的流行病学研究[J].现代预防医学,2009,36(13):2401-2403.
[3]Jiang J,Wang H,Wang L,et al.Multifidus Degeneration,A New Risk Factor for Lumbar Spinal Stenosis:A CaseControl Study[J].World Neurosurg,2017,99:226-231.
[4]BattiéMC,Niemelainen R,Gibbons LE,et al.Is level-and side-specific multifidus asymmetry a marker for lumbar disc pathology[J].Spine J,2012,12(10):932-939.
[5]韩磊,赵平,郭蕾,等.腰椎间盘突出者患侧多裂肌厚度及弹性不同姿势变化观察[J].人民军医,2017,60(6):563-566.
[6]范顺武,胡志军,方向前.腰椎后路手术中脊旁肌保护的相关思考[J].中华骨科杂志,2011,31(4):400-407.
[7]Hoh DJ,Wang MY,Ritland SL.Anatomic features of the paramedian muscle-splitting approaches to the lumbar spine[J].Neurosurgery,2010,66(3 Suppl Operative):13-24;discussion:24-5.
[8]Macintosh JE,Valencia F,Bogduk N,et al.The morphology of the human lumbar multifidus[J].Clin Biomech(Bristol,Avon),1986,1(4):196-204.
[9]Crossman K,Mahon M,Watson PJ,et al.Chronic low back pain-associated paraspinal muscle dysfunction is not the result of a constitutionally determined“adverse”fiber-type composition[J].Spine(Phila Pa 1976),2004,29(6):628-634.
[10]O’Sullivan PB,Grahamslaw KM,Kendell M,et al.The effect of different standing and sitting postures on trunk muscle activity in a pain-free population[J].Spine(Phila Pa 1976),2002,27(11):1238-1244.
[11]Freeman MD,Woodham MA,Woodham AW.The role of the lumbar multifidus in chronic low back pain:a review[J].PM R,2010,2(2):142-146.
[12]陈兴灿,潘建虎,俞一曼.仰卧及俯卧过屈位CT对腰椎间盘突出症的初步临床应用[J].中国医学影像技术,2003,19(4):468-470.
[13]陈兴灿,刘淼,何东,等.仰卧位和俯卧过屈位CT、MRI对腰椎间盘突出症显示的比较研究[J].中华放射学杂志,2011,45(1):65-68.