| 成人退行性脊柱侧凸患者凸、凹侧椎旁肌的不对称性及其与椎体骨质量评分的相关性分析 |
| Asymmetry of paraspinal muscles on the convex and concave sides in adults with degenerative scoliosis and its correlation with vertebral bone quality score |
| 投稿时间：2025-09-09 |
| DOI：10.3969/j.issn.1672-5972.2026.04.004 |
| 中文关键词: 成人退行性脊柱侧凸 椎旁肌 椎体骨质量评分 脂肪浸润率 |
| 英文关键词:Adult degenerative scoliosis Paraspinal muscle Vertebral body bone score Fat infiltration |
| 基金项目:“兴滇英才支持计划”医疗卫生人才项目（XDYC-MY-2022-0026） |
| 作者 | 单位 | 邮编 | | 徐世鑫* | 昆明医科大学第二附属医院骨科,云南 昆明,650101 | 650101 | | 罗洋 | 昆明医科大学第二附属医院骨科,云南 昆明,650101 | 650101 | | 刘文䶮 | 昆明医科大学第二附属医院骨科,云南 昆明,650101 | 650101 | | 李全 | 昆明医科大学第二附属医院骨科,云南 昆明,650101 | 650101 | | 张颖* | 昆明医科大学第二附属医院骨科,云南 昆明,650101 | 650101 |
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| 中文摘要: |
| 目的 分析成人退行性脊柱侧凸（adult degenerative scoliosis, ADS）患者椎旁肌前、后方张力带凸、凹侧的不对称性及其与骨骼参数的相关性分析，旨在为ADS患者的临床术前整体评估提供参考。方法 收集2023年1月至2025年1月在昆明医科大学第二附属医院就诊的ADS患者69例，将符合纳入标准有完整脊柱全长X线、MRI检查的患者资料进行分析，在站立位脊柱全长X线中记录冠状位参数：顶椎偏移距离（apical vertebral translation, AVT）、Cobb角（Cobb angle, CA）、冠状面平衡距离（coronal balance distance, CBD）；矢状位参数：包括脊柱矢状位轴（sagittal vertical axis, SVA）、腰椎前凸角（lumbar lordosis, LL）。在腰椎MRI上顶椎椎体中心层面记录顶椎椎体的横截面积（lumbar cross-sectional area, LCSA），椎旁肌前、后张力带凸、凹侧的横截面积（cross-sectional area, CSA）。CSA/LCSA的比值表示相对横截面积（relative cross-sectional area, rCSA），椎旁肌前、后张力带凸、凹侧的脂肪浸润（fat infiltration, FI）及腰椎MRI矢状位T1WI上测得L1-4椎体骨质和L3椎体后方脑脊液平均信号强度用以计算椎体骨质量（vertebral body bone, VBQ）评分。根据冠状面平衡距离的绝对值CBD≥20 mm分为三组：A组（平衡型CBD＜20 mm，n=40）、B组（凹侧偏移CBD≥20 mm，n=17）、C组（凸侧偏移CBD≥20 mm，n=12）。结果 69例ADS患者的顶椎椎体中心层面后方张力带rCSA和FI在凹侧均显著大于凸侧（P＜0.05）；顶椎椎体中心层面前方张力带rCSA和FI在凸、凹侧比较，差异无统计学意义（P＞0.05）。VBQ评分与前方张力带凸、凹侧FI呈低度正相关（r=0.312、0.246，P＜0.05），与后方张力带凸、凹侧FI呈中度正相关（r=0.690、0.866，P＜0.05）。结论 成人退行性脊柱侧凸患者椎旁肌前后方张力带凸、凹侧rCSA和FI存在不对称性，凹侧比凸侧明显，椎旁肌前后方张力带凸、凹侧FI与VBQ评分显著相关。 |
| 英文摘要: |
| Objective To analyze the asymmetry of the anterior and posterior tension bands on the convex and concave sides of the paraspinal muscles in patients with adult degenerative scoliosis and its correlation with skeletal parameters, aiming to provide a reference for comprehensive preoperative clinical evaluation in ADS patients.Methods A total of 69 ADS patients who visited the Second Affiliated Hospital of Kunming Medical University from January 2023 to January 2025 were collected. These patients underwent full-spine X-ray and MRI examinations. Coronal parameters recorded from standing full-spine X-rays included apical vertebral translation (AVT), Cobb angle (CA), and coronal balance distance (CBD). Sagittal parameters included sagittal vertical axis (SVA) and lumbar lordosis (LL). At the level of the central vertebral body on lumbar MRI, the following measurements were obtained: the lumbar cross-sectional area (LCSA) of the apical vertebral body, the cross-sectional area (CSA) of the anterior and posterior tension bands on the convex and concave sides, the ratio of CSA to LCSA represents the relative cross-sectional area, the fat infiltration (FI) of the anterior and posterior tension bands on the convex and concave sides, and the average signal intensity of the L1-4 vertebral bodies and the cerebrospinal fluid posterior to the L3 vertebral body on sagittal T1-weighted MRI, which were used to calculate the vertebral bone quality (VBQ) score. Based on the absolute value of the CBD, patients were divided into three groups: Group A (balanced, CBD<20 mm, 40 cases), Group B (concave-side deviation, CBD≥20 mm, 17 cases), and Group C (convex-side deviation, CBD≥20 mm, 12 cases).Results In 69 ADS patients, the relative CSA and FI of the posterior tension band on the concave side at the level of the central vertebral body were significantly greater than those on the convex side (P<0.05). No statistically significant differences were observed in the relative CSA and FI of the anterior tension band on the convex and concave sides (P>0.05). The VBQ score showed a mild positive correlation with the FI of the anterior tension band on the convex and concave sides (r=0.312, 0.246, P<0.05) and a significant positive correlation with the FI of the posterior tension band on the convex and concave sides (r=0.690, 0.866, P<0.05).Conclusion Asymmetry in the relative CSA and FI of the anterior and posterior tension bands on the convex and concave sides of the paraspinal muscles is observed in ADS patients, with the concave side being more pronounced than the convex side. The FI of the anterior and posterior tension bands on the convex and concave sides is significantly correlated with the VBQ score. |
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