多裂肌脂肪比例及横截面积与椎间盘Pfirrmann分级椎间盘突出重吸收的关系

doi:10.3969/j.issn.1006-6233.2025.06.27

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摘要 目的: 探析腰椎间盘突出症(LDH)患者多裂肌脂肪百分比及横截面积变化与pfirrmann分级及治疗后椎间盘髓核重吸收的关系。方法: 纳入2020年7月至2023年7月本院收治的LDH患者105例,以磁共振成像(MRI)检测患者多裂肌横截面积及脂肪百分比变化,并分析其与患者pfirrmann分级及治疗后椎间盘髓核重吸收的关系。结果: 在不同Pre-pfirrmann分级LDH中三级、四级患者的患侧占比及健L₅/S₁-pre纯多裂肌肌肉面积、健L₅/S₁-pre脂肪比例比较,差异均有统计学意义(P<0.05);在不同post-pfirrmann分级LDH中三级、四级、五级患者的年龄、患L₄/L₅-post脂肪比例比较,差异均有统计学意义(P<0.05);重吸收与未吸收患者在post-pfirrmann分级占比及患/健L₄/L₅-post脂肪比例、患/健L₅/S₁-post脂肪比例方面比较,差异均有统计学意义(P<0.05);Logistic回归显示:健L₄/L₅-post脂肪比例为影响治疗后重吸收的危险因素(P<0.05);ROC曲线显示:健L₄/L₅-post脂肪比例评估LDH治疗后重吸收的AUC分别为0.729。结论: 健L₅/S₁-pre纯多裂肌肌肉面积、健L₅/S₁-pre脂肪比例在不同pre-pfirrmann分级上存在差异,而患L₄/L₅-post脂肪比例则在不同post-pfirrmann分级上存在差异,且健L₄/L₅-post脂肪比例与LDH治疗后重吸收有关,且对重吸收具有一定的评估价值。

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关键词 ：腰椎间盘突出症, 多裂肌, 脂肪浸润

Abstract：Objective: To explore and analyze the association of multifidus muscle fat ratio and cross-sectional area changes with pfirrmann grading and reabsorption of intervertebral disc nucleus pulposus after treatment in patients with lumbar disc herniation (LDH). Methods: Totally 105 patients with LDH admitted to the hospital from July 2020 to July 2023 were included. The changes of cross-sectional area and fat ratio of multifidus muscle were detected by magnetic resonance imaging (MRI), and the relationship with pfirrmann grading and reabsorption of intervertebral disc nucleus pulposus after treatment was analyzed. Results: There were statistical differences in the proportion of affected side, the muscle area of healthy L₅/S₁-pre pure multifidus muscle and healthy L₅/S₁-pre fat ratio between LDH patients with pre-pfirrmann grade 3 and grade 4 (P<0.05). The differences in age and affected L₄/L₅-post fat ratio among LDH patients with post-pfirrmann grade 3, grade 4 and grade 5 were statistically significant (P<0.05). The proportion of post-pfirrmann grading, affected/healthy L₄/L₅-post fat ratio and affected/healthy L₅/S₁-post fat ratio revealed no statistical differences between patients with reabsorption and without reabsorption (P<0.05). Logistic regression showed that the ratio of healthy L₄/L₅-post fat was a risk factor for reabsorption after treatment (P<0.05). ROC curves showed that the AUC of LDH reabsorption after LDH treatment as assessed by healthy L₄/L₅-post fat ratio was 0.729, respectively. Conclusion: The muscle area of healthy L₅/S₁-pre pure multifidus muscle and the fat proportion of healthy L₅/S₁-pre were different in different pre-pfirrmann grades, while the fat proportion of patients with L₄/L₅-post was different in different post-pfirrmann grades.Moreover, the healthy L₄/L₅-post fat ratio is related to reabsorption after LDH treatment, and has a certain evaluation value for reabsorption.

Key words： Lumbar disc herniation Multifidus muscle Fat infiltration

基金资助:四川省中医药管理局科学技术研究专项课题,(编号:2021MS053);四川省干部保健科研项目,(编号:川干研ZH2023-601);四川省中央引导地方科技发展专项项目,(编号:2022ZYD0105)

引用本文:

王丰, 戴国钢, 杜万里, 陈君蓉, 李曰文. 多裂肌脂肪比例及横截面积与椎间盘Pfirrmann分级椎间盘突出重吸收的关系[J]. 河北医学, 2025, 31(6): 1022-1028.
WANG Feng, DAI Guogang, DU Wanli, et al. The Relationship of Multifidus Muscle Fat Ratio and Cross-Sectional Area with Pfirrmann Grading and Intervertebral Disc Herniation Reabsorption. HeBei Med, 2025, 31(6): 1022-1028.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2025.06.27 或 http://www.hbyxzzs.cn/CN/Y2025/V31/I6/1022

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