中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (33): 5315-5319.doi: 10.12307/2024.641

• 数字化骨科 digital orthopedics • 上一篇    下一篇

椎旁肌功能横截面积预测骨质疏松性椎体压缩骨折

张文胜1，2，宋振杰1，2，郭海威1，2，吴春飞1，2，杨瀚迪1，2，李  颖1，2，李文超1，2，刘洪江1，2，杨晓光1，2，原  超1，2   

  1. 1广东省中医骨伤研究院，广东省广州市   510405；2广州中医药大学第三附属医院，广东省广州市   510405
  • 收稿日期:2023-07-17 接受日期:2023-09-18 出版日期:2024-11-28 发布日期:2024-01-30
  • 通讯作者: 原超，硕士，主任医师，广东省中医骨伤研究院，广东省广州市 510405；广州中医药大学第三附属医院，广东省广州市 510405
  • 作者简介:张文胜，男，1989年生，安徽省马鞍山市人，汉族，硕士，主治医师，主要从事脊柱脊髓病的中医药研究。
  • 基金资助:
    广东省中医骨伤研究院开放基金(GYH202102-04)，项目负责人：原超；广东省中医骨伤研究院开放基金(GYH202101-03)，项目负责人：李颖：广东省自然科学基金面上项目(2022A1515011404)，项目负责人：李颖

Osteoporotic vertebral compression fracture predicted by functional cross-sectional area of paravertebral muscles

Zhang Wensheng1, 2, Song Zhenjie1, 2, Guo Haiwei1, 2, Wu Chunfei1, 2, Yang Handi1, 2, Li Ying1, 2, Li Wenchao1, 2, Liu Hongjiang1, 2, Yang Xiaoguang1, 2, Yuan Chao1, 2   

  1. 1Guangdong Provincial Institute of Traditional Chinese Medicine Osteopathy, Guangzhou 510405, Guangdong Province, China; 2Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Received:2023-07-17 Accepted:2023-09-18 Online:2024-11-28 Published:2024-01-30
  • Contact: Yuan Chao, Master, Chief physician, Guangdong Provincial Institute of Traditional Chinese Medicine Osteopathy, Guangzhou 510405, Guangdong Province, China; Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • About author:Zhang Wensheng, Master, Attending physician, Guangdong Provincial Institute of Traditional Chinese Medicine Osteopathy, Guangzhou 510405, Guangdong Province, China; Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • Supported by:
    Open Fund of Guangdong Provincial Institute of Traditional Chinese Medicine Osteopathy, No. GYH202102-04 (to YC); Open Fund of Guangdong Provincial Institute of Traditional Chinese Medicine Osteopathy, No. GYH202101-03 (to LY) ; Natural Science Foundation of Guangdong Province (General Program), No. 2022A1515011404 (to LY)

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摘要：


文题释义：

骨质疏松性椎体压缩骨折：是由于骨质疏松症致脊柱椎体骨密度、骨质量下降，骨强度减低，椎体在轻微创伤或无明显创伤情况下即发生压缩性骨折，> 60岁绝经后女性发病率超20%。骨质疏松性椎体压缩骨折可导致后凸畸形，产生顽固性背痛，并导致心肺功能下降和胃肠功能紊乱，影响睡眠及心理健康，严重降低患者生活质量。
脊椎旁肌：是长在脊柱旁边的肌肉群，可分为深层肌群和浅层肌群。深层椎旁肌都是起止点附着在椎体横突或棘突上的肌肉，被称为“棘突横突肌群”，包含回旋肌、多裂肌和半棘肌。浅层椎旁肌为竖脊肌群，包括棘肌、最长肌以及髂肋肌。脊柱是由多个椎体组成的节段性结构，且形态较长，因此，附着在脊椎旁的肌肉都是以相对应的节段名称而命名的肌群。


背景：骨质疏松性椎体压缩骨折是继发于骨质疏松症的常见骨折，目前尚缺乏有效的骨质疏松性椎体压缩骨折预测指标及方法。

目的：探讨椎旁肌退变、功能横截面积及脂肪浸润百分比对骨质疏松性椎体压缩骨折的预测作用。
方法：纳入2018年1月至2022年6月确诊的骨质疏松患者224例，随访时间2年以上，根据是否发生椎体骨折分为骨折组和非骨折组，收集患者人口学资料、体质量指数、椎体骨密度等详细信息，测量并计算L2椎体下终板层面双侧腰大肌及背伸肌(竖脊肌和多裂肌)功能横截面积和脂肪浸润百分比。

结果与结论：①224例患者中有126例发生骨折为骨折组，98例未发生骨折为非骨折组，两组年龄、性别、身高、体质量、体质量指数、骨折节段比较差异均无显著性意义(P > 0.05)；②骨折组骨密度显著低于非骨折组(P < 0.05)，骨折组腰大肌、背伸肌功能横截面积显著低于非骨折组(P < 0.05)，骨折组背伸肌脂肪浸润百分比显著高于非骨折组(P < 0.05)，两组腰大肌脂肪浸润百分比差异无显著性意义(P > 0.05)；③受试者操作特征曲线分析显示椎体骨密度、背伸肌脂肪浸润百分比、背伸肌功能横截面积和腰大肌脂肪浸润百分比的截断值分别为0.903 g/cm2，35.426%，418.875 mm2，6.375%；曲线下面积分别为0.634，0.755，0.876，0.585；④结果表明：椎旁肌退变与骨质疏松性椎体压缩骨折的发生密切相关，背伸肌功能横截面积可以有效预测骨质疏松性椎体压缩骨折的发生，有助于早期防治骨质疏松性椎体压缩骨折。

https://orcid.org/0000-0002-0665-3235 (张文胜) 

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

关键词: 椎旁肌, 功能横截面积, 骨质疏松, 腰椎骨折, 预测

Abstract: BACKGROUND: Osteoporosis vertebral compression fracture is a common fracture secondary to osteoporosis, and there is currently a lack of effective predictive indicators and methods for osteoporosis vertebral compression fracture.
OBJECTIVE: To investigate the predictive effects of paravertebral muscle degeneration, functional cross-sectional area, and percentage of fat infiltration on osteoporotic vertebral compression fractures.
METHODS: The 224 patients with osteoporosis diagnosed from January 2018 to June 2022 were included. They were followed up for more than 2 years. They were divided into fracture group and non-fracture group according to the presence and absence of vertebral fracture. The detailed information of demographics, body mass index, bone mineral density and so on were collected. The functional cross-sectional area and percentage of fat infiltration of bilateral Psoas major muscle and extensor dorsi (Erector spinae muscles muscle and multifidus muscle) at the level of lower endplate of L2 vertebral body were measured and calculated. 
RESULTS AND CONCLUSION: (1) 224 patients were ultimately included, of which 126 had fractures as the fracture group and 98 had no fractures as the non-fracture group. There was no statistically significant difference in age, gender, height, body mass, body mass index, and fracture segment between the two groups (P > 0.05). (2) The bone mineral density of the fracture group was significantly lower than that of the non-fracture group (P < 0.05). Functional cross-sectional areas of Psoas major muscle and extensor dorsi in the fracture group were significantly lower than those in the non-fracture group (P < 0.05). The percentage of fat infiltration of the extensor dorsi in the fracture group was significantly higher than that in the non-fracture group (P < 0.05). There was no significant difference in percentage of fat infiltration of Psoas major muscle between the two groups (P > 0.05). (3) Receiver operating characteristic analysis showed that the vertebral bone mineral density, percentage of fat infiltration of extensor dorsi, functional cross-sectional area of extensor dorsi and percentage of fat infiltration of Psoas major muscle were 0.903 g/cm2, 35.426%, 418.875 mm2, and 6.375%, respectively. The areas under curve were 0.634, 0.755, 0.876, and 0.585, respectively. (4) These findings indicate that paravertebral muscle degeneration is strongly associated with the occurrence of osteoporotic vertebral compression fractures. The functional cross-sectional area of extensor dorsi muscle can effectively predict the occurrence of osteoporotic vertebral compression fractures, which is helpful for early prevention and treatment of osteoporotic vertebral compression fractures.

Key words: paravertebral muscle, functional cross-sectional area, osteoporosis, lumbar spine fracture, prediction

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