中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (36): 5891-5897.doi: 10.12307/2023.718

• 骨与关节综述 bone and joint review • 上一篇    下一篇

椎旁肌退变与矢状位力线的关系

刘子文1,2,杨玉明1,2,谢鸿儒3,张泽佩1,徐浩翔1,苗  军1   

  1. 1天津市天津医院脊柱二科,天津市   300210;2天津医科大学骨科临床学院,天津市   300203;3运城市中心医院,山西省运城市   044099
  • 收稿日期:2022-09-28 接受日期:2022-11-11 出版日期:2023-12-28 发布日期:2023-03-27
  • 通讯作者: 苗军,主任医师,博士生导师,天津市天津医院脊柱二科,天津市 300210
  • 作者简介:刘子文,男,2000年生,安徽省淮南市人,汉族,天津医科大学在读硕士,主要从事骨外科方面的研究。
  • 基金资助:
    天津市自然科学基金(S20ZDD484),项目负责人:苗军

Relationship between the degeneration of paraspinal muscle and sagittal alignment

Liu Ziwen1, 2, Yang Yuming1, 2, Xie Hongru3, Zhang Zepei1, Xu Haoxiang1, Miao Jun1   

  1. 1Second Department of Spine, Tianjin Hospital, Tianjin 300210, China; 2Clinical College of Orthopedics, Tianjin Medical University, Tianjin 300203, China; 3Yuncheng Central Hospital, Yuncheng 044099, Shanxi Province, China
  • Received:2022-09-28 Accepted:2022-11-11 Online:2023-12-28 Published:2023-03-27
  • Contact: Miao Jun, Chief physician, Doctoral supervisor, Second Department of Spine, Tianjin Hospital, Tianjin 300210, China
  • About author:Liu Ziwen, Master candidate, Second Department of Spine, Tianjin Hospital, Tianjin 300210, China; Clinical College of Orthopedics, Tianjin Medical University, Tianjin 300203, China
  • Supported by:
    Natural Science Foundation of Tianjin City, No. S20ZDD484 (to MJ)

摘要:


文题释义:

矢状位力线:是利用多种矢状面参数,对脊柱和骨盆相对位置进行描述和对脊柱矢状位平衡情况的评价。其中胸椎后凸角、胸腰段后凸角、腰椎前凸角等脊柱参数和矢状面垂直轴被用来直观描述脊柱矢状位力线。
椎旁肌退变:椎旁肌作为人体躯干肌的主要组成部分,主要包括浅层对的棘肌、最长肌和髂肋肌,以及深层的多裂肌、回旋肌和横突间肌等,在维持脊柱稳定性方面起着非常重要的作用。形态学上,椎旁肌的退变包括萎缩和变性,即肌肉容积减少(肌纤维变细或减少)和脂肪浸润(肌肉被脂肪组织渗透代替)。

背景:脊柱骨盆各参数间相互关联,其数值的改变与一些退行性脊柱疾病的发生、发展及患者症状密切相关。现阶段临床工作者关注术后冠状面与矢状面参数变化,以评价术后脊柱整体平衡性,而忽略了与椎旁肌的联系以及椎旁肌在脊柱退行性病变进程中的作用。
目的:将已有描述椎旁肌退变与矢状位力线关系的研究进行全面汇总,并对脊柱退行性病变进程中骨性结构位置变化和椎旁肌退变的相互影响进行分析。
方法:以“脊柱矢状面畸形,矢状位力线,脊柱骨盆参数,椎旁肌,退行性病变,人类尸体模型;影像学、磁共振成像”为中文关键词,在中国知网、维普、万方等中文数据库中检索,并以“sagittal spinal deformity,sagittal alignment,spinal-pelvic parameter,paraspinal muscle,degeneration,imaging,MRI”作为英文关键词,在Medline、PubMed、Web of Science等数据库中检索。通过阅读标题及摘要进行初步筛选,按纳入及排除标准筛选文献,最终共纳入78篇文献进行结果分析。

结果与结论:①近年来研究者们开始注意到椎旁肌在维持矢状位力线稳定中具有相应作用,保护和改善椎旁肌功能可以延缓脊柱退行性变;②研究者运用不同方法检测椎旁肌退变程度,选取不同种类的矢状位参数来描述矢状位力线;在分析椎旁肌的退变和矢状面参数改变后,发现两者具有相关性,同时该相关性受年龄、种族等因素影响;③矢状位力线不良是决定椎旁肌退变重要的解剖因素,较大的骨盆投射角值为矢状位参数改变的危险因素,但较小的骨盆投射角值通过椎旁肌的代偿能力较小,更易出现矢状位失衡;④椎旁肌通过代偿机制持续影响矢状位力线,在脊柱退变进程中为了对抗脊柱失平衡,椎旁肌处于高负荷状态,引起疼痛、疲劳及萎缩退变。

https://orcid.org/0000-0003-1070-1890 (刘子文) 

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: 脊柱矢状面畸形, 矢状位力线, 脊柱骨盆参数, 椎旁肌, 退行性病变, 人类尸体模型, 影像学, 磁共振成像

Abstract: BACKGROUND: The parameters of the spine and pelvis are interrelated. The changes in their values are closely related to the occurrence, development and symptoms of degenerative spinal diseases. At the present stage, clinical workers focus on the changes in postoperative coronal and sagittal parameters to evaluate the overall balance of the spine after operation, while ignoring the relationship with paraspinal muscle and the role of paraspinal muscle in the process of spinal degeneration. 
OBJECTIVE: To summarize the previous studies on the relationship between the degeneration of paraspinal muscle and sagittal alignment, and analyze the interaction between changes in the relative position of skeleton structures and degeneration of paraspinal muscle during spinal degeneration.
METHODS: A computer-based online retrieval of CNKI, WanFang, and VIP was conducted with the Chinese key words “sagittal spinal deformity, sagittal alignment, spinal-pelvic parameter, paraspinal muscle, degeneration, human cadaver model, imaging, MRI”. The retrieval of Medline, PubMed, and Web of Science databases was performed with the English key words “sagittal spinal deformity, sagittal alignment, spinal-pelvic parameter, paraspinal muscle, degeneration, imaging, MRI”. The preliminary screening was carried out by reading the title and abstract, and the literature was screened according to the inclusion and exclusion criteria. Finally, a total of 78 articles were included for result analysis.
RESULTS AND CONCLUSION: (1) In recent years, researchers have noticed that paraspinal muscles play a corresponding role in maintaining sagittal alignment, and spinal degeneration can be delayed by protecting and improving paraspinal muscle function. (2) The researchers used different methods to detect the degree of paraspinal muscle degeneration, and selected different kinds of sagittal parameters to describe the sagittal alignment. After analyzing the degeneration of paraspinal muscles and the changes in sagittal parameters, we found that there was a correlation between them, and the correlation was affected by age, race and other factors. (3) Poor sagittal alignment is an important anatomic factor determining paraspinal muscle degeneration. A high pelvic incidence of anatomical parameters has often been reported as a risk factor for sagittal alignment. However, the smaller pelvic incidence is more prone to sagittal imbalance due to the smaller compensatory capacity of paraspinal muscles. (4) The paraspinal muscles continue to affect the sagittal alignment through a compensatory mechanism continuously. To combat spinal imbalance during spinal degeneration, the paraspinal muscles are in a state of high muscle load, causing pain, fatigue, atrophy and degeneration.

Key words: sagittal spinal deformity, sagittal alignment, spinal-pelvic parameter, paraspinal muscle, degenerative disease, human cadaver model, imaging, magnetic resonance imaging

中图分类号: