多裂肌萎缩和脂肪浸润是导致严重形变骨质疏松性椎体压缩骨折的危险因素

doi:10.3877/cma.j.issn.2096-0263.2024.03.004

目的

通过MRI影像学参数，探讨多裂肌的退变与骨质疏松性椎体压缩骨折（OVCF）的骨折形变严重程度的相关性。

方法

2021年1月至2022年12月期间，共有156例OVCF患者纳入本研究，收集并分析临床和MRI影像学资料。根据德国骨创伤协会提出新的OF分型标准，我们将OF1型和OF2型定义为骨折轻微压缩组，将OF3-OF5型定义为骨折严重压缩组。采用单因素和多因素Logistic回归分析，探讨OVCF骨折形变严重程度的危险因素。

结果

骨折轻微压缩组共纳入65例患者，骨折严重压缩组共纳入91例患者，两组患者的基线资料无统计学差异。单因素分析有统计学差异的指标为：两组多裂肌的相对横截面积（rCSA%）分别为70.12±7.99和67.45±7.74（t=2.093，P<0.05）；两组多裂肌的相对有效功能面积（relative Effective Functional Area，rEFA%）分别为42.03±7.64和35.31±8.16（t=5.202，P<0.05）；两组多裂肌的脂肪浸润程度（Degree of Fatty Infiltration，DFI%）分别为52.26±7.45和55.51±7.28，（t=2.724，P<0.05）。多因素Logistic回归分析结果提示，多裂肌的rEFA%[P=0.000<0.05，OR=0.906, 95% CI为（0.863，0.950）]和多裂肌的DFI%[P<0.05，OR=1.055，95% CI（1.006，1.107）]是导致严重形变的OVCF的独立影响因素。

结论

多裂肌的肌纤维的萎缩和脂肪浸润，是肌肉退变和功能障碍的重要特征，也是导致严重形变的OVCF独立影响因素。规律的多裂肌运动方案，可以有效地减缓多裂肌的退变，从而降低发生严重形变的OVCF的可能性。

关键词: 骨质疏松性椎体压缩骨折, 骨折形变, 多裂肌退变, 脂肪浸润

Objective

To investigate the association between the degeneration of the multifidus muscle and the severe deformationof osteoporotic vertebral compression fracture (OVCF) utilizing magnetic resonance imaging (MRI) parameters.

Methods

From January 2021 to December 2022, a total of 156 OVCF patients were selected and included in this study. Clinical and MRI imaging data were collected and analyzed. The German Orthopedic Trauma Association had proposed a new classification standard for OVCF, and we defined OF1 and OF2 as the slightly compressed group, and OF3-OF5 as the severely compressed group. Univariate and multivariate logistic regression analysis were employed to identify risk factors predictive of OVCF severity.

Results

The study divided participants into slightly compressed (65 patients) and severely compressed groups (91 patients), finding no significant differences in baseline characteristics between them. Statistically significant differences identified through univariate analysis included relative Cross-Sectional Area (rCSA%) of the multifidus muscle (70.12±7.99 vs. 67.45±7.74, t=2.093, P=0.038); relative Effective Functional Area (rEFA%) of the multifidus muscles (42.03 ± 7.64 vs. 35.31±8.16, t=5.202, P<0.001); and Degree of Fatty Infiltration (DFI%) of the multifidus muscle(52.26±7.45 vs. 55.51±7.28, t=2.724, P=0.007). Multivariate logistic regression analysis revealed that rEFA% (P<0.001, OR=0.906, 95% CI [0.863, 0.950]) and DFI% (P=0.029, OR=1.055, 95% CI [1.006, 1.107]) of the multifidus muscle served as independent predictors for the severe deformation of OVCF.

Conclusions

Atrophy and fat infiltration of the multifidus muscle were important feature for degeneration and dysfunction, serving as independent influencing factors for the severity of OVCF. A regular multifidus muscle exercise regimen can effectively slow down the degeneration of multifidus muscles, thereby reducing the likelihood of severe OVCF.

Key words: Osteoporotic vertebral compression fracture, Fracture deformation, Degeneration of multifidus muscle, Fat infiltration

图1 实验流程图

图2~5 患者，女性，77岁，骨折严重压缩组，重度脂肪浸润。图2提示骨折属于OF4型；图3提示横断位T2加权像的原始图像，位于腰4/5椎间盘水平；图4提示将腰大肌、竖脊肌和多裂肌进行分割，并勾画出轮廓；图5提示调整阈值，显示脂肪浸润情况，并计算相应影像学指标

图6~9 患者，女性，76岁，骨折轻微压缩组，轻度脂肪浸润。图6提示骨折属于OF1型；图7~9提示意义同上

表1 两组骨质疏松性椎体压缩骨折患者资料的单因素分析

一般资料和观察指标	骨折轻微压缩组	骨折严重压缩组	t/χ²值	P值
样本例数	65	91
性别
男	17（10.89%）	14（8.97%）	2.762	0.097
女	48（30.76%）	77（49.36%）
年龄（岁）	73.91±7.89	75.12±8.31	0.918	0.360
高血压
是	11（7.05%）	12（7.69%）	0.421	0.516
否	54（34.61%）	79（50.64%）
糖尿病
是	7（4.48%）	12（7.69%）	0.207	0.649
否	58（37.17%）	79（50.64%）
腰椎骨密度	-2.83±1.07	-2.84±1.22	0.061	0.951
VAS评分	8.54±1.11	8.26±1.08	1.540	0.126
腰大肌的rCSA%	70.60±11.90	71.11±12.12	0.263	0.793
腰大肌的rEFA%	65.65±11.87	66.23±12.06	0.234	0.815
腰大肌的DFI%	23.68±4.01	23.58±3.75	0.169	0.866
竖脊肌的rCSA%	117.95±18.31	116.30±17.82	0.566	0.572
竖脊肌的rEFA%	84.60±18.08	83.21±18.37	0.468	0.640
竖脊肌的DFI%	47.25±6.94	49.14±7.18	1.641	0.103
多裂肌的rCSA%	70.12±7.99	67.45±7.74	2.093	0.038a
多裂肌的rEFA%	42.03±7.64	35.31±8.16	5.202	0.000a
多裂肌的DFI%	52.26±7.45	55.51±7.28	2.724	0.007a

表1 两组骨质疏松性椎体压缩骨折患者资料的单因素分析

一般资料和观察指标	骨折轻微压缩组	骨折严重压缩组	t/χ²值	P值
样本例数	65	91
性别
男	17（10.89%）	14（8.97%）	2.762	0.097
女	48（30.76%）	77（49.36%）
年龄（岁）	73.91±7.89	75.12±8.31	0.918	0.360
高血压
是	11（7.05%）	12（7.69%）	0.421	0.516
否	54（34.61%）	79（50.64%）
糖尿病
是	7（4.48%）	12（7.69%）	0.207	0.649
否	58（37.17%）	79（50.64%）
腰椎骨密度	-2.83±1.07	-2.84±1.22	0.061	0.951
VAS评分	8.54±1.11	8.26±1.08	1.540	0.126
腰大肌的rCSA%	70.60±11.90	71.11±12.12	0.263	0.793
腰大肌的rEFA%	65.65±11.87	66.23±12.06	0.234	0.815
腰大肌的DFI%	23.68±4.01	23.58±3.75	0.169	0.866
竖脊肌的rCSA%	117.95±18.31	116.30±17.82	0.566	0.572
竖脊肌的rEFA%	84.60±18.08	83.21±18.37	0.468	0.640
竖脊肌的DFI%	47.25±6.94	49.14±7.18	1.641	0.103
多裂肌的rCSA%	70.12±7.99	67.45±7.74	2.093	0.038a
多裂肌的rEFA%	42.03±7.64	35.31±8.16	5.202	0.000a
多裂肌的DFI%	52.26±7.45	55.51±7.28	2.724	0.007a

表2 两组骨质疏松性椎体压缩骨折患者资料的多因素logistic回归分析

入选变量	回归系数	标准误	Wald值	P值	OR值	95% CI
多裂肌的rCSA%	-0.006	0.024	0.062	0.803	0.994	0.948，1.043
多裂肌的rEFA%	-0.099	0.024	16.496	0.000a	0.906	0.863，0.950
多裂肌的DFI%	0.054	0.025	4.790	0.029a	1.055	1.006，1.107

表2 两组骨质疏松性椎体压缩骨折患者资料的多因素logistic回归分析

入选变量	回归系数	标准误	Wald值	P值	OR值	95% CI
多裂肌的rCSA%	-0.006	0.024	0.062	0.803	0.994	0.948，1.043
多裂肌的rEFA%	-0.099	0.024	16.496	0.000a	0.906	0.863，0.950
多裂肌的DFI%	0.054	0.025	4.790	0.029a	1.055	1.006，1.107

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Multifidus atrophy and fat infiltration are risk factors for severe deformation of osteoporotic vertebral compression fracture

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Multifidus atrophy and fat infiltration are risk factors for severe deformation of osteoporotic vertebral compression fracture