颈椎椎旁肌三维形态学参数与多节段脊髓型颈椎病术后颈肩痛缓解不良相关性分析

doi:10.3877/cma.j.issn.2096-0263.2026.03.001

中华老年骨科与康复电子杂志 ›› 2026, Vol. 12 ›› Issue (03) : 129 -135. doi: 10.3877/cma.j.issn.2096-0263.2026.03.001

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颈椎椎旁肌三维形态学参数与多节段脊髓型颈椎病术后颈肩痛缓解不良相关性分析

薛澳¹, 李寅², 殷国勇³^,⁴^,⁵, 赵书杰³^,⁴^,⁵^,^†(

)

¹223399　淮安，南京医科大学附属淮安第一医院血管外科
²210008　南京大学医学院附属鼓楼医院疼痛科
³210029　南京医科大学第一附属医院骨科
⁴江苏省功能重建与康复研究所
⁵南京医科大学脊柱脊髓疾病研究中心

收稿日期:2024-10-25 出版日期:2026-06-05
通信作者: 赵书杰
基金资助:
国家自然科学基金重点项目(82030069); 国家自然科学基金面上项目(81772351); 国家重点研发计划重点专项项目(2022YFA1205000)

Correlation between three-dimensional morphological parameters of cervical paraspinal muscles and unsatisfactory relief of cervical shoulder pain of multilevel cervical spondylotic myelopathy after posterior surgery

Ao Xue¹, Yin Li², Guoyong Yin³^,⁴^,⁵, Shujie Zhao³^,⁴^,⁵^,^†()

¹Department of Vascular Surgery, Huai'an First People's Hospital, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an 223399, China
²Department of Pain Medicine, Gulou Hospital Affiliated to Medical School of Nanjing University, Nanjing 210008, China
³Department of Orthopedics, The First Affiliated Hospital with Nanjing Medical University
⁴Jiangsu Provincial Institute of Functional Reconstruction and Rehabilitation
⁵Spinal and Spinal Cord Disease Research Center, Nanjing 210029, China

Received:2024-10-25 Published:2026-06-05
Corresponding author: Shujie Zhao

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引用本文：

薛澳, 李寅, 殷国勇, 赵书杰. 颈椎椎旁肌三维形态学参数与多节段脊髓型颈椎病术后颈肩痛缓解不良相关性分析[J/OL]. 中华老年骨科与康复电子杂志, 2026, 12(03): 129-135.

Ao Xue, Yin Li, Guoyong Yin, Shujie Zhao. Correlation between three-dimensional morphological parameters of cervical paraspinal muscles and unsatisfactory relief of cervical shoulder pain of multilevel cervical spondylotic myelopathy after posterior surgery[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2026, 12(03): 129-135.

目的

探讨颈椎椎旁肌三维形态学参数与颈后路手术治疗多节段脊髓型颈椎病患者手术颈肩痛之间的相关性。

方法

回顾性分析2019年6月至2021年6月接受颈后路椎板减压侧块螺钉内固定手术（PCL+LSF）治疗的162例多节段脊髓型颈椎病患者临床资料，根据术前及术后（24±6）月随访时的颈椎功能障碍指数改善程度分为颈肩痛改善组和颈肩痛残留组，并根据术前及术后（24±6）月随访时的JOA评分计算患者JOA改善率。比较分析两组患者的一般资料、JOA改善率和影像学资料，三维重建椎旁肌以评估颈椎旁肌（颈多裂肌、颈半棘肌、头半棘肌、头夹肌和颈长肌）的相对容积及脂肪浸润率。

结果

颈肩痛改善组与颈肩痛残留组在性别、年龄、BMI、手术时间、术中出血、JOA改善率方面的差异无统计学意义。颈肩痛残留组的颈多裂肌相对容积更小[（9.90±3.15）vs（8.36±2.35），t=3.510，P=0.001]，脂肪浸润率更高[（31.31±8.45）vs（40.55±11.52），t=5.819，P<0.001]；颈肩痛残留组颈半棘肌相对容积更小[（6.57±1.73）vs（5.89±2.14），t=2.233，P=0.027]，脂肪浸润率更高[（11.86±5.63）vs（13.74±5.53），t=1.084，P=0.028]；颈肩痛残留组头半棘肌相对容积更小[（26.33±7.39）vs（23.76±6.03），t=2.424，P=0.017]，脂肪浸润率更高[（13.05±4.09）vs（14.82±4.95），t=2.490，P=0.014]；颈肩痛残留组头夹肌相对容积更小[（25.66±7.38）vs（23.19±5.95），t=2.351，P=0.020]，脂肪浸润率更高[（6.09±1.91）vs（7.28±4.01），t=2.406，P=0.018]，差异具有统计学意义。

结论

颈椎多裂肌、颈半棘肌、头半棘肌、头夹肌相对容积减小及脂肪浸润程度增加与多节段脊髓型颈椎病PCL+LSF术后颈肩痛缓解不良相关。

关键词: 颈椎旁肌, 脊髓型颈椎病, 三维形态学参数, 颈肩痛

Objectives

To investigate the correlation between the three-dimensional morphological parameters of cervical paraspinal muscles and the prognosis of posterior cervical decompression and lateral mass screw fixation (PCL+LSF) for patients with multilevel cervical spondylotic myelopathy.

Methods

The clinical data of 162 patients with multilevel cervical spondylotic myelopathy who had undergone PCL+LSF from June 2019 to June 2021 was retrospectively analyzed. They were divided into two groups based on the Neck Disability Index at (24±6) months follow-up after surgery. The general and imaging data of the two groups of patients were compared and analyzed, Three dimensional reconstruction of the cervical paraspinal muscles was performed to evaluate the relative volume and fatty infiltration rate of the cervical paraspinal muscles.

Results

No statistically significant differences between the two groups were noted in terms of gender, age, BMI, surgical time, JOA score and intraoperative bleeding. The relative volume of the levator scapulae muscle in the residual neck and shoulder pain group is smaller [(9.90±3.15) vs (8.36±2.35), t=3.510, P=0.001], and the fat infiltration rate is higher [(31.31±8.45) vs (40.55±11.52), t=5.819, P<0.001]; The relative volume of the sternocleidomastoid muscle in the residual neck and shoulder pain group is smaller [(6.57±1.73) vs (5.89±2.14), t=2.233, P=0.027], and the fat infiltration rate is higher [(11.86±5.63) vs (13.74±5.53), t=1.084, P=0.028]; The relative volume of the splenius capitis muscle in the residual neck and shoulder pain group is smaller [(26.33±7.39) vs (23.76±6.03), t=2.424, P=0.017], and the fat infiltration rate is higher [(13.05±4.09) vs (14.82±4.95), t=2.490, P=0.014]; The relative volume of the trapezius muscle in the residual neck and shoulder pain group is smaller [(25.66±7.38) vs (23.19±5.95), t=2.351, P=0.020], and the fat infiltration rate is higher [(6.09±1.91) vs (7.28±4.01), t=2.406, P=0.018]. The differences are statistically significant.

Conclusions

Reduced relative volume and increased fatty infiltration of the cervical multifidus, semispinalis cervicis, semispinalis capitis and splenius capitis are associated with poor relief of neck and shoulder pain after PCL combined with LSF for multilevel cervical myelopathy.

Key words: Cervical Paravertebral Muscles, Cervial Spondylotic Myelopathy, Three-dimensional Morphological Parameter, Cervical shoulder pain

图1 78岁，女性，CSM患者的颈椎CT及三维重建；A为颈椎CT矢状面（红线代表C₁上椎板和C₇下椎板，红线之间的区域为需要重建的颈椎旁肌区域，绿线为选择的颈椎层面）；图B　横截面展示椎体ROI；图C　三维空间展示椎体ROI

图2 颈椎椎旁肌三维重建；图A　除去脂肪的肌肉组分，从左到右依次是：颈长肌、多裂肌、颈半棘肌、头半棘肌、头夹肌、颈椎椎旁肌整体观；图B　从左到右依次为：颈长肌脂肪、多裂肌脂肪、颈半棘肌脂肪、头半棘肌脂肪、头夹肌脂肪、颈椎椎旁肌脂肪整体观；图C　颈椎椎旁肌去脂组分与脂肪组分整体观

图3 椎旁肌CT扫描横截面；红色填充区域为去脂LC，蓝色填充区域为去脂MF，灰色填充区域为去脂SCer，绿色填充区域为去脂SCap，粉色填充区域为去脂SPL，黄色区域为脂肪组分，橙色填充区域为椎体部分

表1 两组患者临床一般资料比较

组别	例数	性别（男/女，例）	年龄（岁，±s）	BMI（kg/m²，±s）	手术时间（min，±s）	术中出血量（ml，±s）	NDI改善率（%，±s）	JOA改善率（%，±s）
颈肩痛改善组	81	55/26	55.0±12.0	23.4±4.6	158±54	149±49	65.8±11.9	68.5±10.7
颈肩痛残留组	81	57/24	57.4±14.6	24.6±4.9	146±41	161±41	40.1±6.9	65.1±12.9
统计值		χ²=0.339	t=-1.158	t=-1.558	t=1.590	t=-1.616	t=7.804	t=1.835
P值		0.735	0.249	0.121	0.114	0.108	<0.001	0.068

表1 两组患者临床一般资料比较

组别	例数	性别（男/女，例）	年龄（岁，±s）	BMI（kg/m²，±s）	手术时间（min，±s）	术中出血量（ml，±s）	NDI改善率（%，±s）	JOA改善率（%，±s）
颈肩痛改善组	81	55/26	55.0±12.0	23.4±4.6	158±54	149±49	65.8±11.9	68.5±10.7
颈肩痛残留组	81	57/24	57.4±14.6	24.6±4.9	146±41	161±41	40.1±6.9	65.1±12.9
统计值		χ²=0.339	t=-1.158	t=-1.558	t=1.590	t=-1.616	t=7.804	t=1.835
P值		0.735	0.249	0.121	0.114	0.108	<0.001	0.068

表2 两组患者颈椎椎旁肌形态学参数的比较

项目	颈肩痛改善组（n=81）	颈肩痛残留组（n=81）	t值	P值
LC-RV（cm³）	8.86±3.43	7.91±3.93	1.646	0.102
MF-RV（cm³）	9.90±3.15	8.36±2.35	3.510	0.001
SCer-RV（cm³）	6.57±1.73	5.89±2.14	2.233	0.027
SCap-RV（cm³）	26.33±7.39	23.76±6.03	2.424	0.017
SPL-RV（cm³）	25.66±7.38	23.19±5.95	2.351	0.020
LC-FI（%）	11.11±5.78	12.52±5.99	1.521	0.13
MF-FI（%）	31.31±8.45	40.55±11.52	5.819	<0.001
SCer-FI（%）	11.86±5.63	13.74±5.53	1.084	0.028
SCap-FI（%）	13.05±4.09	14.82±4.95	2.490	0.014
SPL-FI（%）	6.09±1.91	7.28±4.01	2.406	0.018

表2 两组患者颈椎椎旁肌形态学参数的比较

项目	颈肩痛改善组（n=81）	颈肩痛残留组（n=81）	t值	P值
LC-RV（cm³）	8.86±3.43	7.91±3.93	1.646	0.102
MF-RV（cm³）	9.90±3.15	8.36±2.35	3.510	0.001
SCer-RV（cm³）	6.57±1.73	5.89±2.14	2.233	0.027
SCap-RV（cm³）	26.33±7.39	23.76±6.03	2.424	0.017
SPL-RV（cm³）	25.66±7.38	23.19±5.95	2.351	0.020
LC-FI（%）	11.11±5.78	12.52±5.99	1.521	0.13
MF-FI（%）	31.31±8.45	40.55±11.52	5.819	<0.001
SCer-FI（%）	11.86±5.63	13.74±5.53	1.084	0.028
SCap-FI（%）	13.05±4.09	14.82±4.95	2.490	0.014
SPL-FI（%）	6.09±1.91	7.28±4.01	2.406	0.018

表3 椎旁肌形态学参数与NDI改善率相关性分析

	MF-RV	SCer-RV	SCap-RV	SPL-RV	MF-FI	SCer-FI	SCap-FI	SPL-FI
r值	0.467	0.174	0.364	0.353	-0.418	-0.168	-0.377	-0.348
P值	0.001	0.027	0.016	0.020	<0.001	0.047	0.014	0.017

表3 椎旁肌形态学参数与NDI改善率相关性分析

	MF-RV	SCer-RV	SCap-RV	SPL-RV	MF-FI	SCer-FI	SCap-FI	SPL-FI
r值	0.467	0.174	0.364	0.353	-0.418	-0.168	-0.377	-0.348
P值	0.001	0.027	0.016	0.020	<0.001	0.047	0.014	0.017

1	关晓明,马迅.脊髓型颈椎病手术入路及减压融合方式的选择策略[J].中华骨科杂志, 2019, 39(23): 1478-1484.
2	Toledano M, Bartleson JD. Cervical spondylotic myelopathy [J]. Neurol Clin, 2013, 31(1): 287-305.
3	中华外科杂志编辑部.颈椎病的分型、诊断及非手术治疗专家共识(2018) [J].中华外科杂志, 2018, 56(6): 401-402.
4	许春阳,杨晋才,尹鹏,等.颈椎后路手术治疗脊髓型颈椎病的应用进展[J].中华骨与关节外科杂志, 2022, 15(4): 296-301.
5	Ghogawala Z, Terrin N, Dunbar MR, et al. Effect of ventral vs dorsal spinal surgery on Patient-Reported physical functioning in patients with cervical spondylotic myelopathy: a randomized clinical trial [J]. JAMA, 2021, 325(10): 942-951.
6	侯传勇,刘新晖,张海龙,等.肌少症对老年患者髋部骨折术后远近期死亡率的影响[J].中华老年骨科与康复电子杂志, 2020, 6(3): 136-141.
7	Lin TT, Wang ZY, Chen G, et al. Predictive effect of cervical spinal cord compression and corresponding segmental paravertebral muscle degeneration on the severity of symptoms in patients with cervical spondylotic myelopathy [J]. Spine J, 2021, 21(7): 1099-1109.
8	Caffard T, Arzani A, Verna B, et al. Importance of the cervical paraspinal muscles in postoperative patient-reported outcomes and maintenance of sagittal alignment after anterior cervical discectomy and fusion [J]. J Neurosurg Spine, 2024, 41(2): 149-158.
9	Thakar S, Arun AA, Aryan S, et al. Deep flexor sarcopenia as a predictor of poor functional outcome after anterior cervical discectomy in patients with myelopathy [J]. Acta Neurochir (Wien), 2019, 161(10): 2201-2209.
10	Khil EK, Choi JA, Hwang E, et al. Paraspinal back muscles in asymptomatic volunteers: quantitative and qualitative analysis using computed tomography (CT) and magnetic resonance imaging (MRI)[J]. BMC Musculoskeletal Disorders, 2020, 21(1): 403.
11	Henderson L, Kulik G, Richarme D, et al. Is spinal stenosis assessment dependent on slice orientation? A magnetic resonance imaging study [J]. Eur Spine J, 2012, 21 Suppl 6(Suppl 6): S760-S764.
12	Jolivet E, Daguet E, Pomero V, et al. Volumic patient-specific Reconstruction of muscular system based on a reduced dataset of medical images [J]. Comput Methods Biomech Biomed Engin, 2008, 11(3): 281-290.
13	Li F, Laville A, Bonneau D, et al. Study on cervical muscle volume by means of three-dimensional Reconstruction [J]. J Magn Reson Imaging, 2014, 39(6): 1411-1416.
14	赵书杰,李寅,范啸,等.椎旁肌三维形态学参数与腰椎管狭窄症手术预后的相关性分析[J].中华骨与关节外科杂志, 2022, 15(12): 921-926.
15	Costa F, Anania CD, Agrillo U, et al. Cervical spondylotic myelopathy: from the world federation of neurosurgical societies (WFNS) to the Italian neurosurgical society (SINch) recommendations [J]. Neurospine, 2023, 20(2): 415-429.
16	Li Q, Long X, Wang R, et al. Correlation between degeneration of cervical intervertebral disc and degeneration of paravertebral muscle[J]. Frontiers in Endocrinology, 2024, 15: 1391970.
17	Paliwal M, Weber KA2, Smith AC, et al. Fatty infiltration in cervical flexors and extensors in patients with degenerative cervical myelopathy using a multi-muscle segmentation model [J]. PLoS One, 2021, 16(6): e0253863.
18	Tamai K, Grisdela PJ, Romanu J, et al. The impact of cervical spinal muscle degeneration on cervical sagittal balance and spinal degenerative disorders [J]. Clin Spine Surg, 2019, 32(4): E206-E213.
19	Zheng LY, Siegmund G, Ozyigit G, et al. Sex-specific prediction of neck muscle volumes [J]. J Biomech, 2013, 46(5): 899-904.
20	Fortin M, Dobrescu O, Courtemanche M, et al. Association between paraspinal muscle morphology, clinical symptoms, and functional status in patients with degenerative cervical myelopathy [J]. Spine (Phila Pa 1976), 2017, 42(4): 232-239.
21	Fortin M, Wilk N, Dobrescu O, et al. Relationship between cervical muscle morphology evaluated by MRI, cervical muscle strength and functional outcomes in patients with degenerative cervical myelopathy [J]. Musculoskelet Sci Pract, 2018, 38: 1-7.
22	Gu Y, Wang C, Hu J, et al. Association Between the Cervical Extensor Musculature and the Demographic Features, Symptoms, and Sagittal Balance in Patients with Multilevel Cervical Spondylotic Myelopathy [J]. World Neurosurg, 2023, 169: e40-e50.
23	裴勃.颈椎单开门椎板成形术后颈后椎旁肌对比[D].天津:天津医科大学, 2016.
24	Cao Y, Xu C, Sun B, et al. Preoperative Cervical Cobb Angle Is a Risk Factor for Postoperative Axial Neck Pain after Anterior Cervical Discectomy and Fusion with Zero-Profile Interbody [J]. Orthop Surg, 2022, 14(12): 3225-3232.
25	Wang B, Qu R, Liu Z, et al. Comparison of Postoperative Pain and Surgical Outcomes Between Three Types of Modified Muscle-Sparing Laminoplasty and Conventional Laminoplasty for Multilevel Degenerative Cervical Myelopathy [J]. Global Spine J, 2025, 15(3): 1801-1812.
26	Ruan C, Jiang W, Lu W, et al. Analysis of risk factors for axial symptoms after posterior cervical open-door laminoplasty [J]. J Orthop Surg Res, 2023, 18(1): 954.
27	陈波,苏敏,尹正录,等.超声引导下体外冲击波治疗颈肩肌筋膜疼痛综合征的疗效观察[J].中华老年骨科与康复电子杂志, 2019, 5(5): 262-268.

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Correlation between three-dimensional morphological parameters of cervical paraspinal muscles and unsatisfactory relief of cervical shoulder pain of multilevel cervical spondylotic myelopathy after posterior surgery

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Correlation between three-dimensional morphological parameters of cervical paraspinal muscles and unsatisfactory relief of cervical shoulder pain of multilevel cervical spondylotic myelopathy after posterior surgery