背景:椎旁肌脂肪浸润对颈椎退行性疾病的影响已被多项研究证实。然而,对急性颈脊髓损伤(SCI)患者椎旁伸肌的脂肪浸润知之甚少。本研究旨在探讨急性颈性脊髓损伤患者与健康对照组之间椎旁伸肌脂肪浸润的差异。并进一步探讨椎旁伸肌对颈椎SCI患者的保护作用。
方法:对2019年1月至2023年11月急诊科收治的50例急性颈性脊髓损伤患者进行回顾性分析。包括26名男性和24名女性,平均年龄59.60±10.81岁。还包括50名健康中老年人的对照组,包括28名男性和22名女性,平均年龄55.00±8.21岁。颈椎磁共振成像(MRI)用于测量颈浅和深伸肌的横截面积,相应的椎体横截面积,以及使用ImageJ软件在浅表和深伸肌群内的脂肪区域。比较两组之间的差异,并根据脊髓损伤的严重程度和性别差异对颈椎SCI患者进行进一步分析。
结果:宫颈SCI组C4-C7处深层脂肪浸润率(DFIR)和浅表脂肪浸润率(SFIR)明显高于对照组(P<0.001)。颈SCI组C5、C6水平的功能性深伸肌区域(FDEA)相对于椎体区域(VBA)的横截面积和功能性浅伸肌区域(FSEA)相对于VBA的横截面积明显低于对照组(分别P<0.001、P<0.001、P=0.034、P=0.004)。在宫颈SCI患者中,男性的深伸肌区(DEA)和浅伸肌区(SEA)的横截面积明显高于女性(P<0.001)。在C6和C7水平,男性组FDEA/VBA和FSEA/VBA比值高于女性组(P=0.009,P=0.022,P=0.019,P=0.005)。
结论:与健康对照组相比,急性颈SCI患者表现出更高的脂肪浸润和更大程度的椎旁伸肌变性。这一发现强调了椎旁伸肌在颈椎SCI中的重要性,并可能指导未来的治疗策略。
BACKGROUND: The effect of fat infiltration in the paraspinal muscles on
cervical degenerative disease has been confirmed by multiple studies. However, little is known about fat infiltration in the paraspinal extensors in patients with acute
cervical spinal cord injury (SCI). This study aimed to investigate the difference in paraspinal extensor fatty infiltration between patients with acute cervical SCI and healthy controls, and to further explore the protective role of the paravertebral extensor muscles in patients with cervical SCI.
METHODS: A total of 50 patients with acute
cervical SCI admitted to the emergency department from January 2019 to November 2023 were retrospectively analyzed, including 26 males and 24 females, with an average age of 59.60 ± 10.81 years. A control group of 50 healthy middle-aged and elderly individuals was also included, comprising 28 males and 22 females, with an average age of 55.00 ± 8.21 years.
Cervical spine magnetic resonance imaging (MRI) was used to measure the cross-sectional areas of the superficial and deep cervical extensor muscles, the corresponding vertebral body cross-sectional areas, and the fat area within the superficial and deep extensor muscle groups using Image J software. Differences between the two groups were compared, and the
cervical SCI patients were further analyzed based on the severity of the spinal cord injury and gender differences.
RESULTS: The deep fatty infiltration ratio (DFIR) and superficial fatty infiltration ratio (SFIR) at C4-C7 in the cervical SCI group were significantly higher than those in the control group (P < 0.001). The cross-sectional area of the functional deep extensor area (FDEA) relative to the vertebral body area (VBA) and the cross-sectional area of the functional superficial extensor area (FSEA) relative to the VBA at the C5 and C6 levels in the cervical SCI group were significantly lower than those in the control group (P < 0.001, P < 0.001, P = 0.034, P = 0.004 respectively). Among the cervical SCI patients, the cross-sectional areas of the deep extensor area (DEA) and the superficial extensor area (SEA) in males were significantly higher than those in females (P < 0.001). At the C6 and C7 levels, the FDEA/VBA and FSEA/VBA ratios in the male group were higher than those in the female group (P = 0.009, P = 0.022, P = 0.019, P = 0.005, respectively).
CONCLUSIONS: Patients with acute cervical SCI exhibit significantly higher fatty infiltration and a greater degree of paravertebral extensor muscle degeneration compared to healthy controls. This finding underscores the importance of the paravertebral extensor muscles in the context of cervical SCI and may guide future therapeutic strategies.