背景:肌肉的计算机断层扫描(CT)衰减减少与肌肉无力独立相关。在没有腹侧疝的患者中,腹壁肌肉的CT衰减可能与腰大肌的CT衰减有关。这意味着腰大肌的CT衰减可能与切口疝(IH)的发生有关。CT确定的肌肉减少症被认为在预测IH的发展方面效率低下,虽然人们对肌肉脂肪浸润与IH发病率之间的关系给予了有限的关注。在这项研究中,我们的目的是调查腰大肌CT测量参数,包括平均CT衰减,脂肪浸润率和腰大肌指数,与IH相关。
方法:在本研究中,过去接受过阑尾切除术的成年患者,无论出于什么原因,纳入2018年1月至2019年12月在我们医院住院的患者。将患者分为IH组和非IH组。他们的腰大肌CT衰减,测量或计算脂肪浸润率(FIR)和腰肌指数(PMI)。根据其PMI定义肌肉减少症。然后比较两组指数之间的差异。应用逻辑回归模型评估腰大肌CT测量参数对IH发生的影响。
结果:本研究纳入了120例患者。IH组腰大肌CT衰减(p=0.031)和PMI(p=0.042)明显低于非IH组,IH组的FIR显著高于非IH组(p<0.001)。患者腰大肌CT衰减,FIR,PMI,年龄,性别以及他们是否有吸烟史,在单因素logistic回归分析中都是有意义的因素。在调整混杂因素后,多变量logistic回归分析表明腰大肌CT衰减是一个独立的保护因素(p=0.042),FIR是独立风险因素(p=0.018),而PMI(p=0.118)和肌少症(p=0.663)均未对IH的发生率产生显着影响。
结论:进行阑尾切除术后,CT衰减减少和腰大肌FIR增加可被认为是IH的危险因素.
BACKGROUND: Decreased computed tomography (CT) attenuation of muscle is independently associated with muscle weakness. The CT attenuation of the abdominal wall muscles may correlate with that of the psoas in patients without ventral hernias. This means that the CT attenuation of the psoas may be related to the occurrence of incisional hernias (IH). CT-determined sarcopenia was deemed inefficient in predicting the development of IH, while limited attention has been paid to the association between muscle fatty infiltration and incidences of IH. In this study, we aim to investigate whether the psoas\' CT measurement parameters, including the average CT attenuation, fatty infiltration rate and psoas muscle index, are associated with IH.
METHODS: In this study, adult patients who had undergone an appendicectomy in the past and had then, for any reason, been hospitalised in our hospital from January 2018 to December 2019 were enrolled. The patients were classified into an IH group and a non-IH group. Their psoas\' CT attenuation, fatty infiltration rate (FIR) and psoas muscle index (PMI) were measured or calculated. Sarcopenia was defined according to their PMI. Differences between the two groups\' indices were then compared. A logistic regression model was applied to assess the effects of psoas\' CT measurement parameters on the occurrence of IH.
RESULTS: One hundred twenty patients were included in this study. The psoas\' CT attenuation (p = 0.031) and PMI (p = 0.042) in the IH group were significantly lower than those in the non-IH group, and FIR in the IH group was significantly higher than in the non-IH group (p < 0.001). The patients\' psoas\' CT attenuation, FIR, PMI, age, gender and whether they had a history of smoking, were all significant factors in the univariate logistic regression analysis. After adjusting for confounding factors, a multivariate logistic regression analysis demonstrated that the psoas\' CT attenuation was an independent protective factor (p = 0.042), and FIR was an independent risk factor (p = 0.018), while neither PMI (p = 0.118) nor sarcopenia (p = 0.663) showed a significant effect on the incidence of IH.
CONCLUSIONS: When an appendectomy has been performed, a decreased CT attenuation and increased FIR of the psoas can be considered risk factors for IH.