超声多参数成像评价腰部多裂肌损伤的前瞻性临床研究*

Evaluation of lumbar multifidus muscle injury using ultrasound multi-feature: a prospective study*

摘要:

目的：应用超声多参数成像评估慢性下腰痛患者与无症状志愿者腰部多裂肌超声影像特征。 材料和方法：前瞻性纳入慢性下腰痛患者与无症状志愿者各60人，收集受试者的一般资料、腰痛相关评分。常规超声测量多裂肌横切面厚度、面积，L3筋膜厚度，剪切波超声弹性成像测量多裂肌弹性模量。分别评价两位医师测量上述超声指标的一致性、不同腰椎节段的变化，以及比较两组各项超声指标的差异。 结果：两位医师测量的各项超声指标的组内及组间一致性良好，ICC：0.799-0.995。随着腰椎节段的不断增加，多裂肌的厚度和面积均不断增加。腰痛组与无症状组相比，L3-4、L4-5多裂肌厚度显著减低，L2-3、L3-4、L4-5多裂肌面积显著减低；L3筋膜厚度显著增加；多裂肌弹性显著增加（所有P≤0.001）。 结论：腰部多裂肌的厚度、面积、筋膜厚度、弹性等是评价多裂肌病变的可靠超声指标。

Abstract:

Objective: To evaluate the ultrasonic features of lumbar multifidus muscle in patients with chronic low back pain and asymptomatic volunteers by using multi-parameter ultrasound imaging. Materials and Methods: 60 patients with chronic low back pain and 60 asymptomatic volunteers were prospectively enrolled in our study. Their clinical information and low back pain related scores were collected. The thickness and area of the multifidus muscle and the thickness of L3 fascia were measured by conventional ultrasound in transverse section, and the elastic modulus of the multifidus muscle was measured by shear wave sono-elastography. The consistency of the above ultrasound features measured by two sonographers and the changes of different lumbar segments were evaluated respectively, and the differences of the ultrasound features were compared between the two groups. Results: The intra- and inter-group consistency of each ultrasound feature measured by the two sonographers was good (ICC: 0.79-0.995). With the continuous increase of lumbar segments, the thickness and area of the multifidus muscle increase. Compared with the asymptomatic group, the thickness of L3-4, L4-5 multifidus muscle and the area of L2-3, L3-4, L4-5 multifidus muscle were significantly reduced, L3 fascia thickness was significantly increased and the multifidus muscle elasticity was significantly increased in the low back pain group (all P≤0.001). Conclusion: The thickness, area, fascia thickness and elasticity of lumbar multifidus muscle are reliable ultrasound features for evaluating multifidus myopathy. Key words: Low back pain; Multifidus Muscles; Visual Analogue Scale; Ultrasonography; Elasticity;