腰痛で最も影響を受ける筋肉はどれですか？

Which is the most affected muscle in lumbar back pain - multifidus or erector spinae?

• Pırıl Erbay Öztürk
• Nilüfer Aylanç

抄録

目的:

本研究の目的は、腰椎腰痛、腰椎椎間板ヘルニア、脊柱起立筋と多裂筋の脂肪腫性変性との関連性を評価することである。

Purpose: The purpose of this study is to evaluate the relationship between lumbar back pain, lumbar disc herniation, and erector spinae and multifidus muscle lipomatous degeneration.

材料と方法:

臨床研究倫理委員会の承認を得て、整形外科、神経内科、脳神経外科、理学療法科、リハビリテーション科で健康診断を受けた患者を対象に、磁気共鳴画像（MRI）検査を実施した。事前診断は「椎間板ヘルニア」または「腰椎椎椎間板ヘルニア」または「腰痛」であり、年齢は18歳から64歳であった。椎体骨折、脊椎炎-脊椎間板炎、腫瘍、脊椎症、脊柱管狭窄症、椎体分割異常などの構造異常、腰部の手術歴のある患者は除外された。症例群では、L1-S1レベルの間に腰椎椎間板ヘルニアを認めた患者は205人、対照群では腰椎椎間板ヘルニアを認めなかった患者は187人であった。本研究では、患者の年齢、性別、ヘルニアのレベル、脊柱起立筋と多関節筋脂肪腫変性を比較した。筋脂肪織変性は目視スケールで評価した。

Material and methods: After receiving approval from the clinical studies Ethics Committee, magnetic resonance imaging (MRI) studies of patients who had physical examination in orthopaedic, neurology, neurosurgery, physical medicine and rehabilitation clinics were evaluated. Their pre-diagnoses were 'herniated nucleus pulposus' or 'lumbar disc herniation' or 'back pain' and their age range was between 18 and 64 years. Patients who had vertebral fracture, spondylitis-spondylodiscitis, tumours, structural anomalies such as spondylolisthesis, scoliosis and vertebral segmentation anomalies and previous surgery in the lumbar area were excluded. There were 205 patients in the case group who had lumbar disc herniation between L1-S1 level and there were 187 patients in the control group who had no lumbar disc herniation. In the study, patient age, sex, herniation level and erector spinae and multifidus muscle lipomatous degeneration were compared. Muscle lipomatous degeneration were evaluated with a visual scale.

結果:

症例群は男性105名、女性100名、対照群は男性88名、女性99名であった。症例群では、腰椎椎間板ヘルニアがL4-5、L5-S1レベルで多く検出された。脊柱起立筋と多裂筋の脂肪腫性変性については、症例群と対照群の間に有意差はなかった。症例群では、多裂筋に比べて脊柱起立筋の脂肪腫性変性が高かった。

Results: There were 105 men and 100 women in the case group and 88 men and 99 women in the control group. In the case group, lumbar disc herniation was detected mostly at L4-5 and L5-S1 levels. There was no significant difference between case and control groups with regard to erector spinae and multifidus muscle lipomatous degeneration. In the case group, lipomatous degeneration of the erector spinae was higher compared to that of the multifidus muscle.

結論:

腰痛患者では、LDHの有無にかかわらず、立位棘突起や多指筋に脂肪変性がみられることがありますが、LDHはその結果というよりも、むしろその進行を加速させます。LDHを有する患者では、多指腸筋よりも脊柱起立筋の脂肪変性が顕著であり、脊柱起立筋はLDHの過程でより影響を受ける。

Conclusions: Patients with low back pain may have fatty degeneration in erector spina and multifidus muscles with or without LDH, but LDH accelerates this process rather than being a result of it. In patients with LDH, fatty degeneration in the erector spina is more pronounced than in multifidus, and the erector spina is more affected by the LDH process.

Copyright © Polish Medical Society of Radiology 2020.