椎旁肌群磁共振成像在慢性非特异性下腰痛理筋手法疗效评估中的价值

Evaluation value of paraspinal muscle group MRI in the therapeutic effect of tendon manipulation for patients with chronic nonspecific low back pain

摘要:

目的 探讨椎旁肌群磁共振成像（MRI）影像学评估理筋手法治疗慢性非特异性下腰痛疗效的价值。方法 选取2019年3月—2021年3月济南市中西医结合医院收治的114例慢性非特异性下腰痛患者，均给予理筋手法治疗，采用椎旁肌群MRI影像学测定椎旁肌相对横截面积（RCSA）和脂肪信号分数（FSF），绘制受试者工作特征（ROC）曲线分析总RCSA和总FSF在理筋手法治疗效果中的评估价值。结果 治疗后视觉模拟评分法（VAS）和Roland-Morris功能障碍评分（RMDQ）均低于治疗前（P <0.05）；治疗后共有34例治疗显效，52例治疗有效，总有效率为75.44%；无效患者治疗前后多裂肌总RCSA差值和总FSF差值均低于有效患者（P <0.05），无效患者治疗前后竖脊肌总RCSA差值和总RCSA差值均低于有效患者（P <0.05）；多裂肌总RCSA、多裂肌总FSF、竖脊肌总RCSA、竖脊肌总FSF评估理筋手法治疗慢性非特异性下腰痛患者的ROC曲线下面积分别为0.827、0.834、0.804和0.760，敏感性分别为79.36%（95% CI：0.512，0.897）、82.69%（95% CI：0.517，0.952）、75.64%（95% CI：0.457，0.890）和70.21%（95% CI：0.403，0.847）；特异性分别为71.25%（95% CI：0.413，0.857）、78.69%（95% CI：0.563，0.942）、70.25%（95% CI：0.410，0.820）和59.36%（95% CI：0.393，0.806）。结论 椎旁肌群MRI影像学可用于定量评估理筋手法治疗慢性非特异性下腰痛患者的疗效，对于指导临床医师调整治疗方案具有重要价值。

Abstract:

Objective To investigate the value of paraspinal muscle group magnetic resonance imaging (MRI) in evaluating the efficacy of tendon manipulation for chronic nonspecific low back pain.Methods A total of 114 patients with chronic nonspecific low back pain treated at Jinan Hospital of Traditional Chinese and Western Medicine from March 2019 to March 2021 were selected. All patients received tendon manipulation. Paraspinal muscle relative cross-sectional area (RCSA) and fat signal fraction (FSF) were measured using paraspinal muscle group MRI. Receiver operating characteristic (ROC) curves were drawn to analyze the evaluation value of total RCSA and total FSF in tendon manipulation.Results Visual analog scale (VAS) and Roland-Morris Disability Questionnaire (RMDQ) scores were lower after treatment compared to before treatment (P < 0.05). After treatment, 34 cases showed significant improvement, 52 cases showed improvement, and the total effective rate was 75.44%. The differences in total RCSA and total FSF before and after treatment in ineffective patients were lower than those in effective patients (P < 0.05), and the differences in total RCSA before and after treatment in ineffective patients were lower than those in effective patients (P < 0.05). The areas under the ROC curves of total RCSA, total FSF, and total RCSA of the multifidus and erector spinae muscles in evaluating the efficacy of tendon manipulation for chronic nonspecific low back pain were 0.827, 0.834, 0.804, and 0.760, respectively. The sensitivity was 79.36% (95% CI: 0.512, 0.897), 82.69% (95% CI: 0.517, 0.952), 75.64% (95% CI: 0.457, 0.890), and 70.21% (95% CI: 0.403, 0.847), respectively. The specificity was 71.25% (95% CI: 0.413, 0.857), 78.69% (95% CI: 0.563, 0.942), 70.25% (95% CI: 0.410, 0.820), and 59.36% (95% CI: 0.393, 0.806), respectively.Conclusion Paraspinal muscle group MRI can be used for quantitative evaluation of the efficacy of tendon manipulation for chronic nonspecific low back pain, which is of great value for guiding clinicians to adjust treatment plans.