| Objective:To investigate the cross-sectional area atrophy of paravertebral multifidus muscle and erector spine muscle in patients with chronic low back pain at different stages of spinal stability and instability changes of degree,R2*value and FF value.To investigate the functional status of inspiratory muscle group in patients with chronic low back pain at different stages of spinal stability and instability.Methods:Fifty patients with low back pain were divided into 2 groups according to whether the lumbar spine was unstable.Lumbar instability patients were the instability group(25 cases).Lumbar stable patients were included in the stable group(25 cases),Normal group as control group(25 cases).The magnetic resonance scanner GE Discovery MR750W 3.0T was used to perform sagittal T2WI,transverse T1WI and L4-L5 vertebral bodies with IDIQ(Iterative decomposition of water and fat with echo asymmetrical and least-squares estimation quantitation sequence)and Bold(Blood oxygen level dependent magnetic resonance imaging)in the three groups.The scanned images are transmitted to GE’s ADW4.4 workstation for image post-processing and analysis.The L4-L5 intervertebral disc para-lumbar multifission muscle and erector spine muscle were outlined on the workstation,and the corresponding cross-sectional area atrophy,R2*and FF values were measured.M-mode ultrasound was used to measure the diaphragm motion amplitude during calm breathing and deep breathing and Diaphragm thickness at end expiratory and inspiratory ends in the three groups.The Power Breathe K5 inspiratory muscle test system was used to evaluate the actual average muscle strength index value,the actual average peak inspiratory velocity value,the difference between the predicted average muscle force index value and the actual average muscle force index value,the resistance inspiratory times and the inspiratory energy of the three groups.Results:①There were significant differences in the area atrophy of multifidus muscle on the left and right sides among the unstable group,stable group and control group(P<0.05):the instability group was smaller than the stable group and the control group(P<0.05),and the stable group was smaller than the control group(P<0.05),that is,the instability group<stable group<control group.The R2*and FF values of multifidus muscle on the left and right sides of the unstable group,stable group and control group were significantly different(P<0.05):the unstable group was greater than the stable group and the control group(P<0.05),and the stable group was greater than the control group(P<0.05),that is,the unstable group>stable group>control group.②There were statistically significant differences in the area atrophy of the left and right erector spine muscles among the unstable group,stable group and control group(P<0.05):the instability group was less than the stable group and the control group(P<0.05),and the stable group was less than the control group(P<0.05),that is,the instability group<stable group<control group.The R2*and FF values of the erection spinal muscles on the left and right sides of the unstable group,the stable group and the control group were significantly different(P<0.05):the unstable group was greater than the stable group and the control group(P<0.05),and the stable group was greater than the control group(P<0.05),that is,the unstable group>stable group>control group.③There were no significant differences in the area atrophy degree of multifidus muscle on left and right sides,FF value,R2*value and FF value in unstable group(P>0.05).There was statistical significance in R2*of multifidus on left and right sides(P<0.05).④There were no significant differences in the area atrophy degree and R2*of multifidus muscle on left and right sides and the area atrophy degree and R2*of erector spine muscle on left and right sides in stable group(P>0.05).There were statistically significant differences in FF values of left and right multifidus muscles and left and right erector spine muscles(P<0.05).⑤There were no significant differences in the area atrophy,R2*value,FF value of multifidus muscle on left and right sides of the control group,and in the area atrophy,R2*value,FF value of the erector spine muscle on left and right sides of the control group(P>0.05).⑥Diaphragm function:there was no statistical significance in the diaphragmatic movement of calm breathing and the end expiratory diaphragm thickness among the unstable group,the stable group and the control group(P>0.05).Deep breathing diaphragm movement,the end inspiratory diaphragm thickness and diaphragm thickening rate were significantly different among the unstable group,stable group and control group(P<0.05):the instability group was lower than the stable group and the control group(P<0.05),and the stable group was lower than the control group(P<0.05),that is,the instability group<stable group<control group.⑦Inspiratory muscle strength:there was no statistical significance in the predicted average muscle strength index values among the unstable group,stable group and control group(P>0.05).The actual average muscle force index value and the actual average peak inspiratory velocity value among the unstable group,stable group and control group were statistically significant(P<0.05):the unstable group was lower than the stable group and the control group(P<0.05),and the stable group was lower than the control group(P<0.05),that is,the unstable group<stable group<control group.The difference between the predicted average muscle strength index value and the actual average muscle strength index value among the unstable group,stable group and control group was statistically significant(P<0.05):the unstable group was greater than the stable group and the control group(P<0.05),and the stable group was greater than the control group(P<0.05),that is,the unstable group>stable group>control group.⑧inspiratory muscle endurance:there were statistically significant differences in the resistance inspiratory number and inspiratory energy between the unstable group,the stable group and the control group(P<0.05):the unstable group was less than the stable group and the control group(P<0.05),and the stable group was less than the control group(P<0.05),that is,the unstable group<stable group<control group.Conclusion:①The area atrophy of multifidus muscle and erector spine muscle decreased with the decrease of lumbar stability.②The R2*and FF values of multifidus muscle and erector spine muscle increased with the decrease of lumbar spine stability.③The R2*values of left and right multifidus muscles in patients with low back pain and lumbar instability were different.④ There are differences in FF values of left and right multifidus muscles and erector spinal muscles in patients with low back pain and stable lumbar spine.⑤In patients with chronic low back pain,the multifidus and erector spine muscles were atrophy,fat infiltration,and increased deoxyhemoglobin,especially in the lumbar instability group.⑥Deep breathing diaphragmatic mobility,diaphragm thickness at inspiratory ends and diaphragmatic thickening rate decreased with the decline of lumbar spine stability.⑦The actual mean muscle force index and the actual mean peak inspiratory velocity decreased with the decrease of lumbar stability.⑧The difference between the predicted average muscle strength index value and the actual average muscle strength index value decreased with the decrease of lumbar stability.⑨Resistive inspiratory times and inspiratory energy decreased with the decline of lumbar stability.⑩The function of diaphragm and inspiratory muscles were impaired in patients with chronic low back pain,especially in the lumbar instability group. |
PDF Full Text Request