椎旁肌脂肪浸润与下肢骨性关节炎的因果关系

The Causal Relationship Between Paraspinal Muscle Fat Infiltration and Lower Limb Osteoarthritis

摘要: 背景：椎旁肌脂肪浸润(PMFI)是椎旁肌退行性变的重要表现，可能导致肌肉力量下降和脊柱稳定性变差，进而引发多种疾病。骨性关节炎(OA)是全球最常见的关节疾病之一，其主要病因之一是关节长期负荷过重。目前尚缺乏探讨PMFI与下肢骨性关节炎联系的研究。本研究旨在探讨椎旁肌脂肪浸润与下肢骨性关节炎之间的关系，为下肢骨性关节炎的预防和治疗提供新的视角。方法：本研究为回顾性单中心研究，选取2021~2023年就诊于中国云南省某大型三甲医院骨科的患者。采用Goutallier分期标准评估椎旁肌脂肪浸润程度，依据Kellgren-Lawrence分级标准评估下肢骨性关节炎程度。利用SPSS 23.0进行数据分析，包括t检验和多因素回归分析。结果：共纳入4018名患者，45岁以下患者占22.08%，46~60岁患者占47.83%，60~75岁患者占21.55%，75岁以上患者占8.54%。男性患者占49.43%，女性患者占50.57%。椎旁肌脂肪浸润0~4期的分布比例分别为9.53%、18.02%、21.90%、29.99%和20.56%；下肢骨性关节炎0~4级的分布比例分别为12.59%、15.31%、17.00%、29.54%和25.56%。t检验结果显示患PMFI的患者群体中，OA患病率显著高于未患PMFI的患者群体(90.98% vs 53.52%, P < 0.001)。多因素回归分析结果显示椎旁肌脂肪浸润分期对是否患OA有显著正向影响(OR = 3.17, P < 0.001)，年龄对是否患OA也有显著正向影响(OR = 1.04, P < 0.001)，而性别对是否患OA的影响不显著(P = 0.093)。结论：椎旁肌脂肪浸润是下肢骨性关节炎的强危险因素，年龄也是其显著正向影响因素，而性别影响不显著。

Abstract: Background: Paraspinal muscle fatty infiltration (PMFI) is an important manifestation of paraspinal muscle degeneration, which may lead to decreased muscle strength and impaired spinal stability, thereby triggering various diseases. Osteoarthritis (OA) is one of the most common joint diseases globally, with one of its main causes being long-term excessive joint load. Currently, there is a lack of research exploring the relationship between PMFI and lower limb osteoarthritis. This study aims to investigate the relationship between paraspinal muscle fatty infiltration and lower limb osteoarthritis, providing a new perspective for the prevention and treatment of lower limb osteoarthritis. Methods: This study is a retrospective single-center study, selecting patients who visited the orthopedic department of a large tertiary hospital in Yunnan Province, China, from 2021 to 2023. The degree of paraspinal muscle fatty infiltration was assessed using the Goutallier classification, and the severity of lower limb osteoarthritis was evaluated according to the Kellgren-Lawrence grading criteria. Data analysis was conducted using SPSS 23.0, including t-tests and multiple regression analysis. Results: A total of 4,018 patients were included, with 22.08% aged under 45, 47.83% aged 46~60, 21.55% aged 60~75, and 8.54% aged over 75. Male patients accounted for 49.43%, and female patients accounted for 50.57%. The distribution proportions of paraspinal muscle fatty infiltration stages 0~4 were 9.53%, 18.02%, 21.90%, 29.99%, and 20.56%, respectively; the distribution proportions of lower limb osteoarthritis grades 0~4 were 12.59%, 15.31%, 17.00%, 29.54%, and 25.56%, respectively. T-test results showed that the prevalence of OA in patients with PMFI was significantly higher than in those without PMFI (90.98% vs 53.52%, P < 0.001). Multiple regression analysis results indicated that the stage of paraspinal muscle fatty infiltration had a significant positive effect on the likelihood of developing OA (OR = 3.17, P < 0.001), and age also had a significant positive effect on the likelihood of developing OA (OR = 1.04, P < 0.001), while the effect of gender on developing OA was not significant (P = 0.093). Conclusion: Paraspinal muscle fatty infiltration is a strong risk factor for lower limb osteoarthritis, and age is also a significant positive influencing factor, while the effect of gender is not significant.