基于蒋位庄分型的椎间盘源性腰腿痛患者椎旁肌功能性横截面积变化及相关性研究OA

Objective:To investigate the role and underlying mechanisms of paraspinal muscle imbalance in the develop-ment of discogenic lumbocrural pain by measuring the cross-sectional area(CSA)of paraspinal muscle and intervertebral discs in patients with different subtypes of the condition.Methods:A retrospective analysis was conducted on imaging data from 210 patients with lumbar disc herniation who were treated between January 2024 and October 2025.Based on Jiang Weizhuang's classification method,the patients were cate-gorized into four subtypes:disc bulging(Type Ⅰ),elastic protrusion(Type Ⅱ),degenerative instability(Type Ⅲ),and hyperplastic stenotic(Type Ⅳ).The cross-sectional areas(CSAs)of the bilateral psoas major,erector spinae,multifidus muscles,and intervertebral discs were measured at the L4/5 level.Calculated the functional cross-sectional area(FCSA)of each muscle(defined as the ratio of total muscle CSA to intervertebral disc CSA,eliminating confounding factors such as body size and sex).One-way analysis of variance(ANOVA)was used to compare differences among groups,and Pear-son correlation analysis was applied to assess correlations among various indicators.Results:The FCSA of the erector spi-nae and multifidus in Type Ⅲ patients were significantly lower than that in Type Ⅰ and Ⅱ patients(P＜0.05).Similar-ly,the FCSA of the multifidus in Type Ⅳ than patients was significantly lower than those in Type Ⅰ and Ⅱ patients(P＜0.05).The FCSA of the paravertebral muscle(comprising the erector spinae and multifidus)was significantly lower in Type Ⅲ and Ⅳ than patients in Type Ⅰ and Ⅱ(P＜0.05).A positive correlation was observed between intervertebral disc CSA and age(P＜0.001),whereas the CSA and FCSA of all muscles were negatively correlated with age(P＜0.05).Conclusion:Differences in paraspinal muscle CSA were observed among the various subtypes.Type Ⅲ was charac-terized primarily by atrophy of the erector spinae and multifidus,accompanied by a significant reduction in paraspinal mus-cle function.Type Ⅳ was marked mainly by multifidus atrophy,accompanied by a partial impairment of paraspinal muscle function.These findings suggest the TCM proposition that"bone misalignment exacerbates muscular imbalance".The reduction in muscle function in Type Ⅲ and Ⅳ patients was accompanied by a significant increase in disc CSA,indicating that"muscular imbalance aggravates bone misalignment".Thus,this study reveals the mutual promotion mechanism between"muscular imbalance"and"bone misalignment"during the progression of discogenic lumbocrural pain,and pro-vides imaging evidence for the TCM theories of"simultaneous disorders of tendons and bones"and"tendons restraining bones",and offers mechanistic support for the targeted intervention of Tituo Shujin manipulation in patients with different classifications.