Ultrasound Imaging of Thoracolumbar Fascia Thickness: Chronic Non-Specific Lower Back Pain versus Healthy Subjects; A Sign of a “Frozen Back”?
胸腰段筋膜厚度的超声成像：慢性非特异性下腰痛与健康受试者的对比：“背部僵硬”的征兆？
Abstract
The thoracolumbar fascia (TLF) plays an important role in lower back pain (LBP). Recent studies have revealed an association between increases in TLF thickness and reduced TLF gliding in patients with LBP. The purpose of this study was to measure and compare by ultrasound (US) imaging the thickness of the TLF at the bilateral L3 level of the lumbar spine in the longitudinal and transverse axes in chronic non-specific LBP and in healthy subjects. A cross-sectional study was performed using US imaging to measure the longitudinal and transverse axes with a new protocol in a sample of 92 subjects: 46 chronic non-specific LBP patients and 46 healthy participants. The findings for TLF thickness revealed statistically significant differences (p < 0.05) in the longitudinal and transverse axes between the two groups. Moreover, in the healthy group, a statistically significant difference was found between the longitudinal and transverse axes (p = 0.001 for left and p = 0.02 for right), which was not evident in the LBP patients. These findings suggest that the LBP patients lost anisotropy of the TLF, with it becoming homogeneously thicker and losing adaptability in the transversal direction. The US imaging evaluation suggests that TLF thickness behavior points out altered fascial remodelling compared to healthy subjects, a sort of “frozen back”.
胸腰筋膜在下腰痛中起重要作用。最近的研究表明，LBP（下腰痛）患者TLF（胸腰筋膜）厚度的增加和TLF滑移的减少之间存在关联。本研究的目的是通过超声成像测量和比较慢性非特异性下腰痛患者和健康受试者双侧腰椎L3节段纵轴和横轴的TLF厚度。一项横断面研究使用超声成像技术测量了92名受试者的纵轴和横轴：46名慢性非特异性LBP患者和46名健康受试者。两组TLF厚度在纵轴和横轴上差异有统计学意义(P<0.05)。此外，在健康组中，纵轴和横轴之间的差异有统计学意义(P=0.001.0 5，P=0.0 2)，而在腰背痛患者中，这种差异不明显。这些发现表明，LBP患者失去了TLF的各向异性，TLF变得均匀增厚，失去了横向适应性。美国的成像评估表明，与健康受试者相比，TLF厚度行为表明筋膜重塑发生了变化，类似于一种“冻结的背部”。
Study Design
A cross-sectional study based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was conducted [24] in order to compare the US thicknesses of thoracolumbar fascia in the L3 level of the back among lower back pain patients and healthy volunteers. 、
研究设计基于加强流行病学观察研究报告(STROBE)声明的横断面研究，目的是比较下腰痛患者和健康志愿者背部L3节段的US下胸腰筋膜厚度。
A specific protocol was defined
The L3 level of the lumbar spine: The patient was relaxed in the prone position and the US transducer was placed parallel to the spine, approximately 2–3 cm lateral to the L3 spinous process (Figure 1). The scans were taken on the short and long axis, rotating the transducer 180◦ degrees, paying close attention to maintaining the same structure in the center of the US monitoring image, and keeping the probe perpendicular.
特定的治疗方案：腰椎L3水平：患者俯卧位放松，超声探头平行于脊柱放置，大约在L3棘突外侧2-3厘米(如图)。扫描在短轴和长轴上进行，将换能器旋转180◦，密切注意保持US监控图像中心的结构不变，并保持探头垂直。
Results 1
A total of 92 subjects (47 females and 45 males) participated in this study. The descriptive data of the sample are summarized in Table 1. No differences were present for BMI, height, weight, and age, showing homogeneity among the groups. Group 1 reported a visual analogue scale (VAS) of 6.8 ± 0.74.
Results 2
2.Group 1 (Chronic Non-Specific LBP Patients) Regarding Table 2, at the L3 level of the spine, the TLF in the chronic non-specific LBP patients had a mean US thickness of 2.11 ± 0.65 mm (Table 2).
第1组：在脊柱L3水平，慢性非特异性LBP患者的TLF平均超声厚度为2.11±0.65 mm
Long.=纵向扫描；trans.=横向扫描。
Moreover, the left longitudinal axis thickness was statistically significantly greater than the right longitudinal axis thickness (p = 0.038); the same was the case for the left transversal axis vs. the right transversal axis (p = 0.002)
左纵轴厚度显著大于右纵轴厚度(p=0.038)；左横轴与右横轴的情况相同(p=0.002)
Results
3.Ultrasound thickness measurements of the thoracolumbar fascia at the L3 level of the lumbar spine in the healthy volunteers.
健康志愿者腰椎L3节段胸腰筋膜厚度的超声测量
Moreover, the left longitudinal axis thickness was statistically significantly greater than right longitudinal axis thickness (p < 0.0001), while no statistically significant difference was present in the left transverse axis vs. the right transverse axis.
左纵轴厚度显著大于右纵轴厚度(p<0.0001)，而左横轴与右横轴之间差异无统计学意义
Results
4.According to the paired Student’s t-test (Table 5), the comparison between the different axes in the US examination of the TLF thickness within each group showed a statistically significant difference between the longitudinal and the transverse axes in group 2 for both sides (Group 2 Left long. vs. Group 2 Left transv.: p = 0.001; Group 2 Right long. vs. Group 2 Right transv.: p = 0.02).
两组TLF厚度US检查中不同轴之间的比较显示，TLF厚度的纵轴和横轴的差异有统计学意义。组2左长轴VS左侧横轴：P=0.001；组2右长轴VS右横轴：P=0.02)
US permits an optimal visual examination of the fascial layers in patients with chronic non-specific LBP, with it being a safe, inexpensive, non-invasive, portable, and, most of all, effective instrument that can help clinicians to better understand fascial dysfunction and pathology. In addition, it may reveal changes not highlighted by normal clinical examination. A few of these changes require further investigation because they have not yet been described. To conclude, the study results confirm that in chronic non-specific LBP patients, the TLF is thicker than in healthy volunteers. Moreover, in these patients, no statistically significant difference was found between the longitudinal and transverse axes, which was instead evident in the healthy subjects. The TLF thickness behavior in these patients points out altered fascial remodelling that maintains a homogenous and greater thickness compared to the healthy subjects, a sort of “frozen back”
US允许对慢性非特异性LBP患者的筋膜层进行最佳视觉检查，它是一种安全、廉价、非侵入性、便携的有效工具，可以帮助临床医生更好地了解筋膜功能障碍和病理。此外，它可能会揭示正常临床检查没有突出显示的变化。其中一些变化需要进一步调查，因为它们还没有被描述。总之，研究结果证实，在慢性非特异性LBP患者中，TLF比健康志愿者更厚。此外，在这些患者中，纵轴和横轴之间没有统计学上的显著差异，相反，这在健康受试者中明显。这些患者的TLF厚度行为表明，与健康受试者相比，改变的筋膜重塑保持了均匀和更大的厚度，意味着一种“僵硬的背部”的形成。
by 差劲先森
