ﻣﻘﺎﯾﺴﻪ ﻣﯿﺰان آﺗﺮوﻓﯽ ﻋﻀﻼﻧﯽ ﻗﺎﺑﻞ رؤﯾﺖ در ام آر اي در ﺑﯿﻤﺎران ﺻﺮﻓﺎً دﭼﺎر ﮐﻤﺮ درد ﻣﺰﻣﻦ ﻣﮑﺎﻧﯿﮑﺎل ﺑﺎ اﻓﺮاد دﭼﺎر دﯾﺴﮑﻮﭘﺎﺗﯽ ﮐﻤﺮي ﻣﺤﺘﺎج ﻣﺪاﺧﻠﮥ ﺟﺮاﺣﯽ ﺑﺴﺘﺮي در ﺑﯿﻤﺎرﺳﺘﺎن و اﻓﺮاد ﺳﺎﻟﻢ

Comparing the Amount of Visible Muscular Atrophy in MRI between Patients with Low Back Pain, Patients with Lumbar Discopathy who Need Surgery and Healthy People

زﻣﯿﻨﻪ و ﻫﺪف: ﮐﻤﺮ درد ﻣﺰﻣﻦ ﯾﮑﯽ از ﺷﺎﯾﻌﺘﺮﯾﻦ ﻋﻠﻞ درد و ﻧﺎﺗﻮاﻧﯽ در اﻧﺠﺎم ﮐﺎر و ﻫﻤﭽﻨﯿﻦ ﯾﮑﯽ از ﺷﺎﯾﻌﺘﺮﯾﻦ دﻻﯾﻞ وﯾﺰﯾﺖ ﭘﺰﺷﮑﺎن ﮔﺰارش ﺷﺪه اﺳﺖ. MRI (Magnetic Resonance Imaging) روش ﻣﻨﺎﺳﺐ ﺟﻬﺖ ﺗﺸﺨﯿﺺ و ﭘﯿﮕﯿﺮي و ارزﯾﺎﺑﯽ آﺗﺮوﻓﯽ ﻋﻀﻼﻧﯽ ﻣﯽﺑﺎﺷﺪ و ﻋﺪم ﺗﻮﺟﻪ ﺑﻪ ﻣﯿﺰان آﺗﺮوﻓﯽ در ﺑﺎﻟﯿﻦ ﻣﯽﺗﻮاﻧﺪ ﻣﻮﺟﺐ ﻋﺪم ﺗﺸﺨﯿﺺ ﻋﻠﺖ درد ﮐﻤﺮ ﺷﻮد. ﻫﺪف از اﻧﺠﺎم اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﺮرﺳﯽ ارﺗﺒﺎط ﻣﯿﺎن آﺗﺮوﻓﯽ ﻋﻀﻼﻧﯽ و ﺷﺪت آن ﺑﺎ ﻣﯿﺰان درد و ﻧﺎﺗﻮاﻧﯽ در ﺑﯿﻤﺎران ﻣﯽﺑﺎﺷﺪ. ﻣﻮاد و روش ﻫﺎ: اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺑﻪ ﺻﻮرت ﯾﮏ ﻣﻄﺎﻟﻌﻪ ﻣﻘﻄﻌﯽ ﺑﯿﻦ ﺳﺎلﻫﺎي 95 ﺗﺎ 97 ﺑﺮ روي 288 ﻧﻔﺮ ﺑﺎ رده ﺳﻨﯽ 20 ﺳﺎل و ﺑﺎﻻﺗﺮ ﺗﺤﺖ ﺳﻪ ﮔﺮوه )96=N( ﺷﺎﻣﻞ اﻓﺮاد ﺳﺎﻟﻢ )ﮔﺮوه ﮐﻨﺘﺮل(، اﻓﺮاد ﺑﺎ ﮐﻤﺮ درد ﻣﺰﻣﻦ ﻣﮑﺎﻧﯿﮑﺎل و اﻓﺮاد ﺑﺎ دﯾﺴﮑﻮﭘﺎﺗﯽ ﮐﻤﺮي اﻧﺠﺎم ﺷﺪ. ﭘﺎراﻣﺘﺮﻫﺎي ﻣﻮرد ﺑﺮرﺳﯽ در ﺑﯿﻤﺎران ﺷﺎﻣﻞ درﺟﻪ ﺷﺪت آﺗﺮوﻓﯽ، ﻧﺴﺒﺖ ﺑﯿﻦ CSA ﻋﻀﻠﻪ ﭘﺴﻮاس و دﯾﺴﮏ ﺑﯿﻦ ﻣﻬﺮهاي )PS: Disk(، ﻧﺴﺒﺖ ﻋﻀﻠﻪ ارﮐﺘﻮر اﺳﭙﺎﯾﻨﺎ و دﯾﺴﮏ ﺑﯿﻦ ﻣﻬﺮهاي )Er: Disk(، ﻧﺴﺒﺖ ﺑﯿﻦ ﻋﻀﻼت ﻣﻮﻟﺘﯽ ﻓﯿﺪوس و دﯾﺴﮏ ﺑﯿﻦ ﻣﻬﺮه )MF: Disk(، درد و اﺿﻄﺮاب ﺑﻮدﻧﺪ. از آﻣﺎر ﺗﻮﺻﯿﻔﯽ و آزﻣﻮنﻫﺎي T و ANOVA ﺟﻬﺖ ﻣﻘﺎﯾﺴﻪ ﻣﯿﺎﻧﮕﯿﻦﻫﺎي ﻣﺘﻐﯿﺮﻫﺎي ﮐﻤﯽ ﺑﻮﺳﯿﻠﻪ ﻧﺮم اﻓﺰار آﻣﺎري 22 SPSS اﺳﺘﻔﺎده و ﺳﻄﺢ ﻣﻌﻨﯽداري 0/05< P در ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: ﻧﺴﺒﺖ Er: Disk ،PS: Disk و MF: Disk ﺑﻪﻃﻮر ﻣﻌﻨﺎداري در ﮔﺮوه ﺑﯿﻤﺎران ﮐﻤﺮ درد ﻣﺰﻣﻦ از دو ﮔﺮوه دﯾﮕﺮ ﮐﻤﺘﺮ ﺑﺪﺳﺖ آﻣﺪ. ﺷﯿﻮع آﺗﺮوﻓﯽ ﺑﺎ درﺟﻪ ﻣﺘﻮﺳﻂ ﺑﻪﻃﻮر ﻣﻌﻨﺎداري در ﺑﯿﻤﺎران ﮔﺮوه ﮐﻤﺮ درد ﻣﺰﻣﻦ )23/96%( از دو ﮔﺮوه دﯾﮕﺮ ﺑﯿﺸﺘﺮ ﺑﻮد. اﯾﻦ ﺣﺎﻟﺖ در دو ﮔﺮوه ﺑﯿﻤﺎران ﺑﺎ دﯾﺴﮑﻮﭘﺎﺗﯽ و اﻓﺮاد ﺳﺎﻟﻢ ﺑﺎ ﯾﮑﺪﯾﮕﺮ اﺧﺘﻼف ﻣﻌﻨﺎداري ﻧﺪاﺷﺖ. ﻣﯿﺎﻧﮕﯿﻦ ﻧﻤﺮه ﻣﻌﯿﺎر اوﺳﻮﺳﺘﺮي )ODI( ﺑﻪ ﻃﻮر ﻣﻌﻨﺎداري در ﮔﺮوه دﯾﺴﮑﻮﭘﺎﺗﯽ از دو ﮔﺮوه دﯾﮕﺮ ﺑﯿﺸﺘﺮ ﺑﻮد. ﻫﻤﭽﻨﯿﻦ ﻧﻤﺮه ODI ﮔﺮوه ﺑﯿﻤﺎران ﺑﺎ ﮐﻤﺮدرد ﻣﺰﻣﻦ ﺑﻪ ﻃﻮر ﻣﻌﻨﺎداري از اﻓﺮاد ﺳﺎﻟﻢ ﺑﯿﺸﺘﺮ ﮔﺰارش ﺷﺪ. ﻣﯿﺎﻧﮕﯿﻦ ﻣﺪت زﻣﺎن درد، ﻧﻤﺮه درد آﮔﺰﯾﺎل ﮐﻤﺮ و ﻣﯿﺰان اﺿﻄﺮاب در ﺑﯿﻤﺎران ﮔﺮوه ﮐﻤﺮدرد ﻣﺰﻣﻦ ﺑﻪﻃﻮر ﻣﻌﻨﺎداري از ﺳﺎﯾﺮ ﮔﺮوهﻫﺎ ﺑﯿﺸﺘﺮ ﺑﻮد. ﻧﺘﯿﺠﻪ ﮔﯿـﺮي: ﺑﺮاﺳﺎس ﻧﺘﺎﯾﺞ ﺑﺪﺳﺖ آﻣﺪه ﺷﺪت درد ﮐﻤﺮ و درﺟﻪ آﺗﺮوﻓﯽ ﻋﻀﻼت ﭘﺎرا اﺳﭙﺎﯾﻨﺎل ﺣﺠﻢ ﻋﻀﻼﻧﯽ در ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ ﮐﻤﺮ درد ﻣﺰﻣﻦ ﺑﯿﺶ از ﺑﯿﻤﺎران ﻣﺒﺘﻼ ﺑﻪ دﯾﺴﮑﻮﭘﺎﺗﯽ ﺑﻮد. ﻣﯿﺰان CSA ﻋﻀﻼت در ﺑﯿﻤﺎران ﮔﺮوه دﯾﺴﮑﻮﭘﺎﺗﯽ و اﻓﺮاد ﺳﺎﻟﻢ ﺗﻔﺎوت

Introduction & Objective: Low Back Pain (LBP) is among the most common causes for pain and disability to do different tasks. Also, it is one of the common reasons for medical appointments. Magnetic Resonance Imaging (MRI) is a suitable method to diagnose and assess muscular atrophy and lack of attention to atrophy may lead to lack of back pain diagnosis. The objective of the present study is to examine the relationship between muscular atrophy and its severity with pain and disability in patients. Materials & Methods: This analytical cross sectional study was conducted on 288 people above 20 years old during 2016-2018 on three groups (n = 96) including healthy people (control group), people with LBP and people with lumbar discopathy. Parameters of interest in patients included atrophy severity, ratio between CSA of psoas muscles and intervertebral disk (PS: Disk), the ratio of erector spinae muscle and intervertebral disk (Er: Disk), the ratio between multifidus muscle and intervertebral disk (MF: Disk), pain, and anxiety. Results: The ratio of PS: Disk, Er: Disk, and MF: Disk was significantly lower in LBP group. The prevalence of moderate fatty atrophy was significantly higher in LBP group (96.23%). This was not significantly different from other groups of the study. Average Oswestry Disability Index (ODI) was significantly higher in lumbar discopahy. Also, ODI in LBP group as significantly larger than healthy people. Pain duration, axial LBP, and anxiety in LBP group were significantly larger than other groups. Conclusions: According to the results, LBP and para-spinal muscle atrophy in patients with LBP were larger in patients with LBP compared with patients with lumbar discopahy. CSA in patients with lumbar discopahy and healthy patients showed no significant difference. ODI and disability in patients with lumbar discopahy (24.5 ± 67.164) were larger than other groups.