腰椎终板、椎间盘退变及椎间盘造影疼痛激发试验的相关性研究  

The correlation between the lumbar endplate Modic degeneration and degeneration of lumbar intervertebral disc or pain provocation observed on CT discography

作　　者：赵凤东[1] 黄悦[1] 范顺武[1] 方向前[1] 赵凯[1] 施培华[1] 林伟[2] 

机构地区：[1]浙江大学医学院附属邵逸夫医院骨科,杭州310016 [2]浙江大学医学院附属邵逸夫医院放射科,杭州310016

出　　处：《中华骨科杂志》2006年第1期30-34,共5页Chinese Journal of Orthopaedics

摘　　要：目的探讨下腰痛患者腰椎终板Modic退变、椎间盘退变及CT引导下腰椎间盘造影疼痛激发试验的相关性。方法对45例下腰痛患者常规行腰椎X线和MR检查,分别按Modic终板退变标准(0～3级)与Pearce椎间盘退变标准(Ⅰ～Ⅴ级)对终板和椎间盘进行评估。在CT引导下对45例患者中的40例(120个椎间盘)进行造影和疼痛激发试验,并按Dallas椎间盘造影分级系统(DDD)测评椎间盘退变程度。采用SPSS11.5统计学软件分析腰椎终板Modic退变、椎间盘退变与腰椎间盘造影疼痛激发试验之间的相关性。结果40例下腰痛患者的腰椎终板Modic分级与椎间盘退变Pearce分级存在较强的相关性(Pearsonχ2=43.326,P=0.000),与椎间盘造影疼痛激发试验有显著相关性(Pearsonχ2=27.858,P=0.000);椎间盘退变Pearce分级与CT椎间盘造影椎间盘退变Dallas分级也呈较强的相关性。结论腰椎终板Modic退变分级与椎间盘退变Pearce分级密切相关,而与椎间盘疼痛激发试验有显著相关性,提示终板Modic退变可能是下腰痛的原因之一。Objective To determine the correlation between the Modic degeneration of lumbar endplate on MRI and the pain provocation or degeneration of lumbar intervertebral discs observed on CT discography. Methods One hundred and twenty lumbar intervertebral discs （40 L3-4, 40 L4-5, 40 LsSi intervertebral discs） of 40 patients among 45 patients were examined. 120 intervertebral discs underwent discography guided by CT scan, according to Dallas Discography Description system, degeneration of lumbar interertebral disc were divided into 0-3 grade, and pain provocation were graded into negative, indifferent and positive. On the basis of Modic classification system of the lumbar endplate changes and Pearce classification system of the degeneration of lumbar intervertebral disc, the lumbar endplate changes were divided into 0-3 grade, the degeneration of lumbar intervertebral disc were graded into Ⅰ - Ⅴ. All the results were analysed by Chi-Square test for the correlations. Results There was positive correlation between pain provocation test and the lumbar endplate Modic degeneration; There was a positive correlation between the Modic degeneration of lumbar endplate and the degeneration of lumbar intervertebral disc and so is the relation be- tween the CT discography and MRI on discs. Conclusion There is positive correlation between pain provocation test and the Modic degeneration of lumbar endplate, it suggest the endplate might be one of the sources of low back pain. There is a positive correlation between the Modic degeneration of lumbar endplate and the degeneration of lumbar intervertebral disc.

关 键 词：MR 腰椎终板退变 椎间盘退变 椎间盘造影 疼痛激发试验 

分 类 号：R681.5[医药卫生—骨科学]