椎间盘源性下腰痛的MRI和椎间盘造影的相关性研究  

Discogentic lumbar pain： association with MRI and discography

作　　者：陈建宇[1] 刘庆余[1] 梁碧玲[1] 叶瑞心[1] 钟镜联[1] 

机构地区：[1]中山大学附属第二医院放射科,广州510120

出　　处：《中华放射学杂志》2008年第8期871-876,共6页Chinese Journal of Radiology

摘　　要：目的探讨椎间盘源性下腰痛患者的MRI和椎间盘造影表现与椎间盘造影一致性诱发痛的相关性。方法93例慢性下腰痛患者腰椎MR检查和256个腰椎椎间盘造影。椎间盘造影按照Adams等分级标准进行，MRI髓核退变按Pearce等分级标准，终板退变按Modic标准分级，疼痛诱发评价分为一致性诱发痛和无痛或非一致性诱发痛。分析MRI椎间盘退变分级、椎间盘造影分级与一致性诱发痛的相关性。获得的数据采用X^2检验进行统计分析。结果93例256个椎间盘造影，116个出现一致性诱发痛。椎间盘造影：Ⅰ型椎间盘17个（6．6％），Ⅱ型椎间盘25个（9．8％），Ⅲ型椎间盘91个（35．5％），Ⅳ型椎间盘77个（30．1％），Ⅴ型椎间盘46个（18．0％）。MRI椎间盘退变分级：Ⅰ级23个（9．0％），Ⅱ级34个（13．3％），Ⅲ级84个（32．8％），Ⅳ级85个（33．2％），Ⅴ级30个（11．7％）。椎间盘造影与MRI分级密切相关（r=0．62，X^2=160．87，P〈0．01）；椎间盘造影Ⅳ～Ⅴ型椎间盘123个，104个出现一致性诱发痛，与一致性诱发痛密切相关（r=0．60，X^2=144．08，P〈0．01）；MRI椎间盘Ⅳ～Ⅴ级退变115个，99个出现一致性诱发痛，与一致性诱发痛密切相关（r=0．59，X^2=137．11，P〈0．01）；椎间盘后缘高信号区60个，52个出现一致性诱发痛，两者具有密切相关性（r=0．41，X^2=51．93，P〈0．01）；椎间盘终板异常58个，51个出现一致性诱发痛，两者具有密切相关性（r=0．41，X^2=52．76，P〈0．01）。结论MRI显示髓核中、重度退变、椎间盘后缘高信号区、椎体终板退变，以及椎间盘造影表现为外纤维环破裂、后纵韧带复合体破裂和出现一致性诱发痛时，可高度提示椎间盘源性下腰痛。椎间盘造影显示的椎间盘纤维环破裂伴随造影时的一致性诱发痛，是椎间盘源性下腰痛诊断的重要依据。Objective To evaluate the correlation between MRI and X-Ray discography findings and pain response at provocative discography in patients with discogenic back pain. Methods Two hundred and fifty-six lumbar intervertebral discs in 93 patients who underwent MRI and X-Ray discography were included in this study. MR images were retrospectively evaluated regarding disc degeneration, endplate abnormalities and high intensity zone. Disc degeneration was graded according to the modified criteria of Pearce, et al. Evaluation of disc morphology was performed with X-Ray discography by using the classification of Adams, et al. Endplates and adjacent bone marrow abnormalities were classified according to Medic, et al. During discography concordant pain was regarded as positive, whereas discordant pain and no pain were regarded as negative. The data were analyzed using the Chi-square test. Results There were 116 discs with concordant pain and 140 discs with discordant pain or no pain. of 256 discs on discography , 17 discs were type Ⅰ 17（6.6%）,type Ⅱwere 25（9.8%）,type m were 91（35.5%）, type Ⅳwere 77（30. 1% ） and type Ⅴ were 46（ 18.0% ）. On MR images, discs of grade Ⅰ were 23 （9. 0% ） ,grade Ⅱwere 34（13.3%）, grade Ⅲ were 84（32.8%）, grade Ⅳ were 85 （33.2%） and grade Ⅴ were 30（ 11.7% ）. There was positive correlation between Pearce graded of MRI and classification of Adams of discography （r = 0. 62, X^2 = 160. 87, P 〈 0.01 ）. In 123 discs of type Ⅳ to type Ⅴ on discography, 104 discs were with concordant pain. There was positive correlation between type Ⅳ-Ⅴ and concordant pain（r =0. 60, X^2 = 144.08, P 〈 0. 01 ）. In 115 discs of Ⅳ-Ⅴ grade degeneration,99 discs presented with concordant pain. There was positive correlation between Ⅳ-Ⅴ grade disc degeneration and concordant pain（r = 0. 59, X^2 = 137.11, P 〈0. 01）. In 60 discs with high intensity zone（HIZ）, 52 discs presented with concordant pain. There was positive correlation between HI

关 键 词：关节造影术 椎间盘 磁共振成像 腰痛 

分 类 号：R686[医药卫生—骨科学]