退变性腰椎侧凸椎体终板Modic改变的分布情况及其影响因素  

Distribution and associated factors of endplate Modic changes in degenerative lumbar scoliosis

作　　者：吴海龙[1] 丁文元[1] 申勇[1] 张为[1] 刘西斌[2] 郭金库[1] 曹来震[1] 梁昌凡[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄市050051 [2]河北省黄骅市人民医院骨科,黄骅市061100

出　　处：《中国脊柱脊髓杂志》2011年第4期285-289,共5页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:观察退变性腰椎侧凸患者终板Modic改变的分布情况,分析其相关影响因素及与腰痛的关系。方法:回顾分析2000年3月～2009年3月我院收治的126例退变性腰椎侧凸患者的影像学资料,采用VAS对患者腰痛程度进行评估。观察患者终板Modic改变的发生率、类型及分布特点;比较存在Modic改变与不存在Modic改变患者的VAS评分;分析Modic改变与椎间盘退变、终板倾斜度、腰椎侧凸角及体重指数间的相关性。结果:126例患者756个腰椎间盘中,69例(54.8%)124(18.2%)个椎间盘邻近终板存在Modic改变。存在Modic改变患者VAS评分5.5±2.0,不存在Modic改变患者VAS评分3.0±1.5,两者比较差异有显著性(P<0.01)。Modic分型:Ⅰ型有15例患者(11.9%)19个椎间盘退变(2.5%),Ⅱ型48例(38.1%)97个椎间盘退变(12.8%),Ⅲ型6例(4.8%)8个椎间盘退变(1.1%)。退变终板节段:L5/S1椎间盘32个(25.8%),L4/5椎间盘26个(21.0%),L3/4椎间盘9个(7.3%),L2/3椎间盘47个(37.9%),L1/2椎间盘6个(4.8%),T12/L1椎间盘4个(3.2%)。Modic改变发生于终板凹侧99(13.1%)个,发生于终板凸侧25(3.3%)个;凹侧与凸侧发生率比较差异有显著性(P<0.01)。Modic改变与椎间盘退变、终板倾斜度、腰椎侧凸角及体重指数存在显著相关性(P<0.05)。结论:Modic改变与椎间盘退变、终板倾斜度、腰椎侧凸角及体重指数之间存在相关关系;Modic改变以Ⅱ型多见,多发生于终板的凹侧,以L2/3、L5/S1和L4/5节段多发。Objective：To investigate the distribution of endplate Modic changes in degenerative lumbar scoliosis,and the associated factors with low back pain.Method：The imaging data of 126 patients diagnosed with degenerative lumbar scoliosis in our hospital from March 2000 to March 2009 were reviewed retrospectively.The incidence,type and distribution of Modic changes were reviewed.Degree of Low back pain determined by VAS was compared between patients with and without Modic changes.The correlation between Modic changes and disc degeneration,slipping degree of endplate,lumbar scoliosis Cobb′s angle and body mass index（BMI）were analyzed.Result：Of 756 lumbar discs from 126 patients,Modic changes were observed in 124（18.2℅）discs from 69（54.8%） patients.The VAS score for patients with and without Modic changes was 55±20 and 30±15 respectively,which showed significant difference between them（P0.01）.19（2.5%）discs of 15 patients（11.9%）were classified as typeⅠ,97（12.8%） discs of 48（38.1%） patients as type Ⅱ,8（1.1%）discs of 6 patients（4.8%） was type Ⅲ.32（25.8%） Modic degenerative discs were noted in L5/S1,26（21.0%） in L4/5,9（7.3%） in L3/4,47（37.9%） in L2/3,6（4.8%） in L1/2,4（3.2%） in T12/L1.99（13.1%） Modic changes were noted on concave side and 25（3.3%） on convex side,which showed significant difference between concave side and convex side（P0.01）.Modic changes were significantly correlated with intervertebral disc degeneration,slipping degree of endplate,lumbar scoliosis Cobb′s angle and BMI（P0.05）.Conclusion：Modic changes correlate with intervertebral disc degeneration,slipping degree of endplate,lumbar scoliosis Cobb′s angle and BMI,and the prevalences of Modic changes are L2/3,L5/S1 and L4/5,most of them are type Ⅱ and locate on the concave side.

关 键 词：MODIC改变 退变性腰椎侧凸 椎间盘退变 腰痛 

分 类 号：R681.5[医药卫生—骨科学]