Modic改变与椎间盘高度及椎体骨质增生的关系  

The study on the relationship between modic change and disc height together with lumbar hyperosteogeny

作　　者：马铮[1] 丁文元[1] 申勇[1] 孙亚澎[1] 杨大龙[1] 徐佳欣[1] 

机构地区：[1]河北医科大学第三附属医院脊柱外科,石家庄050051

出　　处：《中华外科杂志》2013年第7期610-614,共5页Chinese Journal of Surgery

摘　　要：目的 研究Modic改变与椎间盘高度及椎体边缘骨质增生的关系,探讨Modic改变在腰椎退变中的意义.方法 回顾性研究分析2011年4月至2012年4月150例老年慢性腰腿痛患者的影像学资料,所有患者均进行MRI及腰椎正侧位X线检查,选择患者L1～2至L5～S1椎间盘为研究对象,150例患者共观测750个椎间盘、椎体及椎间盘邻近终板.观察患者腰椎终板Modic改变的发生率、椎间盘高度以及椎体边缘骨质增生程度,定义椎间盘高度/椎间盘平均高度＜50％为椎间盘塌陷.将所有患者腰椎间盘分为4组,A1组：椎间盘塌陷,椎体无或轻度骨质增生;A2组：椎间盘塌陷,椎体重度骨质增生;B1组：无椎间盘塌陷,椎体无或轻度骨质增生;B2组：无椎间盘塌陷,椎体重度骨质增生.采用x2检验方法,对4个组Modic改变发生率进行比较,分析椎间盘高度以及椎体骨质增生与Modic改变的关系.结果 4组共观测了750个椎间盘,A1组208个椎间盘,终板Modic改变发生率为54.3％;A2组135个椎间盘,终板Modic改变发生率为34.8％;B1组225个椎间盘,终板Modic改变发生率为16.9％;B2组182个椎间盘,终板Modic改变发生率为29.7％.4组间Modic改变发生率差异有统计学意义（x2 =69.565,P＜0.05）.组间两两比较,A1组与A2、B1和B2组比较,差异均有统计学意义（x2=12.524、66.701和24.102,P ＜0.00714）.A2组与B1组比较差异有统计学意义（x2=15.032,P＜0.00714）,但与B2组比较差异无统计学意义（x2=0.945,P＞0.00714）.B1与B2组比较,差异有统计学意义（x2=9.395,P＜0.00714）.结论 老年慢性腰腿痛患者中椎间盘高度的丢失且不伴有重度椎体骨质增生的终板Modic改变发生率较高,椎间盘塌陷合并重度椎体骨质增生患者与单纯重度椎体骨质增生患者的Modic改变发生率无明显差别.Objectives To evaluate the relationship between Modic change and disc height together with lumbar hyperosteogeny and study the role of Modic change in lumbar degeneration. Methods The imaging data of 150 elderly patients with chronic low back pain were analysed retrospectively. All patients underwent MRI and lumbar lateral X-ray examination. The lumbar disc from Ll -L2 to Ls-S1 were selected for this study, including 750 discs, vertebral and endplate close to disc in 150 patients. The incidence rate of lumbar endplate Modic change, disc height and the degree of vertebral bone hyperplasia were recorded. The ratio of disc height/lumbar intervertebral disc height 〈 50% was defined as disc collapse. The patients were divided into 4 groups in the basis of imaging changes. Group A1 ： disc collapse without severe lumbar hyperosteogeny; Group A2： disc collapse with severe lumbar hyperosteogeny; Group BI： Neither disc collapse nor severe lumbar hyperosteogeny; Group B2 ： severe lumbar hyperosteogeny without disc collapse. The incidence rates of Modic change were compared between the 4 groups by X2 test. Finally, the influence of disc height and vertebral bone hyperplasia on the incidence rate of Modic change was analysed. Results Four groups of patients observed a total of 750 discs. The number of intervertebral discs in the group A1 was 208,the incidence rate was 54.3%. The number of intervertebral discs in the group A2 was 135, the incidence rate of group A2 was 34. 8%. The number of intervertebral discs in the B1 group was 225, the incidence rate of group BI was 16. 9%. The number of intervertebral discs in the B2 group was 182, the incidenee rate of group B2 was 29.7%. There was significant difference of hnnbar endplate Modie change incidence rate among the 4 groups （ X2 = 69. 565, P 〈 0. 05 ）. The results of post hoc lest showed that the incidence rate of Modie change in group AI was higher than group A2, BI and B2 （ X2= 12. 524, 66. 701 and 24. 102, P 〈 0. 00714）. There was significant differen

关 键 词：腰椎 椎间盘 骨质增生 

分 类 号：R6[医药卫生—外科学]