颈椎终板Modic改变在脊髓型颈椎病例中的分布和相关因素分析  

The distribution of Modic changes of cervical endplate in patients with cervical spondylotic myelopathy and its related factors

作　　者：乔攀[1] 丁文元[2] 张晓林[1] 张雯[3] 

机构地区：[1]天津市天津医院脊柱外科,300000 [2]河北医科大学第三医院脊柱外科 [3]天津市儿童医院内科

出　　处：《中华骨科杂志》2014年第5期503-509,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨颈椎终板Modic改变在脊髓型颈椎病例中的临床分布特点，并探讨其发生的相关因素。方法选择2012年1月至2013年6月期间，行颈椎正、侧位x线和颈椎矢状位、轴位MR检查并确诊为脊髓型颈椎病患者共426例，回顾性分析颈椎矢状位及轴位MRI中存在Modic改变在人群、年龄、病程、椎间盘节段、颈椎曲度和椎间盘退变分级中的分布特点和其发生的相关因素。结果426例共2556个颈椎椎间盘中54例（12．7％）69个椎间盘117个终板（2.3％）发生Modic改变。Ⅰ型15例（3．5％），22个椎间盘42个终板（0．8％）；Ⅱ型31例（7-3％），34个椎间盘61个终板（1．2％）；Ⅲ型8例（1．9％），13个椎间盘14个终板（0．3％）。按各个椎间盘节段发病数统计，C2-3 0个、c3-4 5个、c4-5 16个、C5-6 26个、C6-7 19个、c7T-3个，发病率分别为0、0．2％、0．6％、1．0％、0．7％和0．1％。Modic改变和椎间盘退变明显相关。40岁以上患者是Modic改变发生较多的年龄段。通过BinaryLogistic检验逐步回归法得出回归方程为Y=-14．314＋4．037D＋0．784C＋0．310L＋0．203T＋0．162A（Y为Modic改变、A为年龄、T为病程、L为椎间盘节段、D为椎间盘退变程度、c为Cobb角分组），P=0．001，EXP值：D=23．038，C=1．893，L=1．307，T=1．187，A=1．164。结论脊髓型颈椎病终板Modic发生与椎间盘退变、椎间盘节段、病程、年龄和颈椎曲度存在相关性，椎间盘退变是最重要的影响因素。Modic改变中Ⅱ型最为多见，Ⅰ型次之，Ⅲ型最为少见，多发生于C5-6椎间盘，40岁以上多发。Objective To evaluate the distribution of Modic changes of cervical endplate in patients with cervical spondy- lotic myelopathy and its related factors. Methods All of 426 patients with cervical spondylotic myelopathy were examined by MRI scan and X-ray. According to the criteria of Modic changes, the distribution feature of Modic changes in cervical endplate on age, course of disease, segment and grade of intervertebral disc degeneration were retrospectively analyzed. Results Among 2556 intervertebral discs in 426 cases of patients, 54 （12.7 %） patients and 69 （2.3 %） intervertebral discs were involved with Mod- ic changes. 22 （0.8%） discs in 15 （3.5%） cases were type I; 34（1.2%） discs in 31 （7.3%） cases were type Ⅱ ; 13 （0.3%） discs in 8 （1.9%） cases were type Ⅲ. There were 0 （0） lesion in C2-3 disc,5 （0.2%） in C3-4, 16 （0.6%） in C4-5,26 （1.0%） in C^-6,19 （0.7%） in C6-7 and 3 （0.1%） in C7T1. Modic changes were distributed mainly over the age of 40 and correlated with disc degeneration, disc level, condition of cervical curve, course of disease and ages, moreover, disc degeneration played the most important role in the occurrence of Modic changes. Conclusion Modic changes of cervical endplate mainly occur in C5-6, and type Ⅱ is the most and type Ⅲ is the least. Modic changes are distributed mainly over the age of 40 and correlated with disc degeneration, disc level condition of cervical curve, course of disease and ages, moreover, disc degeneration plays an important role in the occurrence of Modic changes.

关 键 词：颈椎 脊髓压迫症 椎间盘退行性变 

分 类 号：R681.5[医药卫生—骨科学]