腰椎MR退变征象与慢性下腰痛关系的最优尺度回归研究  

Regression between MR findings of lumbar elements and chronic low back pain

作　　者：张堃[1] 李曼[2] 裴新龙[2] 袁慧书[2] 

机构地区：[1]湖南中医药大学第一附属医院放射科,长沙410007 [2]北京大学第三医院放射科,100191

出　　处：《中华放射学杂志》2014年第12期1019-1023,共5页Chinese Journal of Radiology

摘　　要：目的 探讨腰椎MR退变征象与慢性下腰痛的关系.方法 回顾性分析201例受试者资料,包括行腰椎MRI检查,并进行下腰痛问卷调查,且问卷有效的慢性下腰痛患者139例,其中68例MRI显示有神经根压迫,71例无神经根压迫;同期本院行上述问卷调查及行腰椎MRI检查,无下腰痛症状且MRI显示无神经根压迫的62名志愿者.所有受试者均行常规腰椎平扫.依据视觉模拟评分（VAS）将腰痛程度分为4级.观察的MRI征象包括：神经根受压、平均间盘退变分级（ADD）、间盘后方高信号区（HIZ）、许莫结节、MODIC Ⅰ型改变、平均小关节退变分级（AZZ）、小关节积液、棘间韧带高信号、皮下或椎后旁肌肉水肿.采用最优尺度回归分析MRI征象与慢性下腰痛程度的关系.结果 对201例受试者的人口特征及影像征象进行最优尺度回归分析,结果表明回归模型具有统计学意义（F值=9.478,P＜0.01）,即至少有1个自变量对因变量有影响.该模型的凋整后的决定系数为0.446.神经根受压、ADD、AZZ、皮下或椎后旁肌肉水肿与慢性下腰痛程度有统计学关联（P＜0.05）,重要程度之和为0.983.变量转化后的量化图显示,量化VAS分级在有神经根压迫者更高;随ADD增高而增高;随AZZ分级增高,量化VAS分级先增高后降低,AZZ分级为2时,量化VAS最大;有皮下或椎后旁肌肉水肿者量化VAS分级更高.结论 ADD、AZZ、皮下或椎后旁肌肉水肿可能足除神经根受压外影响慢性下腰痛程度的因素.Objective To investigate the relationship between the MR findings of lumbar elements and chronic low back pain（CLBP）.Methods The patients underwent lumbar MRI examinations and sent for a questionnaires of low back pain （LBP）.Among them,139 patients whose questionnaires illustrated with CLBP were enrolled.The enrolled patients included 68 patients with nerve roots compression and 71 patients without.Meanwhile,198 hospital staffs underwent lumbar MRI examinations and were sentfor a LBP questionnaire.Among them,62 patients without LBP and nerve roots compression were enrolled.Categorical regression was used to analyze the relationship between MR findings and CLBP.The MR findings iucluded nerve roots compression,average disk degeneration scores（ADD）,high-intensity zones （HIZ）,Schmorlnodes,Modic Ⅰ change,average facet joints degeneration scores（AZZ）,facet joint effusion,high T2 signal in interspinous ligament and subcutaneousparaspinal muscles edema.The regression model was used to analyze the MR imaging and CLBP.Results The regression model was statistically significant （F=9.478,P＜0.01）.All predictors yielded an adjusted value was 0.446.Among all predictors,nerve roots compression,ADD,AZZ,subcutaneous or paraspinal muscles edema were statistically associated with the VAS degree （P＜0.05）.The sum of the importance of the four predictors above was 0.983.The quantification of predicted VAS degree increased as ADD level increased.The quantification of predicted VAS degree increased to the top at the 2 AZZ level and then decreased.Nerve roots compression and Subcutaneous or paraspinal muscles edema yielded higher quantification of predicted VAS degree level.Conclusion ADD,AZZ,subcutaneousparaspinal muscles edema were probably associated with CLBP degree after adjusting for nerve roots compression.

关 键 词：腰痛 磁共振成像 对比研究 

分 类 号：R445.2[医药卫生—影像医学与核医学] R681.55[医药卫生—诊断学]