腰痛患者下腰椎MRI上Modic改变与高信号区的发生情况及意义

Prevalence and value of Modic change and high-intensity zone on MRI in lower lumbar spine of patients with low back pain

中文关键词:  腰痛  MRI  Modic改变  高信号区

英文关键词:Low back pain  MRI  Modic change  High-intensity zone

中文摘要:

  【摘要】 目的：探讨腰痛患者下腰椎MRI上Modic改变与腰椎间盘局限性高信号区（high-intensity zone，HIZ）的发生情况及意义。方法：对511例腰痛患者（男263例，女248例；年龄20~70岁，平均48岁）腰椎MRI上L4/5和L5/S1节段的Modic改变和HIZ进行评估，统计两者及两者共存于同一节段的发生率。将有Modic改变和/或HIZ的椎间盘分为Modic组、Modic-HIZ组、HIZ组，比较3组的年龄、椎间盘高度、椎间盘退变程度、腰痛VAS和ODI评分。结果：511例患者中，190例（37.18%）209个节段有Modic改变，127例（24.85%）142个椎间盘有HIZ，18例（3.52%）18个节段出现Modic改变和HIZ共存的现象。HIZ组、Modic-HIZ组和Modic组分别为89例（124个节段）、18例（18个节段）、152例（191个节段），患者平均年龄分别为46.0±11.0岁、49.2±9.2岁和53.5±10.6岁，仅HIZ组和Modic组差异有统计学意义（P<0.05）；椎间盘平均高度分别为9.93±2.46mm、8.73±2.45mm和7.57±2.21mm，组间两两比较差异有统计学意义（P<0.05）；3组椎间盘退变分级均≥Ⅲ级，其中Ⅳ级+Ⅴ级退变率分别为48.39%、72.22%和75.92%，仅HIZ组与Modic组、Modic-HIZ组差异有统计学意义（P<0.05）；腰痛VAS分别为8.39±0.32分、8.45±0.30分、8.61±0.54分，ODI评分分别为38.22±4.23分、38.45±4.16分、39.18±3.53分，3组间无统计学差异（P>0.05）。结论：腰痛患者下腰椎Modic改变和HIZ的发生率较高，但两者共存于同一节段的发生率低，当两者共存于同一节段时腰痛并不会明显加重。

英文摘要:

  【Abstract】 Objectives: To investigate the prevalence and value of Modic change and high-intensity zone(HIZ) on MRI in lower lumbar spine of patients with low back pain(LBP). Methods: The lumbar MRI of L4/5 and L5/S1 from 511 patients(263 men and 248 women) presenting with LBP and with the age of 20 to 70 years were reviewed retrospectively. The prevalence of Modic change, HIZ and their coexistence were evaluated. All patients(discs) with Modic changes or HIZs were divided into Modic group, Modic-HIZ group and HIZ group. The parameters including age, disc height, disc degeneration and degree of LBP(VAS score and ODI score) were compared among three groups. Results: Of 511 patients with LBP, 190 patients(37.18%) and 209 segments showed Modic changes, 127 patients(24.85%) and 142 segments presented with HIZs, 18 patients(3.52%) and 18 segments had coexistence of Modic change and HIZ in one level. The number of cases in HIZ group, Modic-HIZ group and Modic group was 89(124 segments), 18(18 segments) and 152(191 segments) respectively, with the average age of 46.0±11.0, 49.2±9.2 and 53.5±10.6 years old for HIZ group, Modic-HIZ group and Modic group respectively, which sowed significant difference between HIZ and Modic group(P<0.05); the average disc height was 9.93±2.46mm, 8.73±2.45mm and 7.57±2.21mm for three groups respectively, which showed significant difference among three groups(P<0.05); the average degree of disc degeneration of 3 groups was over grade Ⅲ with the incidence of grade Ⅳ and grade Ⅴ degeneration of 48.39%, 72.22% and 75.92% respectively, which showed significant difference between HIZ and Modic group or Modic-HIZ group(P<0.05); VAS scores were 8.39±0.32, 8.45±0.30 and 8.61±0.54 and ODI scores were 38.22±4.23, 38.45±4.16 and 39.18±3.53 for 3 groups respectively, which showed no significant difference among three groups(P>0.05). Conclusions: The prevalence of Modic change and HIZ in lower lumbar spine of patients with LBP is very high, but their coexistence in one level is rare. When coexistence happens, LBP will not increase simultaneously.