腰椎管狭窄症中与腰痛相关的影像学因素分析

Analysis of the iconographic factors related to the low back pain in the patients with lumbar spinal stenosis

中文关键词:  腰痛  腰椎管狭窄症  节段性不稳定  Modic改变  HIZ

英文关键词:Low back pain  Lumbar ｓｐｉｎａｌ　ｓtenosis  Modic changeｓ  HIZ  Segmental instability

中文摘要:

  【摘要】 目的：探讨影像学上节段不稳定、椎间盘后缘高信号区（HIZ）、Modic改变等的特征性表现与腰椎管狭窄症患者腰痛之间的关系。方法：回顾2007年1月～2010年1月间我科治疗的、有完整资料的腰椎管狭窄症患者共246例，按照影像学特点和腰痛症状是否存在进行分析，提取节段不稳定、椎间盘后缘高信号区（HIZ）、Modic改变各相关影像学数据，使用流行病学病因研究中的统计分析方法，计算OR值及其可信区间，衡量影像学危险因素与腰痛发生的相关性强度，观察节段性不稳定、HIZ、Modic改变等因素与腰痛的关系。结果：患者平均年龄59.8岁（35~86岁），腰痛者170例，无明确腰痛者76例，腰痛的发生率为69.1%。腰痛患者的VAS评分为3.5~9.0分，平均5.67分。伴HIZ患者80例，其中腰痛66例，腰痛的阳性率为82.5%，χ2=9.96，P<0.01，OR值=2.81，95%可信区间1.48～5.34；Modic改变64例，其中腰痛56例，腰痛阳性率87.5%，χ2=13.71，P<0.01，OR值=4.18，95%可信区间：1.96～8.90；Modic分期Ⅰ期7例，有腰痛6例，腰痛阳性率85.7%；Ⅱ期44例，有腰痛40例，腰痛阳性率90.9%；Ⅲ期13例，有腰痛10例，腰痛阳性率76.9%。伴节段性不稳定88例，有腰痛74例，腰痛阳性率84.1%，χ2=14.41，P<0.01，OR值=3.41，95%可信区间：1.81～6.43。HIZ、Modic改变、节段性不稳定与腰痛症状呈高度相关（P<0.05）。结论：腰椎节段不稳定、HIZ、Modic改变是腰椎管狭窄患者腰痛产生的危险因素。

英文摘要:

  【Abstract】 Objective：To explore the relationship between the low back pain and imaging findings（segmental instability，high-intensity zone（HIZ）and Modic change）in lumbar spinal stenosis patients.Methods：Retrospective iconographic analysis of 246 patients with lumbar spinal stenosis between January 2007 and January 2010 in our hospital．According to the imaging characristics and the patient symptoms，the data about the images were analyzed and attemtped to find the relationship between the imaging changes（segmental instability，HIZ，Modic changes）and low back pain.Results:The mean age was 59.8 years（range=35-86）.There were 170 patients with low back pain and 76 patients without pain.The incidence of low back pain was 69.1%，and the mean VAS score for back pain was 5.67（range=3.5-9.0）.There were 80 patients with HIZ in which 66 patients had low back pain.The positive rate was 82.5%，χ2=9.96，P<0.01，OR=2.81，95% CI：1.48－5.34.There were 64 patients with Modic changes in which 56 patients had low back pain.The positive rate was 87.5%，χ2=13.71，P<0.01，OR=4.18，95% CI：1.96－8.90.There were 7 patients with Modic changes I stage in which 6 patients had low back pain.The positive rate was 85.7%.There were 44 patients with Modic changes Ⅱ stage in which 40 patients had low back pain.The positive rate was 90.9%.There were 13 patients with Modic changes Ⅲ stage in which 10 patients had low back pain.The positive rate was 76.9%.There were 88 patients with segmental instability in which 74 patients had low back pain.The positive rate was 84.1%,χ2=14.41，P<0.01,OR=3.41,95% CI：1.81~6.43. The correlation between the imaging changes(HIZ, Modic changes,segmental instability)and low back pain was statistical significant（P＜0.05）.Conclusions：Segmental instability，HIZ　ａｎｄ　Modic changes were risk factors resulting in low back pain for lumbar spinal stenosis patients.