腰椎间盘退变性疾患下腰椎终板形态的MRI观察

Morphology of endplate in lumbar degenerative disc disease, a MRI study

中文关键词:  腰椎间盘退变  终板形态  MRI  Modic改变

英文关键词:Lumbar disc degeneration  Endplate shape  MRI  Modic changes

中文摘要:

  【摘要】　目的：在MRI片上观察腰椎间盘退变患者下腰椎终板形态的分布规律，分析终板形态和椎间盘退变的关系。方法：回顾分析两组腰椎间盘退变性疾病患者的术前腰椎MRI，A组110例为单节段腰椎间盘突出症患者，B组35例为椎间盘源性腰痛患者。根据正中矢状面MRI T1像，将终板形态分为凹面、平坦、不规则三型；根据Pfirrmann法评定椎间盘退变程度并将Ⅰ～Ⅴ级分别计为1～5分；按Modic改变分级标准判定各节段终板有无Modic改变。分析下腰椎终板的形态特点及三种分型与椎间盘退变程度、Modic改变等的关系。结果：①435个下腰椎节段中，凹面型终板最多（215/435），A组中占50.6％（167/330），B组中占45.7％（48/105），且主要分布于L3/4（108/215）、L4/5（83/215）节段；平坦型终板占29.0％（126/435），并主要位于L5/S1节段（76/126）；不规则型终板最少（94/435），A组中占23.0％（76/330），B组中占17.1％（18/105），也主要位于L5/S1节段（45/94）。②A组患者中，凹面型终板退变程度平均为3.31±0.81分，平坦型为3.66±0.64分，不规则型为4.16±0.67分，两两比较有显著差异（P＜0.05）；椎间盘突出节段以平坦型（37/110）和不规则型（43/110）终板占多数，无突出节段则以凹面型（137/220）终板占多数，差异有显著性（P＜0.05）；不规则型终板比凹面型和平坦型更容易伴发Modic改变，差异有显著性（P＜0.05），凹面型和平坦型间无显著性差异（P＞0.05）。③B组患者中，凹面型终板的椎间盘退变程度平均为3.23±0.86分，平坦型为3.54±0.85分，不规则型为3.94±0.54分，仅凹面型和不规则型间差异有显著性（P＜0.05）。④相同终板形态时A组和B组椎间盘退变程度相比均无显著性差异（P＞0.05）。结论：终板形态与椎间盘退变、Modic改变之间有相关性。终板形态由凹面型到平坦型再到不规则型，腰椎间盘退变程度逐渐加重。影像学上终板形态改变在一定程度上反映了椎间盘退变的程度。

英文摘要:

  【Abstract】　Objectives: To investigate the morphology of endplate shape in lumbar degenerative disc disease by means of magnetic resonance imaging(MRI) and the correlation between endplate shape and lumbar disc degeneration. Methods: A retrospective review was carried out in this study. The preoperative lumbar MRIs of 110 patients with single lumbar intervertebral disc herniation(group A) and 35 patients suffering from discogenic low back pain(group B) were reviewed and analyzed respectively. The morphology of endplate was classified into three groups: concave, flat and irregular based on the midsagittal T1-weighed MRI; the degree of disc degeneration was graded on T2-weighed MRI according to the Pfirrmann′s method, with one to five points behaving grade Ⅰ to Ⅴ; all endplates were determined by Modic grading system. The associations between morphology of endplate in lower lumbar spine and disc degenerative degree as well as Modic changes were evaluated retrospectively.　Results: ①Among the 435 lower lumbar spine endplates, concave represented the maximum proportion(215/435), with 50.6% in group A(167/330) and 45.7% in group B(48/105), and they almost sited in L3/4(108/215) and L4/5(83/215). Flat accounted for 29.0%(126/435), mostly sited in L5/S1(76/126). Irregular represented the least proportion(94/435), with 23.0% in group A(76/330) and 17.1% in group B(18/105), almost sited in L5/S1(45/94). ②In group A, the average degenerative degree for concave, flat and trregular endplate was 3.31±0.81 point, 3.66±0.64 point and 4.16±0.67 point respectively, which showed significant difference(P<0.05). Flat(37/110) and irregular(43/110) endplates were more common than concave ones in herniated discs, however which(137/220) were more common in no-herniated discs, which showed significant difference(P<0.05). For patients with lumbar disc herniation, irregular endplates were associated with Modic changes more often than the other two shapes(P<0.05), but the latter two shapes showed no difference(P＞0.05). ③In group B, the average degeneration degree for concave, flat and irregular endplate was 3.23±0.86 point, 3.54±0.85 point and 3.94±0.54 point respectively, with significant difference existing only in concave and irregular shape(P<0.05). Conclusions: Endplate morphology is associated with degree of disc degeneration and Modic changes. Disc degeneration presents from concave to flat and finally to irregular shape on MRI. Endplate shape on MRI can reflect the degree of disc degeneration to a certain degree.