中老年腰腿痛患者腰椎终板Modic改变的分布情况及其与腰椎不稳的关系

Distribution of Modic changes of lumbar endplate in middle-elderly population with low back pain and its relationship with lumbar instability

中文关键词:  腰椎  Modic改变  腰椎不稳  腰椎曲度

英文关键词:Lumbar spine  Modic changes  Lumbar instability  Lumbar curvature

中文摘要:

  【摘要】 目的：探讨中老年腰腿痛患者腰椎终板Modic改变的分布情况，分析其与腰椎不稳之间的关系。方法：随机选取2007年3月~2011年12月因腰腿痛在我院行腰椎MRI和常规X线片检查的年龄≥40岁的患者430例，男210例，女220例，年龄40~73岁。观察患者腰椎终板Modic改变的发生率、类型及分布特点；根据腰椎是否稳定分为腰椎稳定组和腰椎不稳定组，分析其与Modic改变之间的关系；腰椎稳定组患者分为腰椎曲度正常组和异常组，分析其与Modic改变之间的关系。结果：430例共计2150个腰椎椎间盘中，124例（28.84%）154个（7.16%）椎间盘终板存在Modic改变，其中Ⅰ型34例（7.91%）、34个椎间盘（1.58%），Ⅱ型72例（16.74%）、100个椎间盘（4.65%），Ⅲ型18例（4.19%）、20个椎间盘（0.93%）；L2/3 14个，L3/4 24个，L4/5 50个，L5/S1 66个，其发生率分别为0.65%、1.12%、2.32%、3.07%；其中Modic改变位于终板前部79个，后部31个，整个终板44个；仅累及上终板52个，仅累及下终板41个，累及上、下终板61个。腰椎不稳定组终板Modic改变的发生率为36.68%，腰椎稳定组为19.90%，两组差异有统计学意义（P<0.05）；Modic Ⅰ、Ⅱ、Ⅲ型中腰椎不稳的发生率分别为82.35%、69.44%、33.33%，三者差异有统计学意义（P<0.05）；腰椎曲度正常组终板Modic改变的发生率为11.11%，腰椎曲度异常组为23.91%，两组差异有统计学意义（P<0.05）。结论：中老年腰腿痛患者腰椎终板Modic改变以Ⅱ型最多见，以L4/5和L5/S1节段多发；其与腰椎不稳和腰椎曲度之间存在相关关系，ModicⅠ型改变与腰椎不稳相关性最强。

英文摘要:

  【Abstract】 Objectives: To investigate the distribution of Modic changes of lumbar endplate in middle-elderly population with low back pain, and its relationship with lumbar instability. Methods： 430 patients(210 males and 220 females) aged more than 40 years old(range, 40-73 years) in our hospital from March 2007 to December 2011 were reviewed retrospectively. The incidence, type and distribution of Modic changes were reviewed. All patients were divided into lumbar stable group and unstable group, and the relationship between Modic changes and lumbar instability was analyzed. The patients with lumbar stability were further divided into two subgroups based on lumbar curvature. The correlation between Modic changes and lumbar curvature was analyzed. Results： Among 2150 intervertebral discs of 430 patients, 154（7.16%） discs of 124（28.84%） cases were involved in Modic changes; 34（1.58%） discs were diagnosed as type Ⅰ; 100（4.65%） discs as type Ⅱ; 20（0.93%） discs as type Ⅲ; the lesions involved L2/3（0.65%）, L3/4(1.12%), L4/5(2.32%) and L5/S1（3.07%）. The location of Modic changes was noted in 154 levels(52 superior end plate, 41 inferior end plate, 61 both) , and 79 sited anteriorly, 31 sited posteriorly, 44 sited both anteriorly and posteriorly. The incidence of Modic changes in unstable group and stable group was 36.68% and 19.90% respectively, which showed significant difference(P<0.05). The incidence of lumbar instability in Modic Ⅰ, Ⅱ, Ⅲ type was 82.35%, 69.44% and 33.33% respectively, and there were significant differences among them(P<0.05). The incidence of Modic changes in normal lumbar curvature group and abnormal curvature group was 11.11% and 23.91% respectively, which showed significant differences between both groups(P<0.05). Conclusions： Modic changes of lumbar endplate in middle-elderly population correlate with lumbar instability and lumbar curvature, and Modic Ⅰ type change is related to lumbar instability greatly, while Modic Ⅱ type change is the most prevalent, which almost sites in L4/5 and L5/S1.