腰椎Modic改变与终板缺损体积和形态的联系及二者与腰痛相关性的研究

A study of Modic changes′ association with the volume and morphology of the endplate defects in the lumbar spine and their correlations with low back pain

中文关键词:  Modic改变  终板缺损  MRI  腰痛  腰椎退行性变

英文关键词:Modic change  Endplate defect  MRI  Low back pain  Degenerative changes in lumbar spine

中文摘要:

  【摘要】 目的：分析腰椎Modic改变的体积与终板缺损的体积、形态的相关性，探究相关终板病变与腰痛症状的联系。方法：回顾性分析2020年10月~2023年10月于苏州大学附属第二医院行腰椎MRI检查有终板缺损的401例患者的临床及影像资料，根据是否合并Modic改变分为两组：Modic改变组（204例）和无Modic改变组（197例），测量并计算两组患者终板缺损的体积分数并评估两组患者腰椎终板缺损的形态，分为典型形态组（凹陷形、三角形、圆形）和非典型形态组（矩形、不规则形）。测量Modic改变204例患者Modic改变的长、宽、高，并计算体积分数。分析Modic改变的体积分数与终板缺损的体积分数、形态的相关性。根据所有患者椎间盘退变等级分组，对每组患者分别进行Modic改变的体积分数与终板缺损的体积分数、形态分组的相关性分析。随访患者腰痛情况，对不同终板缺损形态与是否合并Modic改变患者腰痛患病率进行比较。结果：典型形态组共369个椎体，152个椎体合并Modic改变；非典型形态组共191个椎体，149个椎体合并Modic改变。Modic改变组的腰椎终板缺损体积分数为0.017±0.014，无Modic改变组的腰椎终板缺损体积分数为0.008±0.007。非典型形态组终板缺损患者的Modic改变体积分数0.20±0.13，典型形态组终板缺损患者Modic改变体积分数0.11±0.10，差异有统计学意义（P<0.001）。腰椎Modic改变的体积分数与终板缺损体积分数的变化呈线性正相关（P<0.001）。椎间盘轻度与中度退变的患者中，Modic改变的体积与终板缺损的体积与形态有着相关性（P<0.05）；在椎间盘重度退变的患者中，Modic改变的体积与终板缺损的体积有着相关性（P<0.001），Modic改变的体积分数与终板缺损的形态之间未见相关性（P＞0.05）。共随访65例患者腰痛情况，有30例患者出现腰痛症状（Modic改变组24例，无Modic改变组6例），终板缺损合并Modic改变的患者腰痛患病率高于单纯终板缺损患者（P<0.05），不同终板缺损形态患者腰痛患病率间无明显差异（P>0.05）。结论：腰椎Modic改变的体积分数与终板缺损的体积分数呈现显著的线性正相关性；椎间盘轻度与中度退变的患者中，非典型组形态的终板缺损患者的Modic改变体积分数普遍大于典型形态组；合并Modic改变患者中腰痛的比例更高。

英文摘要:

  【Abstract】 Objectives: To analyze the association between the volume of Modic changes(MC) in the lumbar spine with the volume and morphology of endplate defects(ED), and investigate the correlation between the associated endplate lesions and low back pain(LBP) symptoms. Methods: The clinical and imaging data of 401 patients with ED examined with lumbar MRI at the Second Affiliated Hospital of Soochow University between October 2020 and October 2023 were retrospectively analyzed. The patients were divided into MC group(204 patients) and non-MC group(197 patients) according to whether or not combined with MC, and the volume of ED was measured in the two groups of patients. The morphology of ED was categorized into typical group(depressed, triangular, and round) and atypical group(rectangular and irregular). The length, width and height of MC were measured in patients of the MC group, and the volume fraction was calculated. The volume fraction of MC was analyzed for correlation with the volume fraction of ED and morphological grouping. Then the intervertebral disc degeneration(IDD) grade of all the patients were evaluated and grouped, and the correlations between the volume fraction of MC and volume fraction and morphology grouping of ED for each IDD group of patients were analyzed separately. The low back pain(LBP) condition was followed-up, and the prevalence of LBP in patients with different ED morphology and with or without MC was compared. Results: In the typical morphology group, there were 369 vertebrae, and 152 vertebrae were combined with MC; In the atypical morphology group, there were 191 vertebrae, and 149 vertebrae were with combined MC. The mean volume fraction of ED in the group with MC was 0.017±0.014, and the mean volume fraction of ED in the group without MC was 0.008±0.007. The mean volume fraction of MC in patients with ED in the atypical group was 0.20±0.13, which was 0.11±0.10 in patients with ED in the typical group, with statistically significant difference(P<0.001). Overall MC volume fraction correlated linearly and positively with changes in ED volume fraction(P<0.001). The volume of MC correlated with the volume and morphology of ED in patients with mild and moderate IDD(P<0.05); In patients with severe IDD, there was a correlation between the volumes of MC and ED(P<0.001), but there was no correlation between the range of MC and the morphology of ED(P>0.05). The prevalence of LBP was higher in patients with ED combined with MC than in patients with ED alone(P<0.05). 65 patients were followed up to record the LBP condition, and 30 patients had LBP(24 cases in the MC group and 6 cases in the non-MC group), There was no significant difference in the prevalence of LBP between patients with different ED morphology(P>0.05). Conclusions: The volume fraction of lumbar MC shows a significant linear and positive correlation with ED volume fraction; In patients with mild and moderate disc degeneration, the patients with ED of atypical group of morphology tend to have a greater volume fraction than the patients in typical group of morphology; Patients combined with MC have a higher prevalence of LBP.