腰椎Modic改变的MRI定量与下腰痛相关性研究

摘要

Objective:To analyzed the relationship between lumbar endplate Modic area changes rate and low back pain by measuring MRI T2 sagittal image of lumbar endplate Modic area changes rate. Methods:From December 2011 to June 2012,70 patients with low back pain in operation were evaluated on pain by VAS and function by JOA ,and examined by MRI including 39 males and 31 females with an average age of (51.00±11.89) years ranging from 29 to 72 years old. Among them, 54 cases had lumbar endplate Modic changes involving 15 cases in types ModicⅠ,21 cases in type ModicⅡ,11 cases in type ModicⅢ,mixed type Modic in 7 cases (eliminated for too few cases). Modic area changes and corresponding vertebral area were measured on MRI T2 median sagittal. The areas of two ways were compared to yield the rate of changes for Modic ,for multisegmental Modic changes to calculate the total ratios. A correlation was observed among JOA ,VAS and the rate of Modic changes. Results:The correlation coefficient of change rate of ModicⅠwith JOA score was r=-0.308,P=0.048<0.05,there was a negative correlation;the correlation coefficient of change rate of ModicⅠwith VAS scores was r=0.428,P=0.021<0.05,there was a positive correlation. The correlation coefficient of change rate of Modic Ⅱwith JOA score was r=-0.375,P=0.043<0.05, there was a negative correlation;the correlation coefficient of change rate of Modic Ⅱwith VAS score was r=0.352,P=0.041<0.05, there was a positive correlation. The area change rate of Modic Ⅲhad no significant correlation with low back pain de-gree (P>0.05). Conclusion:ModicⅠandⅡarea changes rate of of patients with low back pain is closely related to the degree of pain low back pain,ModicⅢarea changes rate is not significant correlated to the degree of lower back pain.%目的：通过测定MRI T2正中矢状位像上腰椎终板Modic面积改变率分析Modic面积改变率大小与下腰痛程度的相关性。方法：2011年12月至2012年6月，对因下腰痛手术的70例患者进行疼痛和功能评分（JOA、VAS）和MRI检查，男39例，女31例；年龄29～72岁，平均（51．00±11．89）岁。70例中54例有腰椎终板Modic改变，将54例患者按Modic分型标准分为4型：Modic I型15例，ModicⅡ型21例，ModicⅢ型11例，Modic混和型7例（由于Modic混合型例数太少未纳入研究排除）。在MRI T2正中矢状位上测量各分型Modic改变面积及对应椎体的面积，两者面积比较得出Modic改变率，对于多节段Modic改变的求比率之和，观察JOA、VAS评分与Modic改变率之间的相关性。结果：ModicⅠ型改变率和JOA评分的相关系数r＝-0．308，P＝0．048＜0．05，两者具有负相关性；与VAS评分的相关系数r＝0．428，P＝0．021＜0．05，两者具有正相关性。 ModicⅡ型改变率和JOA评分的相关系数r＝-0．375，P＝0．043＜0．05，两者有负相关性；与VAS评分的相关系数r＝0．352，P＝0．041＜0．05，两者具有正相关性。ModicⅢ型面积改变率与下腰痛程度无明显相关性（P＞0．05）。结论：下腰痛患者中ModicⅠ、Ⅱ型面积改变率分别与下腰痛的疼痛程度有密切关系，ModicⅢ型面积改变率与下腰痛程度无明显相关性。