椎间盘源性下腰部疼痛患者腰椎间盘MRI高信号区发生特点

摘要

目的 探讨椎间盘源性下腰部疼痛(LBP)患者腰椎间盘MRI高信号区(HIZ)发生特点与规律.方法 对72例椎间盘源性LBP患者(LBP组)、30例无LBP病史患者(对照组)行1.5T腰椎MRI,评价所有节段腰椎间盘退变程度及HIZ,并对采集数据进行统计学分析.结果 两组患者HIZ均发生于Ⅲ～Ⅴ级退变椎间盘,以L3-4、L4-5、L5-S1腰椎间盘最易受累.LBP组HIZ阳性34例,共累及99个腰椎间盘,25例为多发HIZ(HIZ累及≥2个腰椎间盘);对照组HIZ阳性11例,共累及21个腰椎间盘,4例为多发HIZ.两组患者椎间盘HIZ发生率(LBP组:99/360,27.50％;对照组:21/150,14.00％)、多发HIZ患者数差异均有统计学意义(x2=10.725、5.010,P=0.001、0.025).结论 HIZ是Ⅲ级以上椎间盘退变的表现,并不是椎间盘源性LBP的特异性征象,但LBP患者椎间盘HIZ发生率增高,多椎间盘受累对提示椎间盘源性LBP诊断有重要意义.%Objective To investigate the occurring characteristics and regularity of high-intensity zone (HIZ) of lumbar intervertebral disc on MRI in discogenic low back pain (LBP) patients.Methods Seventy-two patients with discogenic LBP (LBP group) and thirty subjects without history of clinically relevant LBP (control group) were examined by a 1.5 tesla MR scanner.The lubar disc degeneration and HIZ were evaluated.Then all obtained data were analyzed by statistical analysis.Results HIZs were occurred in grades Ⅲ-Ⅴ degenerative discs in both groups,most of which at L3-4 、L4-5 、L5-S1.HIZs were identified in 34 LBP patients involving 99 lubar discs,and 25 cases were found to be multiple HIZs (HIZ involved≥ 2 lumbar discs).Whereas HIZs were positive in 11 cases of control group involving 21 lubar discs,and 4 cases were found to be multiple HIZs.Significant differences (x2 =10.725,5.010,P=0.001,0.025) were found in incidence rates of HIZ (LBP group:99/360,27.50％ ; control group:21/150,14.00％) of intervertebral disc and cases of multiple HIZs between the two group.Conclusion HIZ is a manifestation of grades Ⅲ to Ⅴ degenerative discs but not specific for discogenic LBP.However,HIZ is more frequently occurred in LBP patients' lumbar discs,and multiple HIZs in a patient can be considered as important marker of discogenic LBP.