CAJ | 학술논문

目的研究Modic改变与椎间盘高度及椎体边缘骨质增生的关系,探讨Modic改变在腰椎退变中的意义.方法回顾性研究分析2011年4月至2012年4月150例老年慢性腰腿痛患者的影像学资料,所有患者均进行MRI及腰椎正侧位X线检查,选择患者L1～2至L5～S1椎间盘为研究对象,150例患者共观测750个椎间盘、椎体及椎间盘邻近终板.观察患者腰椎终板Modic改变的发生率、椎间盘高度以及椎体边缘骨质增生程度,定义椎间盘高度/椎间盘平均高度＜50％为椎间盘塌陷.将所有患者腰椎间盘分为4组,A1组:椎间盘塌陷,椎体无或轻度骨质增生;A2组:椎间盘塌陷,椎体重度骨质增生;B1组:无椎间盘塌陷,椎体无或轻度骨质增生;B2组:无椎间盘塌陷,椎体重度骨质增生.采用x2检验方法,对4个组Modic改变发生率进行比较,分析椎间盘高度以及椎体骨质增生与Modic改变的关系.结果 4组共观测了750个椎间盘,A1组208个椎间盘,终板Modic改变发生率为54.3％;A2组135个椎间盘,终板Modic改变发生率为34.8％;B1组225个椎间盘,终板Modic改变发生率为16.9％;B2组182个椎间盘,终板Modic改变发生率为29.7％.4组间Modic改变发生率差异有统计学意义(x2 =69.565,P＜0.05).组间两两比较,A1组与A2、B1和B2组比较,差异均有统计学意义(x2=12.524、66.701和24.102,P ＜0.00714).A2组与B1组比较差异有统计学意义(x2=15.032,P＜0.00714),但与B2组比较差异无统计学意义(x2=0.945,P＞0.00714).B1与B2组比较,差异有统计学意义(x2=9.395,P＜0.00714).结论老年慢性腰腿痛患者中椎间盘高度的丢失且不伴有重度椎体骨质增生的终板Modic改变发生率较高,椎间盘塌陷合并重度椎体骨质增生患者与单纯重度椎体骨质增生患者的Modic改变发生率无明显差别.
목적 연구Modic개변여추간반고도급추체변연골질증생적관계,탐토Modic개변재요추퇴변중적의의.방법 회고성연구분석2011년4월지2012년4월150례노년만성요퇴통환자적영상학자료,소유환자균진행MRI급요추정측위X선검사,선택환자L1～2지L5～S1추간반위연구대상,150례환자공관측750개추간반、추체급추간반린근종판.관찰환자요추종판Modic개변적발생솔、추간반고도이급추체변연골질증생정도,정의추간반고도/추간반평균고도＜50％위추간반탑함.장소유환자요추간반분위4조,A1조:추간반탑함,추체무혹경도골질증생;A2조:추간반탑함,추체중도골질증생;B1조:무추간반탑함,추체무혹경도골질증생;B2조:무추간반탑함,추체중도골질증생.채용x2검험방법,대4개조Modic개변발생솔진행비교,분석추간반고도이급추체골질증생여Modic개변적관계.결과 4조공관측료750개추간반,A1조208개추간반,종판Modic개변발생솔위54.3％;A2조135개추간반,종판Modic개변발생솔위34.8％;B1조225개추간반,종판Modic개변발생솔위16.9％;B2조182개추간반,종판Modic개변발생솔위29.7％.4조간Modic개변발생솔차이유통계학의의(x2 =69.565,P＜0.05).조간량량비교,A1조여A2、B1화B2조비교,차이균유통계학의의(x2=12.524、66.701화24.102,P ＜0.00714).A2조여B1조비교차이유통계학의의(x2=15.032,P＜0.00714),단여B2조비교차이무통계학의의(x2=0.945,P＞0.00714).B1여B2조비교,차이유통계학의의(x2=9.395,P＜0.00714).결론 노년만성요퇴통환자중추간반고도적주실차불반유중도추체골질증생적종판Modic개변발생솔교고,추간반탑함합병중도추체골질증생환자여단순중도추체골질증생환자적Modic개변발생솔무명현차별.
Objectives To evaluate the relationship between Modic change and disc height together with lumbar hyperosteogeny and study the role of Modic change in lumbar degeneration.Methods The imaging data of 150 elderly patients with chronic low back pain were analysed retrospectively.All patients underwent MRI and lumbar lateral X-ray examination.The lumbar disc from L1-L2 to L5-S1 were selected for this study,including 750 discs,vertebral and endplate close to disc in 150 patients.The incidence rate of lumbar endplate Modic change,disc height and the degree of vertebral bone hyperplasia were recorded.The ratio of disc height/lumbar intervertebral disc height ＜ 50％ was defined as disc collapse.The patients were divided into 4 groups in the basis of imaging changes.Group A1:disc collapse without severe lumbar hyperosteogeny; Group A2:disc collapse with severe lumbar hyperosteogeny; Group B1:Neither disc collapse nor severe lumbar hyperosteogeny; Group B2:severe lumbar hyperosteogeny without disc collapse.The incidence rates of Modic change were compared between the 4 groups by x2 test.Finally,the influence of disc height and vertebral bone hyperplasia on the incidence rate of Modic change was analysed.Results Four groups of patients observed a total of 750 discs.The number of intervertebral discs in the group A1 was 208,the incidence rate was 54.3％.The number of intervertebral discs in the group A2 was 135,the incidence rate of group A2 was 34.8％.The number of intervertebral discs in the B1 group was 225,the incidence rate of group B1 was 16.9％.The number of intervertebral discs in the B2 group was 182,the incidence rate of group B2 was 29.7％.There was significant difference of lumbar endplate Modic change incidence rate among the 4 groups (x2 =69.565,P ＜ 0.05).The results of post hoc test showed that the incidence rate of Modic change in group A1 was higher than group A2,B1 and B2 (x2 =12.524,66.701and 24.102,P ＜ 0.00714).There was significant difference of Modic change incidence rate between group A2 and B1 (x2 =15.032,P ＜0.00714),but there was no significant difference of Modic change incidence rate between group A2 and B2 (x2 =0.945,P ＞ 0.00714).There was significant difference of Modic change incidence rate between group B2 and group B1 (x2 =9.395,P ＜ 0.00714).Conclusions The incidence rate of Modic change with disc collapse but without severe lumbar hyperosteogeny is high in elderly patients with chronic low back pain.There is no significant difference of Modic change incidence between patients with both disc collapse and severe lumbar hyperosteogeny and patients with severe lumbar hyperosteogeny but without disc collapse.