CAJ | 학술논문

目的：探讨下腰痛患者中腰椎终板Modic改变的分布情况及与腰椎间盘退变的关系。方法选取2011年10月至2013年10月因下腰痛在我院行腰椎MRI检查的患者942例。统计Modic改变在不同性别、年龄、节段、终板位置中的分布情况。参照Pfirrmann分级标准来评估腰椎间盘的退变程度，分析Modic改变与腰椎间盘退变程度的相关性。结果942例下腰痛患者4710个腰椎间盘中，405例（42.99%）患者的560个（11.89%）腰椎间盘邻近终板发生了Modic改变。在560处Modic改变中，Ⅰ型70处（12.5%），Ⅱ型478处（85.36%），Ⅲ型12处（2.14%）。男、女性患者Modic改变的发生率分别为40.08%（196/489）和46.14%（209/453），差异无统计学意义（P＞0.05）。Modic改变发生在40岁以上年龄段的比率明显高于40岁以下年龄段（P＜0.05）。L4/5和L5/S1节段Modic改变的发生率高于L1/2～L3/4节段（P＜0.05）。Modic改变发生在终板前部的比率明显高于中、后部（P＜0.05）。腰椎间盘从1级退变至5级退变中，Modic改变的发生率分别为0（0/162）、1.01%（11/1084）、6.70%（152/2267）、30.37%（338/1113）和70.24%（59/84），差异有统计学意义（P＜0.05）。Spearman 相关性检验表明，Modic 改变与椎间盘退变程度呈正相关（P＜0.01）。结论下腰痛患者中腰椎终板Modic改变发生率较高，且以Ⅱ型最常见。Modic改变主要发生在下腰段，且常累及终板的前1/3区域。Modic改变不存在性别差异但和年龄及腰椎间盘退变有较强的相关性。
목적：탐토하요통환자중요추종판Modic개변적분포정황급여요추간반퇴변적관계。방법선취2011년10월지2013년10월인하요통재아원행요추MRI검사적환자942례。통계Modic개변재불동성별、년령、절단、종판위치중적분포정황。삼조Pfirrmann분급표준래평고요추간반적퇴변정도，분석Modic개변여요추간반퇴변정도적상관성。결과942례하요통환자4710개요추간반중，405례（42.99%）환자적560개（11.89%）요추간반린근종판발생료Modic개변。재560처Modic개변중，Ⅰ형70처（12.5%），Ⅱ형478처（85.36%），Ⅲ형12처（2.14%）。남、녀성환자Modic개변적발생솔분별위40.08%（196/489）화46.14%（209/453），차이무통계학의의（P＞0.05）。Modic개변발생재40세이상년령단적비솔명현고우40세이하년령단（P＜0.05）。L4/5화L5/S1절단Modic개변적발생솔고우L1/2～L3/4절단（P＜0.05）。Modic개변발생재종판전부적비솔명현고우중、후부（P＜0.05）。요추간반종1급퇴변지5급퇴변중，Modic개변적발생솔분별위0（0/162）、1.01%（11/1084）、6.70%（152/2267）、30.37%（338/1113）화70.24%（59/84），차이유통계학의의（P＜0.05）。Spearman 상관성검험표명，Modic 개변여추간반퇴변정도정정상관（P＜0.01）。결론하요통환자중요추종판Modic개변발생솔교고，차이Ⅱ형최상견。Modic개변주요발생재하요단，차상루급종판적전1/3구역。Modic개변불존재성별차이단화년령급요추간반퇴변유교강적상관성。
Objective To investigate the distribution of Modic changes (MCs) of lumbar endplates in patients with low back pain and analyze its relation to lumbar intervertebral disc degeneration. Methods Nine hundred and forty-two patients with LBP were examined by MR scan from October 2011 to October 2013. The features of distribution of MCs on age, segment and degree of intervertebral disc degeneration and its relation to lumbar intervertebral disc degeneration were analyzed retrospectively. Results Among 4 710 intervertebral discs of the 942 patients, 405(42.99%) cases and 560 (11.89%) discs were involved with MCs. Among 506 MCs, there were 70(12.5%) type-Ⅰ MCs, 478 (85.36%) type-ⅡMCs and 12 (2.14%) type-Ⅲ MCs. There was no significant difference between men (196 cases, 40.08%) and women (209 cases, 46.14%)(P>0.05). MCs occurred more often in those patients between 40 to 49 years of age (P<0.05). The incidence of MCs at the lower segments was significantly higher than that at the upper segments (P<0.05). MCs occurred more often in the front of lumbar endplates. The incidence of MCs at the lower segments was higher than that at the upper segments (P<0.05). The incidence of MCs at the segments from 1 grade degeneration to 5 grade generation were as follow: 0% (0/162), 1.01%(11/1084), 6.70%(152/2 267), 30.37%(338/1 113) and 70.24%(59/84) respectively. Spearman correlation test showed MCs and disc degeneration was positively correlated (P<0.01). Conclusions The incidence of MCs in patients with low back pain is very high and type-Ⅱ is the most frequent type. MCs more frequently occurs in the anterior third of the endplates and mainly locates in the lower part of the spine (L4-S1). MCs is strongly correlated with age and disc degeneration.