腰椎终板骨软骨炎的MRI表现与临床意义

MRI findings and clinical significance of the lumbar endplate osteochondritis

目的总结腰椎终板骨软骨炎MRI表现,探讨其分型、分期及与下腰痛的关系。方法回顾性分析连续性1926例腰椎MRI资料。结果 1681例显示腰椎退变。432例共539个终板显示终板骨软骨炎。依据MRI表现将终板骨软骨炎分为骨髓型、椎间盘型、Schmorl结节型和混合型,分别占77.3%,0.7%,13.2%及8.8%。骨髓型Modic1型41例,占全部退变病例的2.5%;Modic2型289例,占17.2%;Schmorl结节伴周围Modic1型18例,占1.1%;Schmorl结节伴周围Modic2型39例,占2.3%。单纯终板骨软骨炎病例中,Modic1型最多见(32.3%,10/31例);终板骨软骨炎合并腰椎退变病例中,Modic2型最多见(71.1%,285/401例)。62.7%(271/432例)的终板骨软骨炎患者有下腰痛症状,其中骨髓型Modic1型、Schmorl结节伴周围Modic1型、椎间盘型患者下腰痛的发生率明显高于其他型,分别为97.6%、88.9%和100%。51/56个Modic1型终板经保守治疗后完全或部分转换为Modic2型,腰痛症状消失或减轻,而Modic2型病例经随访MRI表现及临床症状保持稳定。结论腰椎终板骨软骨炎是椎间盘退变的一种表现,是造成局部下腰痛的原因之一。MRI是最佳检查手段。

Objective：To explore the MRI fi ndings of lumbar endplate osteochondritis and discuss the correlation between its type,stage and low back pain.Materials and Methods：All the 1926 sequential lumbar MRI materials were analyzed retrospectively.Results：In all 1926 cases,1681 cases presented lumbar degenerative disease,539 endplates in 432 patients demonstrated osteochondritis,which were subdivided into 4 types according to the MRI fi ndings：bone marrow type,disc type,Schmorl’s node type and mixing type,accounting for 77.3%,0.7%,13.2% and 8.8% respectively.Modic 1 of bone marrow type （n=41） account for 2.5% in all lumbar degenerative cases,while Modic 2 （n=289） account for 17.2%.Schmorl’s node type accompanied by Modic 1 （n=18） account for 1.1%,while Schmorl’s node type accompanied by Modic 2 （n=39） account for 2.3%.In pure endplate osteochondritis patients,Modic 1 type was most common （32.3%,10/31）,while in patients associated with lumbar degenerative disease,Modic 2 type was most common （71.1%,285/401）.62.7% （271/432） patients with osteochondritis complained of low back pain.The incidence of low back pain in Modic 1 of bone marrow type,Schmorl’s node type and disc type were 97.6%,88.9% and 100%,respectively,obviously higher than that in other types.Fifty-one in 56 Modic 1 endplates transform to Modic 2 completely or partially after conservative management,and the pain disappeared or released.Modic 2 endplate keep stable in MRI fi ndings and clinical symptoms.Conclusion：Endplate osteochondritis is a kind of MRI fi ndings of disc degeneration which results in low back pain.MRI is the best and fi rst choice of modality for detecting it.