腰椎间盘突出症Modic改变与腰椎退变程度的关系

Relationship between Modic changes and degree of disc degeneration in lumbar intervertebral disc protrusion

目的探讨腰椎间盘突出症Modic改变与腰椎椎间盘退变程度之间的关系。方法手术治疗腰椎椎间盘突出症患者44例。对术前MRI上病变节段进行Modic分型,分别用椎间盘退变Pfirrman分级标准和改良Pfirrman分级标准评定病变节段的椎间盘退变程度。分析不同类型Modic改变的椎间盘退变Pfirrman分级和改良Pfirrman分级之间的差异;评价Modic改变的类型和椎间盘退变程度之间的关系。结果 44例中,无Modic改变者19例,病变节段Pfirrman分级为(3.63±0.60),改良Pfirrman分级为(5.95±0.91);ModicⅠ型改变者10例,病变节段Pfirrman分级为(3.90±0.57),改良Pfirrman分级为(6.80±0.79);ModicⅡ型改变者15例,病变节段Pfirrman分级为(3.93±0.26),改良Pfirrman分级为(6.40±0.83);无ModicⅢ型改变病例。ModicⅠ型的改良Pfirrman分级明显高于无改变组(P<0.05)。Modic改变与椎间盘退变的相关性最强,而年龄因素最弱。结论腰椎间盘突出症的Modic改变与椎间盘退变改良Pfirrman分级之间有明显关联。

Objective To investigate the relationship between Modic changes and the degree of disc degeneration in patients with lumbar disc protrusion. Methods From January 2009 to December 2011,44 patients with lumbar disc protrusion were treated by surgery.Preoperative MRI was performed to observe Modic changes.Pfirrman grading assessment and modified Pfirrman grading assessment were also performed.The relationship between Modic changes and the degree of disc degeneration was analyzed. Results Of 44 cases,19 cases were without Modic changes,who had Pfirrman grade of 3.63±0.60 and modified Pfirrman grade of 5.95±0.91.Ten cases were with Modic change type I,who had Pfirrman grade of 3.90±0.57 and modified Pfirrman grade of 6.80±0.79. Fifteen cases were with Modic change type Ⅱ,who had Pfirrman grade of 3.93±0.26 and modified Pfirrman grade of 6.80±0.83.No Modic change of type III was found in 44 cases.The modified Pfirrman grade was higher in the cases with Modic change type Ⅰ than that in those without Modic changes （P0.05）.The Modic changes were the most relevant factor with disc degeneration. Conclusion In lumbar intervertebral disc protrusion,there is a clear connection between Modic changes and the degrees of disc degeneration graded by the modified Pfirrman grading system.