腰椎4至5节段不稳程度与小关节积液和Modic改变及Oswestry功能障碍指数的相关性分析

Correlation analysis of degree of L4-5 segment instability with lumbar facet fluid and Modic type on MRI and Oswestry disability index

目的分析L4-5节段不稳患者磁共振成像（MRI）上小关节积液、Modic改变以及Oswestry功能障碍指数（ODI）评分与腰椎不稳程度的相关性。方法2012年3月至2013年7月在江苏大学附属医院行腰椎MRI和站立位过伸过屈X线检查的226例腰腿痛患者中，选取82例符合纳入标准患者，按腰椎不稳程度分为3组，A组（41例，L4～5移位3～5mm）、B组（29例，L4-5，移位〉5～7mm）、C组（12例，L4-5，移位〉7mm）。在轴位MRI的T2加权像上测量小关节积液，并记录小关节的积液量，观察L4～5终板Modic改变；在患者同意的情况下，让其根据自身的情况独立完成ODI评分量表。对上述相关指标与腰椎不稳间的相关性进行统计分析。结果82例腰椎不稳患者中，64例出现了小关节积液，其中A组31例，积液量1．58（0～3．28）mm；B组23例，积液量2．15（0～5．31）mm；C组10例，积液量3．08（0～6．12）mm。小关节积液量与腰椎不稳存在相关性（Х^2=5．75，P〈0．05）。A、B、C组Modic改变发生率分别为41．5％（17／41）、72．4％（21／29）、75．0％（9／12），3组差异有统计学意义（P〈0．05）。A、B、C组ODI单项功能评分别为11．19、14．57、17．13分，与腰椎不稳程度具有相关性（r=0．670，P〈0．05）。结论腰椎不稳程度与腰椎小关节积液量存在等级相关性；腰椎不稳患者Modic改变的发生率和ODI单项功能评分与不稳程度有关。

Objective To analyze the correlation between degree of L4-5 segment instability and relevant indications including lumbar facet fluid and modic type on MRI and Oswestry disability index （ODI） in patients with lumbar instability at L4-5. Methods Totally 82 patients meeting the inclusive standard from 226 patients of lumboerural pain in the Affiliated Hospital of Jiangsu University from March 2012 to July 2013 were enrolled. All the patients underwent MRI of lumbar spine and X-ray of hyperextension and hyperflexion, and the patients were divided into group A （displacement 3-5 ram）, group B （displacement 〉 5-7 mm） and group C （displacement 〉 7 mm） according to the degree of lumbar instability. The facet fluid was measured on axial MR T2WI; Modic change of L4.5 endplate was observed on MRI and the ODI were assessed. The correlation between degrees of lumbar instability with above relevant indications was analyzed. Results There were 64 patients showing small joint effusion, among them 31 were from group A with mean effusion amount of 1.58 mm （0-3.28 mm）, 23 were from group B with mean effusion amount of 2.15 mm （0-5.31 ram）, and 10 were from group C with mean effusion amount of 3.08 mm （0-6.12 mm）. The lumbar facet fluid was positively correlated with degree of lumbar instability （P 〈 0.05）. Modic changes of L4-5 endplate occurred in 47, including 17 cases of group A with incidence of 41.5% （ 17/41）, 21 cases of group B with incidence of 72.4% （21/29） and 12 cases of group C with incidence of 75.0% （9/12）, with statistical differences among the three groups （P 〈 0.05 ）. The incidence of Modic changes in A group was lower than that in B group and C group . The indiviual function score of ODI was 11. 19, 14.57, 17.13 in group A, B, C, which was correlated with degree of lumbar instability（ r = 0. 670, P 〈 0.05 ）. Conclusions There is a grade correlation between degree of lumbar instability and amount of the lumbar facet fluid and the incidence of Modic changes is related to the degree of instability in patients with lumbar instability. The greater the degree of instability is, the higher the score of ODI individual function is.