中重度腰骶部硬膜外脂肪增多与临床腰腿痛症状相关性的MRI研究

MRI Study of the Correlation between Lumbosacral Epidural Fat Hypertrophy and the Symptoms of Lumbocrural Pain

目的探讨中重度腰骶部硬膜外脂肪增多的发生率及其与临床腰腿痛症状的相关性。方法回顾性分析6921例腰骶椎MRI影像,根据腰骶部硬膜外脂肪分级标准,将中重度硬膜外脂肪增多者列为研究对象,统计其发生率、与性别和年龄的关系。另外,按有无腰腿痛症状将患者分为有症状组和无症状组,研究中重度硬膜外脂肪增多与腰腿痛症状的相关性。结果 6921例中,中重度腰骶部硬膜外脂肪增多患者发生率为2.76%,其中男性和女性发生率分别为3.84%和1.79%,男性发生率明显高于女性;各年龄组间中重度腰骶部硬膜外脂肪增多发生率无统计学意义。症状组中重度硬膜外脂肪增多发生率2.21%,无症状组5.93%,症状组发生率低于无症状组。症状组中96.15%的病例有明确的腰骶部骨和/或椎间盘异常,包括椎间盘病变或退变者70.77%,椎管狭窄37.69%,小关节病变29.23%,黄韧带肥厚23.84%,退变或峡部不连椎体滑移9.23%和椎体终板炎8.46%。中重度腰骶部硬膜外脂肪增多硬膜囊末端位置多位于腰5、骶1水平,症状组与无症状组间无明显统计学差异。结论腰骶部中重度硬膜外脂肪增多在腰腿痛患者及无症状人群中较常见,尤其在男性患者中具有较高的发生率。该现象与年龄和临床腰腿痛症状无明确相关性。只有在MRI横断位显示硬膜囊变形,而患者缺乏其他影像学异常能够解释临床腰腿疼症状时,腰骶部硬膜外脂肪增多现象才需要考虑硬膜外脂肪增多症的可能性。

Objective To investigate the incidence of moderate to severe lumbosacral epidural fat hypertrophy and to discuss its relationship with the symptoms of lumbocrural pain. Methods The lumbosacral vertebral MRI images that were accumulated in one year duration were retrospective analyzed. According to lumbosacral epidural adipose classification standard, the patients with moderate to severe lumbosacral epidural fat hypertrophy were recruited to this study. The incidence was calculated and its correlations with the sex and age were evaluated. Besides, According to the presence or absence of the lumbocrural pain symptoms, the patients were classified into symptomatic group and asymptomatic group. The relationship between the epidural fat hypertrophy determined by MRI and the lumbocrural pain symptoms was analyzed. Results A total of 6921 cases were recruited for this study. The incidence of moderate to severe lumbosacral epidural fat hypertrophy was 2.76% , with the incidence being 3.84% in males and 1.79% in females. The incidence in males was higher than that in females. No statistically significant difference in the incidence of moderate to severe lumbosacral epidural fat hypertrophy existed among the different age groups. The incidences of moderate to severe lumbosacral epidural fat hypertrophy in symptomatic group and asymptomatic group were 2.21% and 5.93% respectively; the incidence in symptomatic group was lower than that in asymptomatic group. In symptomatic group, definite abnormality of lumbo-sacrum and/ or intervertebral disc was observed in 96.15% of patients, including intervertebral disc degeneration and herniation （70. 77% ）, spinal canal stenosis （37.69%）, small joint degeneration （29.69%）, yellow ligament hypertrophy （23.84%）,lumbar spondylolysis with spondilolisthesis （9.23%） and endplate inflammation （8.46%）. Epidural capsule terminal position was located at the L5 or S1 level; no statistically significant difference in epidural capsule terminal position existed between the symptomatic group and the asymptomatic group. Conclusion Moderate to severe lumbosacral epidural fat hypertrophy displayed on MR imaging is commonly found in symptomatic and asymptomatic sibjects, especially in males; the incidence in males is usually higher than that in females. This phenomenon has no definite correlation to the age and clini- cal symptoms. Only in the case when deformation of dural sac is observed on MR images and the other abnormalities that can explain the symptoms are absent, the diagnosis of spinal epidural lipomatosis should be taken into consideration.