年轻患者腰椎间盘Pfirrmann分级与椎间盘膨出及突出的相关性研究

MR Imaging assessment of correlations between Pfirrmann's grading system and lumbar disc bulge and lumbar disc protrution in young patients

目的通过磁共振成像,观察30岁以下腰痛患者腰椎间盘退行性改变的Pfirrmann分级特征以及相关的其他改变,并评价Pfirrmann分级与椎间盘膨出及突出的相关性。材料与方法回顾性分析83例30岁以下因腰痛行腰椎MRI检查的患者,其中男50例,女33例,平均年龄25岁。由2名影像科医师对MR图像进行分析,观察L1~S1椎间盘信号、椎间盘形态、纤维环撕裂、椎间盘膨出、椎间盘突出、椎体终板及许莫氏结节的改变。椎间盘退行性改变采用Pfirrmann分级。观察指标的相关性分析采用Pearson多元相关分析。结果纳入研究的椎间盘共415个,其中Pfirrmann分级Ⅰ~Ⅱ级退变322个（77.6%）,Ⅲ级退变56个（13.5%）,Ⅳ级退变33个（7.9%）,Ⅴ级退变4个（1.0%）;103个椎间盘出现膨出或突出;椎间盘膨出以L4~5椎间盘最多（42.2%）,且多合并Ⅲ级退变（51.1%）;椎间盘突出以L5~S1椎间盘最多（51.7%）,且多合并Ⅳ级退变（46.6%）;17例患者出现椎间盘后方高信号区（HIZ）,且均位于L4~5、L5~S1椎间盘水平;3例患者出现终板退变。多元相关分析结果显示PfirrmannⅢ级退变与椎间盘膨出有明显相关性（r=0.972;P=0.006）,与椎间盘突出无明显相关性（r=0.639;P=0.245）;PfirrmannⅣ级退变与椎间盘突出（r=0.999,P=0.000）及HIZ（r=0.919,P=0.028）有明显相关性,与椎间盘膨出无明显相关性（r=0.769,P=0.128）。HIZ与椎间盘膨出（r=0.919,P=0.027）及突出（r=0.935,P=0.020）均有相关性。结论腰椎MRI成像能够清晰显示年轻患者椎间盘早期退行性改变的不同病理阶段;PfirrmannⅢ退变与PfirrmannⅣ级退变分别与椎间盘膨出和椎间盘突出有相关性;年轻患者应及早发现椎间盘早期退变,以对临床评价提供更有价值信息。

Objective： To find the MRI characteristics of the lumbar intervertebral disc degeneration in patients less than 30 years old with low back pain, and try to evaluate the correlations between Pfirrmann＇s grading scale and intervertebral disc bugle and intervertebral disc protrution. Material and Methods： It is a cross-sectional and observational study. A total of 83 patients with low back pain performed lumbar MRI examination. All patients were less than 30 years old, of whom 50 were men and33 were women, with mean age 25. All MR imaging were evaluated by two radiologists in the following aspects： signal intensity and morphology of the intervertebral discs, annular tear, intervertebral disc bulge, intervertebral disc protution, Modic changes and the Schmorl＇s nodes. The intervertebral discs degeneration were evaluated through Pfirrmann＇s classification system. The association between these different aspects were analyzed by Pearson multiple correlation. Results： A total of 415 intervertebral discs were examined, of which gradeⅠ—Ⅱ discs were 322（77.6%）, grade Ⅲ 56（13.5%）, grade Ⅳ 33（7.9%） and grade Ⅴ 4（1%）. One hundred and three intervertebral discs were found with disc bulge and disc protrution, most of which were at disc L4—5 and L5—S1 level and werecommon in grade Ⅲ and grade Ⅳ degenerations. Seventeen patients were found with HIZ, and were all at disc L4—5 and L5—S1 level. Three patients were found with modic change. The statistic results show that grade Ⅲ degeneration were correlated well with disc bulge（r=0.972, P=0.006）, but not with disc protrution（r=0.639, P=0.245） and the grade Ⅳ disc degeneration were correlated with disc protrution（r=0.999, P=0.000） and HIZ（r=0.919, P=0.028）, but not with disc bulge（r=0.769, P=0.128）. HIZ were correlated well with both disc bulge（r=0.919, P=0.027） and disc protrution（r=0.935, P=0.020）. Conclusions： MRI is a good imaging modality for detecting the pathology character of disc degeneration in early stage. Grade and grade degenerations have close relationship with intervertebral disc bulge and protrution. It may have great clinical value to detect early changes of intervertebral disc degeneration in young patients.