急性和亚急性下腰痛患者腰椎MRI影像学特征分析

Analysis of magnetic resonance imaging features of lumbar vertebra in patients with acute and subacute low back pain

目的:探讨急性和亚急性下腰痛患者腰椎MRI影像学特征及临床意义。方法:回顾性连续收集因下腰痛至本院就诊并行腰椎MRI检查患者177例。根据病程时间将患者分为亚急性下腰痛组(n=103)和急性下腰痛组(n=74例),另招募42例无下腰痛志愿者作为正常对照组。采用视觉模拟评分(visual anologue scale,VAS)评定患者腰痛程度。观察各组研究对象腰椎MRI影像学特征,包括:椎间盘退变、椎间盘突出、椎间盘膨出、纤维环后方高信号、Schmorl结节、椎体终板炎、小关节退变、小关节积液、棘间韧带高信号、皮下或椎后旁肌肉水肿、小关节退变等,对不同组间腰椎MRI影像学特征分布进行统计学比较分析。结果:与正常对照组相比,急性、亚急性下腰痛组研究对象椎间盘退变、椎间盘突出发生率较高(P<0.05)。3组间椎间盘膨出、Schmorl结节、腰椎终板Modic改变发生情况差异无统计学意义。急性下腰痛组患者腰椎MRI纤维环后方高信号、棘间韧带高信号、皮下或椎后旁软组织肿胀发生率均高于亚急性下腰痛组和正常对照组(P<0.05);亚急性下腰痛组患者中小关节退变和小关节积液发生率均高于急性下腰痛组和正常对照组(P<0.05)。结论:椎间盘退变、突出是腰痛症状持续存在的原因;腰椎间盘局限性高信号、棘间韧带高信号和皮下或椎后旁软组织肿胀与急性下腰痛相关;小关节退变、小关节积液与亚急性下腰痛有关。

Objective：To investigate the magnetic resonance imaging （MRI） features of acute and subacute lower back pain, and to evaluate its clinical significance. Methods：A total of 177 consecutive patients underwent lumbar MRI examination due to low back pain in our hospital were retrospectively reviewed. According to the duration of disease, patients were divided into group A （subacute low back pain group, 103 cases） and group B （acute low back pain group, 74 cases）, and 42 cases without low back pain were recruited as normal control group, group C. The degrees of low back pain were based on the visual analogue scale （VAS）. The MRI findings including disc degeneration, disc bulging, disc herniation, posterior high signal of fibrous rings, Schmorl nodes, Modic changes, facet joints degeneration, facet joint effusion, high T2 signal in interspinous ligament, and subcutaneous/paraspinal muscles edema were analyzed. The distribution difference of magnetic resonance findings in the three groups above were analyzed. Results：The incidences of disc degeneration and disc herniation of group A and group B were higher than that in group C （P〈0.05）. There was no statistical difference in disc bulging, Schmorl nodes, and Modic changes among the three groups. The findings of posterior high signal of fibrous rings, interspinous ligament high signal, subcutaneous or paraspinal muscles edema in group B were more prevalent than those in group A and group C（P〈0.05）. The incidence of facet joints degeneration, facet joint effusion in group A was higher than those in group B and group C （P〈0.05）. Conclusions：The degeneration and herniation of the intervertebral disc may be the main cause of the persistent symptoms of low back pain. Posterior high signal of fibrous rings, high signal in interspinous ligament and subcutaneous or paraspinal muscles edema may be the cause of pain in patients with acute low back pain. Facet joints degeneration and facet joints effusion may be related to the subacute low back pain.