老年腰椎后皮下水肿样信号改变与腰椎疾病的相关性

Correlation of posterior lumbar subcutaneous edema in elderly patients with lumbar spine disease

目的探究椎间盘退行性变、Modic终板退变和小关节退变、强直性脊柱炎和感染性脊柱炎与腰椎后皮下水肿样信号改变(PLSE)的关系。方法取2016年1月至2018年12月行腰椎磁共振成像(MRI)检查的65岁以上患者,进行短时反转恢复序列MRI检查并由两位医师分别独立阅片共同判读有无PLSE,采用Logistic多元回归模型分析PLSE与各因素的相互关系。结果研究对象共324例,年龄65~97岁,平均78.31岁;椎间盘退变,Modic终板退变合并小关节退变,强直性脊柱炎及感染性脊柱炎4组年龄、体重指数(BMI)及性别差异均有统计学意义(P<0.05);23%患者有PLSE,其中椎间盘退变患者17%,Modic终板退变合并小关节退变患者24%,强直性脊柱炎患者14%,感染性脊柱炎患者53%;在Modic终板退变合并小关节退变患者中,年龄与PLSE有相关性(P<0.05)。除感染性脊柱炎外,其余各组PLSE与BMI均有相关性(P<0.05)。结论PLSE与老年各种退行性、免疫性和感染性腰椎疾病有关,特别是在肥胖患者中,PLSE很可能是腰椎疾病的早期表现,影像科医师应重视PLSE征象以更好地指导临床诊疗。

Objective To explore the relationship between disc degeneration,Modic and facet joint degeneration,axial spondylitis and infectious spondylitis with PLSE.Methods Patients aged 65 years or older who underwent lumbar spine MRI were subjected to a sagittal short tau inversion recovery MRI examination and two physicians independently read the films for PLSE.Logistic multiple regression model was used to analyze the correlation between PLSE and various factors.Results The age of the study group was 324 patients,aged 65~97 years,mean age 78.31 years.There were statistically significant differences in the proportions of age,BMI,and sex in the four groups of disc degeneration,Modic and facet joint degeneration,axial spondylitis and infectious spondylitis patients;23%of patients had PLSE,of which 17%in disc degeneration,24%in Modic and facet joint degeneration,14%in axial spondylitis,53%in infectious spondylitis.In patients with Modic and facet joint degeneration,age showed a correlation with PLSE.Except infectious spondylitis,PLSE and BMI in all other groups were significantly correlated.Conclusions PLSE is related to various degenerative,immune and infectious lumbar spine diseases in elderly patients.Especially in obese patients,PLSE is likely to be an early manifestation of lumbar spine disease.Radiology doctors should pay attention to PLSE signs to better guide clinical treatment.