腰椎Modic Ⅰ型终板炎与腰椎压缩性骨折的临床鉴别

目的探讨腰椎ModicⅠ型终板炎与腰椎压缩性骨折的临床鉴别。方法选择2017年1月至2018年12月行腰椎MRI检查的患者,诊断为腰椎ModicⅠ型终板炎患者30例,诊断为腰椎压缩性骨折患者32例。比较两组患者性别、年龄、视觉模拟疼痛评分(VAS)、腰痛Oswestry功能障碍评分表(ODI)评分及MRI影像学表现。结果两组患者性别差异无统计学意义(P>0.05),年龄差异有统计学意义(P<0.05),腰椎压缩性骨折患者VAS评分及ODI评分均高于ModicⅠ型终板炎患者,两组患者VAS评分及ODI评分差异有统计学意义(P<0.05)。在影像学上,ModicⅠ型终板炎及腰椎压缩性骨折均表现为TiWI低信号,T2WI及压脂像高信号,ModicⅠ型终板炎椎体异常信号边界清,终板连续但毛糙,椎间盘退变伴突出,病变易发生在下腰椎,椎体无改变;腰椎压缩性骨折椎体异常混杂伴边界不清且改变范围更广,伴有椎体终板塌陷,椎间盘可无变化,病变易发生在胸腰段,椎体易发生楔形变。结论腰椎ModicⅠ型终板炎与腰椎压缩性骨折的鉴别诊断在观察MRI表现的同时需结合年龄、病史及临床体征。

Objective To explore the clinical identification points of lumbar Modic type Ⅰ endplate inflammation and lumbar compression fracture.Methods Patients who met the inclusion criteria and underwent lumbar MRI examination in our hospital from January 2017 to December 2018 were analyzed,including 30 patients diagnosed with lumbar Modic type Ⅰ endplate and 32 patients diagnosed with lumbar vertebral compression fracture.The gender,age,visual analogue scale(VAS),low back pain Oswestry disability scale(ODI)score and MRI imaging findings were compared between the two groups.Results There was no statistical diference in gender between the two groups(P>0.05),but there was a statistical difference in age(P<0.05).The VAS and ODI scores of patients with lumbar vertebral compression fractures were higher than those of patients with Modic type Ⅰ endplate inflammation.There were significant differences in VAS score and ODI score between patients(P<0.05).On imaging,the Modic type Ⅰ endplate inflammation and lumbar vertebral compression fracture showed low signal on T,WI,high signal on T2WI and fat pressure image.Modic Type I endplate inflammation vertebral body abnormal signal boundary was clear.The endplate was continuous but rough.The imaging showed intervertebral disc degeneration and herniation,lesions easily occurred in the lower lumbar spine,and vertebral body had no change.The lumbar compression fracture vertebral body abnormal mixed with unclear boundary and change range was more extensive,accompanied by vertebral endplate collapse.The intervertebral disc might be unchanged,and the lesions were likely to occur in the thoracolumbar segment.The vertebral body was prone to wedge deformation.Conclusion The diferential diagnosis of lumbar Modic type Ⅰ endplate inflammation and lumbar compression fracture in the observation of MRI findings should be combined with age,medical history and clinical signs.