腰椎滑脱患者Modic改变的MRI表现和相关性研究

MRI Characteristics and Correlation of Modic Changes in Lumbar Spondylolisthesis Patients

目的观察腰椎滑脱患者中Modic改变的MRI表现和分布情况,以及分析腰椎滑脱与否、腰椎滑脱程度、类型和Modic改变的相关性。方法回顾分析明确诊断的腰椎滑脱患者311例[男113例,女198例,平均年龄(64.07±10.78)岁]的影像学资料,观察腰椎滑脱患者中Modic改变的分布,分析腰椎滑脱与否、腰椎滑脱程度、类型与Modic改变的相关性。并观察腰椎滑脱是否对邻近终板造成影响。结果 311例患者1555个椎间隙中,Modic改变Ⅰ型42个,Ⅱ型103个,Ⅲ型39个。腰椎滑脱间隙发生Modic改变的概率为33.8%,其他间隙发生Modic改变的概率为6.4%,差异具有统计学意义。腰椎滑脱程度和Modic改变具有正相关性。真性腰椎滑脱患者中滑脱间隙Modic改变的发生率为63.0%,假性腰椎滑脱患者中滑脱间隙Modic改变的发生率为24.8%,差异具有统计学意义。在L_(3～5)滑脱患者中,滑脱节段相邻间隙,Modic改变的发生率为9.5%,远处椎间隙Modic改变的发生率为3.7%,差异具有统计学意义。结论 MRI是诊断腰椎Modic改变的主要手段。腰椎滑脱患者中滑脱节段终板Modic改变较其他节段多见,随着滑脱程度的增加,Modic改变的发生率增加。腰椎真性滑脱责任间隙发生Modic改变的概率高于腰椎退变性滑脱。腰椎滑脱不仅仅导致滑脱节段发生Modic改变,还可能导致相邻间隙出现Modic改变。

Objective To evaluate MRI characteristics and the distribution of Modic changes(MCs)in lumbar spondylolisthesis patients.And the purpose of this study was to elucidate the relationship of MCs to the degree and classification of lumbar spondylolisthesis.Methods The imaging data of 311 patients with lumbar spondylolisthesis disease treated in our hospital from August 2015 to February 2017 were reviewed retrospectively.(113 were male,198 were female,mean age64.07±10.78)The distribution of Modic changes(MCs)in lumbar spondylolisthesis patients was observed.The correlaiton between Modic changes and lumbar spondylolisthesis,its slipping degree and classification were analyzed.The influence of lumbar spondylolisthesis to its proximal segment endplate was also obeserved.Results Among all 1555 intervertebral space in 311 patients,42 were classified as typeⅠ,103 as typeⅡ,39 as typeⅢ.The incidence of MCs was higher in the level of spondylolysis(33.8%)than in other levels(6.4%),with a significant statistical difference.The slipping degree of lumbar spondylolisthesis showed a positive correlation to the Modic changes.According to the classification,the results indicated that the incidence of MCs in the patients with the lumbar isthmic spondylolisthesis was 63.0%.This rate was obviously higher than those with degenerative spondylolisthesis(24.8%),with statistically significant difference.Meanwhile,in the patients with spondylolisthesis from L3 to L5,we found that the incidence of MCs was higher in proximal segment(9.5%)than distal segments(3.7%),also with statistical significance.Conclusion MRI was was significant in diagnosis of lumbar Modic changes.Endplate MCs appear more frequently in the listhetic verterbral body.MCs are postively related to the slipping degree of lumbar spondylolisthesis.The incidence rate of MCs was higher in the isthmus type than degenerative ones in the slipping segment.Lumbar spondylolisthesis may cause MCs in proximal segment.