腰椎终板Modic改变与退行性腰椎滑脱的相关性研究

发布时间：2018-09-09 13:31

【摘要】：目的:研究腰椎终板Modic改变在退变性腰椎滑脱中的规律,探讨腰椎终板Modic改变、退变性腰椎滑脱、临床症状之间的关联度,为临床治疗退变性腰椎滑脱提供理论支持,提高临床治疗效果。方法:选取2014年1月至2014年12月因下腰痛或坐骨神经痛于我院行手术治疗的退变性腰椎滑脱患者为研究对象,统计并记录患者基本信息,并对所有患者均行腰椎MRI及标准正侧位X线摄像,以滑脱节段椎体为研究对象,在腰椎MRI中线矢状面T2图像上,利用图像分析软件Spine Examiner分别测量终板Modic改变的面积及最大椎体面积,并计算Modic面积改变率(Modic改变面积/最大椎体面积);拍摄标准站立位腰椎正侧位X线片,借助系统软件测量滑脱椎体后缘与下位椎体后缘之间的距离(AB)及下位椎体矢状径(AC),并计算椎体滑脱程度(Taillard指数),Taillard指数=AB/AC;测量记录患者入院和复查时的视觉疼痛模拟评分(VAS)及测量并记录Oswestry功能障碍指数(ODI),并计算VAS评分改善率及ODI改善率。比较分析腰椎终板Modic改变与滑脱节段间的关系;同时比较观察Modic面积改变率与Taillard指数及术前VAS与ODI评分之间的相互关系;并评估Modic改变组与非Modic改变组术后的临床效果,分析终板Modic改变面积比例的大小与腰椎滑脱程度及临床症状之间的关系及Modic改变对手术疗效的影响。结果:共有52例患者,其中男15例,女37例,平均年龄55.48岁,L3/4滑脱2例,发生率3.8%,L4/5滑脱44例,发生率84.6%,L5-S1滑脱6例,发生率11.5%;Modic改变31例,非Modic改变21例,Modic改变发生率59.6%;modic1型13例,发生率17.3%;modic2型15例,发生率19.2%;modic3型3例,发生率9.5%。发生腰椎Modic改变的节段为L3/4 1例;L4/5 26例;L5/S1 4例,L4/5是腰椎退变性滑脱好发部位,也是腰椎Modic改变最常发生节段,Modic改变在滑脱节段发生率高,在稳定节段的发病率低,差别有意义(P0.05);Modic面积改变率与Taillard指数明显相关(P0.05),有统计学意义;Modic面积改变率与术前VAS及ODI评分相关(P0.05),有统计学意义;Modic改变组与非Modic改变组术后改善率有显著差异(P0.05)。结论:1腰椎终板Modic改变在退变性腰椎滑脱中发病率较高,主要发生在滑脱节段。2腰椎终板Modic改变面积比例大小与退变性腰椎滑脱程度呈正相关。3腰椎终板Modic改变面积比例大小与患者临床症状呈正相关。4 PLIF是治疗退行性腰椎滑脱的有效方法,但伴有终板Modic改变者术后恢复疗效较没有终板Modic改变者差。
[Abstract]:Objective: to study the regularity of Modic changes of lumbar endplate in degenerative lumbar spondylolisthesis, to explore the correlation between Modic changes of lumbar endplate, degenerative lumbar spondylolisthesis and clinical symptoms, and to provide theoretical support for clinical treatment of degenerative lumbar spondylolisthesis. To improve the effect of clinical treatment. Methods: from January 2014 to December 2014, patients with degenerative lumbar spondylolisthesis who were treated with low back pain or sciatic neuralgia in our hospital were selected as study objects. All the patients were examined by MRI and standard anteroposterior radiography. The spondylolisthesis segment vertebrae was taken as the study object, and T _ 2 images on the midline sagittal plane of lumbar MRI were performed. Image analysis software Spine Examiner was used to measure the change area of Modic and the maximum vertebral body area of endplate, and calculate the change rate of Modic area (Modic change area / maximum vertebral body area). The distance between posterior margin of spondylolisthesis and posterior edge of lower vertebral body was measured by systematic software (AB) and sagittal diameter (AC), of lower vertebra were measured and the degree of spondylolisthesis (Taillard index) was calculated. To score (VAS) and measure and record Oswestry dysfunction index (ODI),) and calculate VAS score improvement rate and ODI improvement rate. To compare and analyze the relationship between Modic change of lumbar endplate and segment of spondylolisthesis, to observe the relationship between Modic area change rate and Taillard index, VAS and ODI score before operation, and to evaluate the clinical effect of Modic change group and non-Modic change group after operation. To analyze the relationship between the ratio of Modic change area and the degree of lumbar spondylolisthesis and the clinical symptoms and the effect of Modic changes on the surgical outcome. Results: there were 52 patients, including 15 males and 37 females, with an average age of 55.48 years (n = 2). The incidence of L4 / 5 slippage was 3.8g / L / 5 in 44 cases, the incidence rate was 84.6C / L ~ 5-S1 slippage in 6 cases, the incidence of 11.5% modic changes in 31 cases and non-Modic changes in 21 cases (59.6modic1). There were 15 cases of type 2 and 3 cases of type 3 of type 19.2 modic3, the incidence of which was 9.5%. L3 / 41 cases of L4 / 526 cases of L5 / S1 4 cases of lumbar degenerative spondylolisthesis were the most common site of lumbar degenerative spondylolisthesis, and the incidence of lumbar Modic changes was higher in the spondylolisthesis segment and lower in the stable segment. There was significant difference (P0.05) between Modic area change rate and Taillard index (P0.05). There was significant correlation between Modic area change rate and preoperative VAS and ODI score (P0.05). There was significant difference between Modic change group and non-Modic change group (P0.05). Conclusion the incidence of Modic changes in 1 / 1 lumbar endplate in degenerative lumbar spondylolisthesis is higher than that in degenerative lumbar spondylolisthesis. The percentage of Modic change in lumbar endplate is positively correlated with the degree of degenerative lumbar spondylolisthesis. 3 the area ratio of Modic change in lumbar endplate is positively correlated with clinical symptoms. 4. 4 PLIF is the treatment of degenerative lumbar spondylolisthesis. The effective method of lumbar spondylolisthesis, But the effect of postoperative recovery in patients with endplate Modic changes was worse than that in patients without endplate Modic changes.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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