-
腰椎终板改变即Modic改变,是指MRI上可见的邻近椎体终板退变引起的骨髓信号改变[1]。1987年DeRoos第一次提出腰椎退行性病变的病人中MRI影像靠近终板椎体信号有异常改变,随后Modic在1988年提出了Modic的定义。Modic变化共分为Ⅰ型、Ⅱ型和Ⅲ型变化,以说明在MRI上观察到的椎体区终板的炎症期。在骨组织活检中PERILLI等[2]发现Modic Ⅰ型改变的病理变化为骨组织代谢旺盛,Modic Ⅱ型改变表现为成骨减少,而Modic Ⅲ型改变则表现为广泛地骨组织硬化状态。XIAO等[3]在模拟骨质疏松的动物模型中发现去除卵巢组的大鼠出现了椎体骨质疏松和软骨终板骨软骨重建,促进了骨-软骨表面血管生成和孔隙率增加,影响了基质代谢,从而对椎间盘产生不利影响,但在临床上骨质疏松和Modic变化的研究涉及不多。本研究通过分析骨质疏松和Modic变化的相关性,旨在探究椎体骨密度在Modic改变发生中的意义。现作报道。
-
一位经验丰富的放射核医学科主治医师和一名脊柱外科医师对腰椎椎体Modic改变的评估一致性良好(Kappa=0.80)。
-
152例腰痛病人中,骨量正常89例,其中Modic改变29例,发生率32.6%;骨量减少43例,其中Modic改变23例,发生率53.5%;骨质疏松20例,其中Modic改变17例,发生率85.0%。3组Modic改变发生率差异有统计学意义(P < 0.05)。骨质疏松Modic改变率与骨量正常组比较差异有统计学意义(P < 0.05)(见表 1)。Modic Ⅰ型VAS评分最高,无Modic改变组VAS评分最低,Modic Ⅰ型组和Ⅱ、Ⅲ、无改变组腰痛程度比较差异有统计学意义(P < 0.05~P < 0.01);Modic Ⅱ型组和Ⅲ型组之间比较差异无统计学意义(P>0.05)(见表 2)。Spearman等级相关检验证明骨质疏松和Modic改变呈正相关关系(r=0.396,P < 0.01)。3型Modic改变图示见图 1~3。
分组 n 正常 Ⅰ型 Ⅱ型 Ⅲ型 发生情况 骨质正常组 89 60 12 15 2 29(32.58) 骨质减少组 43 20 10 12 1 23 (53.49) 骨质疏松组 20 3 5 8 4 17 (85.00)* χ2 — — — — — 6.57 P — — — — — < 0.05 与骨质正常组比较*P < 0.05 表 1 骨密度评价与Modic改变比较[n; 百分率(%)]
Modic改变 n VAS评分/分 无改变组 83 3.52±1.54 Ⅰ组 27 7.00±1.17** Ⅱ组 35 5.00±1.28**## Ⅲ组 7 5.57±0.97**# F — 44.76 P — < 0.01 MS组内 — 1.969 与无改变组比较**P < 0.01;与Ⅰ组比较#P < 0.05,##P < 0.01 表 2 Modic改变三种类型下腰痛VAS评分情况(x±s)
骨质疏松和Modic改变的相关性分析
Correlation analysis of osteoporosis and Modic changes
-
摘要:
目的研究50岁以上的腰痛病人椎体骨密度与腰椎MRI上Modic改变的相关性,探讨椎体骨密度在Modic改变中的意义。 方法收集脊柱外科行椎体骨密度测定及腰椎MRI检查的152例腰痛病人,测定椎体骨量并观察影像学资料。将所有病人根据其骨量水平分为骨量正常组(89例)、骨量减少组(43例)及骨质疏松组(20例)。比较3组Modic改变的发生率,分析椎体骨密度与Modic改变的关系,并用疼痛视觉模拟法(VAS)进行腰痛程度评分,分析Modic改变和骨质疏松及腰痛的关系。 结果152例腰痛病人中,骨量正常89例,其中Modic改变29例,发生率32.6%;骨量减少43例,其中Modic改变23例,发生率为53.5%;骨质疏松20例,其中Modic改变17例,发生率为85.0%。3组Modic改变发生率差异有统计学意义(P < 0.05)。骨质疏松Modic改变率与骨量正常组比较差异有统计学意义(P < 0.05);ModicⅠ型VAS评分最高,无Modic改变组VAS评分最低,ModicⅠ型组和Ⅱ、Ⅲ、无改变组腰痛程度比较差异有统计学意义(P < 0.05~P < 0.01);ModicⅡ型组和Ⅲ型组之间比较差异无统计学意义(P>0.05),Ⅲ组和Ⅱ组均高于无改变组(P < 0.01)。Spearman等级相关检验证明,骨质疏松和Modic改变呈正相关关系(r=0.396,P < 0.01)。 结论50岁以上的老年人椎体骨密度与Modic改变有相关性,且Modic改变的发生率随着椎体骨密度的减低而升高,ModicⅠ型改变和腰痛关系密切。 Abstract:ObjectiveTo study the correlation between vertebral bone mineral density and Modic changes of lumbar, and explore the significance of vertebral bone mineral density in Modic changes. MethodsThe vertebral bone mineral density(BMD) and lumbar MRI examination in 152 patients with low back pain were measured to detect the vertebral bone mass, and the imaging data were observed.According to the level of bone mass, the patients were divided into the normal bone mass group(n=89), osteopenia group(n=43) and osteoporosis group(n=20).Among three groups, the incidence rates of Modic changes were compared, and the relationship between vertebral bone mineral density and Modic changes were analyzed.The degree of low back pain was scored using pain visual simulation(VAS), and the relationship between Modic changes and osteoporosis, low back pain were analyzed. ResultsAmong the 152patients, there were 89 cases of normal bone mass(including 29 cases of Modic changes with incidence rate of 32.6%), 43 cases of osteopenia(includimg 23 cases of Modic changes with incidence rate of 53.5%), and 20 cases of osteoporosis(including 17 cases of Modic changes with incidence rate of 85.0%).The differences of the incidence rate of Modic changes among three groups were statistically significant(P < 0.05).The differences of the incidence rate of Modic changes between normal bone mass group and osteoporosis group were statistically significant(P < 0.05).The VAS score in Modic type Ⅰ and nochange Modic group were the highest and lowest, repsectively.The differences of lumbago degree between Modic type Ⅰ group and Ⅱ, Ⅲ type, nochange group were statistically significant(P < 0.05 to P < 0.01).The differences of lumbago degree between Modic type Ⅱand Ⅲ was not statistically significant(P>0.05), which in type Ⅱ and Ⅲ groups were higher than that in no change group(P < 0.01).The results of Spearman rank correlation test proved that there was a weak positive correlation between osteoporosis and Modic changes(r=0.396, P < 0.01). ConclusionsIn the elderly over 50 years old, there is a correlation between vertebral bone mineral density and Modic changes, and the incidence rate of Modic changes increases with the decreasing of vertebral bone mineral density.Modic type Ⅰ changes is closely related to low back pain. -
Key words:
- osteoporosis /
- back pain /
- bone mineral density /
- magnetic resonance imaging /
- Modic change
-
表 1 骨密度评价与Modic改变比较[n; 百分率(%)]
分组 n 正常 Ⅰ型 Ⅱ型 Ⅲ型 发生情况 骨质正常组 89 60 12 15 2 29(32.58) 骨质减少组 43 20 10 12 1 23 (53.49) 骨质疏松组 20 3 5 8 4 17 (85.00)* χ2 — — — — — 6.57 P — — — — — < 0.05 与骨质正常组比较*P < 0.05 表 2 Modic改变三种类型下腰痛VAS评分情况(x±s)
Modic改变 n VAS评分/分 无改变组 83 3.52±1.54 Ⅰ组 27 7.00±1.17** Ⅱ组 35 5.00±1.28**## Ⅲ组 7 5.57±0.97**# F — 44.76 P — < 0.01 MS组内 — 1.969 与无改变组比较**P < 0.01;与Ⅰ组比较#P < 0.05,##P < 0.01 -
[1] 吴凯, 封志云, 胡小坚. 经皮脊柱内镜手术治疗伴Modic Ⅱ型改变的腰椎间盘突出症的疗效观察[J]. 浙江医学, 2019, 41(15): 1657. doi: 10.12056/j.issn.1006-2785.2019.41.15.2019-1242 [2] PERILLI E, PARKINSON IH, TRUONG LH, et al. . Modic (endplate) changes in the lumbar spine: bone micro-architecture and remodelling[J]. Eur Spine J, 2015, 24(9): 1926. doi: 10.1007/s00586-014-3455-z [3] XIAO ZF, HE JB, SU GY, et al. Osteoporosis of the vertebra and osteochondral remodeling of the endplate causes intervertebral disc degeneration in ovariectomized mice[J]. Arthritis Res Ther, 2018, 20(1): 207. doi: 10.1186/s13075-018-1701-1 [4] 董冰子, 孙晓方. 骨质疏松症治疗新进展: 从分子机制到药物靶点[J]. 中华骨质疏松和骨矿盐疾病杂志, 2018, 11(6): 620. doi: 10.3969/j.issn.1674-2591.2018.06.016 [5] 刘丹丹. 1, 25(OH) 2D3对类风湿关节炎破骨细胞形成影响可能机制的研究[D]. 太原: 山西医科大学, 2016: 1. [6] 才林, 艾光禹, 孙强. 老年骨质疏松机制及股骨转子间骨折治疗的研究进展[J/CD]. 中华损伤与修复杂志(电子版), 2016, 11(6): 469. [7] DUDLI S, HASCHTMANN D, FERGUSON SJ. Persistent degenerative changes in the intervertebral disc after burst fracture in an in vitro model mimicking physiological post-traumatic conditions[J]. Eur Spine J, 2015, 24(9): 1901. doi: 10.1007/s00586-014-3301-3 [8] DUDLI S, LIEBENBERG E, MAGNITSKY S, et al. Propionibacterium acnes infected intervertebral discs cause vertebral bone marrow lesions consistent with Modic changes[J]. J Orthop Res, 2016, 34(8): 1447. doi: 10.1002/jor.23265 [9] DUDLI S, FIELDS AJ, SAMARTZIS D, et al. Pathobiology of Modic changes[J]. Eur Spine J, 2016, 25(11): 3723. doi: 10.1007/s00586-016-4459-7 [10] CHEN Z, ZHENG Y, YUAN Y, et al. Modic changes and disc degeneration caused by inoculation of propionibacterium acnes inside intervertebral discs of rabbits: a pilot study[J]. Biomed Res In, 2016, 2016: 9612437. doi: 10.1155/2016/9612437 [11] HAN C, WANG T, JIANG HQ, et al. An animal model of Modic changes by embedding autogenous nucleus pulposus inside subchondral bone of lumbar vertebrae[J]. Sci Rep, 2016, 6: 35102. doi: 10.1038/srep35102 [12] PERERA RS, DISSANAYAKE PH, SENARATH U, et al. Single nucleotide variants of candidate genes in aggrecan metabolic pathway are associated with lumbar disc degeneration and Modic changes[J]. PLoS One, 2017, 12(1): e0169835. doi: 10.1371/journal.pone.0169835 [13] 贺宪, 黄东生, 孔畅, 等. 下腰痛病人中腰椎终板Modic改变的分布情况及与腰椎间盘退变的关系[J/CD]. 中华临床医师杂志(电子版), 2015, 9(8): 1283. [14] HILTON RC, BALL J. Vertebral rim lesions in the dorsolumbar spine[J]. Ann Rheum Dis, 1984, 43(2): 302. doi: 10.1136/ard.43.2.302 [15] LIU J, HAO L, SUYOU L, et al. Biomechanical properties of lumbar endplates and their correlation with MRI findings of lumbar degeneration[J]. J Biomech, 2016, 49(4): 586.