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目的探讨下腰痛患者的腰椎终板矢状位形态重塑、Modic改变及腰椎间盘退变与腰椎节段活动度的关系。方法回顾性分析420例(男249例,女171例)下腰痛患者共2 100个腰椎节段,采用动态MRI技术在患者中立及过屈、过伸3个体位成像,统计各节段的椎间位移和椎间角度变化,分析腰椎终板矢状位形态(凹陷型、平坦型和不规则型),Modic改变(0~3型),椎间盘退变(Ⅰ~Ⅴ级)与腰椎节段活动度的相关性。结果腰椎终板凹陷型(63.24%)、2型Modic改变(71.79%)和Ⅱ级椎间盘退变(40.33%)最常见;1~3型Modic改变在不规则型、平坦型和凹陷型腰椎终板中的发生率依次减少,而椎间盘退变程度在凹陷型、平坦型和不规则型腰椎终板中依次加重,同样椎间盘退变程度随着腰椎终板0~3型Modic改变亦逐渐加重;腰椎椎间位移在不规则型、平坦型和凹陷型腰椎终板节段中依次增加,而椎间角度变化相反,在不规则型腰椎终板节段中最大,在凹陷型腰椎终板节段中最小;腰椎终板2型Modic改变节段椎间位移最大,而椎间角度变化在Modic改变各型中依次增加。结论腰椎终板重塑与Modic改变可能参与机体对抗节段过度活动的调节机制,与腰椎节段活动度密切相关。
Objective To investigate the relationship between the changes of the sagittal shape of the lumbar endplate and Modic changes and lumbar disc degeneration and lumbar activity in patients with low back pain. Methods A total of 2 100 lumbar segments of 420 patients (249 males and 171 females) with low back pain were retrospectively analyzed. Neonatal, flexion and extension were performed in 3 patients by dynamic MRI. Intervertebral disc displacement and intervertebral angle changes were analyzed. The changes of sagittal shape (concave type, flat type and irregular type), changes of Modic type (0-3), degeneration of disc (Ⅰ ~ Ⅴ grade) Relevance of activity. Results The deformity of lumbar endplate (63.24%), Modic change of type 2 (71.79%) and grade Ⅱ disc degeneration (40.33%) were the most common. The Modic changes of type 1 to type 3 were found in irregular, flat and concave lumbar vertebrae The incidence of degenerative disc decreased in turn, while the degenerative degree of degenerative disc increased successively in depressed, flat and irregular lumbar endplate. The degenerative degree of disc degenerated gradually with Modic change of 0 ~ 3 in lumbar endplate. Lumbar intervertebral displacement in the irregular, flat and concave lumbar endplate segments in turn increased, while intervertebral angle changes in the contrary, the largest irregular lumbar endplate segment, in the concave lumbar endplate segment ; The lumbar endplate type 2 Modic changes the segment intervertebral displacement the largest, while the intervertebral angle changes in the Modic changes in each type in turn increases. Conclusion Lumbar endplate remodeling and Modic changes may be involved in the regulatory mechanism of the body against the excessive movement of the segments, which is closely related to the mobility of the lumbar segments.