Modic改变与下腰椎三关节复合体退变相关性的回顾性分析

目的探讨Modic改变(modic changes,MCs)与下腰椎三关节复合体退变的相关性。方法选择2016年3月~2020年6月在本院住院治疗的231例腰椎间盘突出症(lumbar disc herniation,LDH)患者进行分析,观察MCs的发生率、椎间盘的Pfirmann分级和小关节退变分级(Weishaupt分级)的关系。结果MCs总发生率为45.31%(296/693),L_3-4、L_4-5、L₅-S₁节段MCs发生率分别为25.11%(58/231)、54.11%(125/231)和48.92%(113/231),组间差异存在统计学意义(P<0.05)。L_3-4、L_4-5和L₅-S₁节段MCsⅠ型、Ⅱ型和Ⅲ型病变节段的椎间盘退变程度均高于无MCs病变节段(P<0.05)。L_3-4节段MCsⅢ型与无MCs患者的小关节退变差异存在统计学意义(P<0.05)。L_4-5和L₅-S₁节段MCsⅡ型患者与无MCs患者的小关节退变差异存在统计学意义(P<0.05)。结论MCs与三关节复合体退变存在相关性,主要表现在MCs不同类型均与腰椎间盘退变分级相关,MCsⅡ型与腰椎小关节退行性病变相关。

Retrospective analysis of correlation between Modic changes and degeneration of lower lumbar three joint complex

Objective To investigate the correlation between Modic changes(MCs)and degeneration of the lower lumbar three joint complex.Methods The clinical data of 231 patients with lumbar disc herniation(LDH)who were hospitalized in our hospital from March 2016 to June 2020 were selected for retrospective analysis.The relationship of incidence rate of MCs,Pfirmann grading of intervertebral discs and facet joint degeneration grading(Weishaupt classification)was observed.Results The overall incidence rate of MCs was 45.31%(296/693),and the incidence rates of MCs in L_3-4,L_4-5and L₅-S₁segments were 25.11%(58/231),54.11%(125/231)and 48.92%(113/231),respectively.There were significant differences among the groups(P<0.05).The degree of intervertebral disc degeneration in typeⅠ,ⅡandⅢof MCs in L_3-4,L_4-5and L₅-S₁segments was higher than that in non-MCs segments(P<0.05).There was significant difference in facet joint degeneration between patients with MCs typeⅢand those without MCs(P<0.05).There were significant differences in facet joint degeneration between patients with MCs typeⅡat L_4-5and L₅-S₁segments and those without MCs(P<0.05).Conclusion MCs is related to the degeneration of the three-joint complex,the main manifestation is that different types of MCs are related to the grade of lumbar intervertebral disc degeneration,and typeⅡMCs is related to lumbar facet joint degeneration.