【摘要】：目的:研究腰椎終板Modic改變在退變性腰椎滑脫中的規(guī)律,探討腰椎終板Modic改變、退變性腰椎滑脫、臨床癥狀之間的關(guān)聯(lián)度,為臨床治療退變性腰椎滑脫提供理論支持,提高臨床治療效果。方法:選取2014年1月至2014年12月因下腰痛或坐骨神經(jīng)痛于我院行手術(shù)治療的退變性腰椎滑脫患者為研究對象,統(tǒng)計并記錄患者基本信息,并對所有患者均行腰椎MRI及標準正側(cè)位X線攝像,以滑脫節(jié)段椎體為研究對象,在腰椎MRI中線矢狀面T2圖像上,利用圖像分析軟件Spine Examiner分別測量終板Modic改變的面積及最大椎體面積,并計算Modic面積改變率(Modic改變面積/最大椎體面積);拍攝標準站立位腰椎正側(cè)位X線片,借助系統(tǒng)軟件測量滑脫椎體后緣與下位椎體后緣之間的距離(AB)及下位椎體矢狀徑(AC),并計算椎體滑脫程度(Taillard指數(shù)),Taillard指數(shù)=AB/AC;測量記錄患者入院和復查時的視覺疼痛模擬評分(VAS)及測量并記錄Oswestry功能障礙指數(shù)(ODI),并計算VAS評分改善率及ODI改善率。比較分析腰椎終板Modic改變與滑脫節(jié)段間的關(guān)系;同時比較觀察Modic面積改變率與Taillard指數(shù)及術(shù)前VAS與ODI評分之間的相互關(guān)系;并評估Modic改變組與非Modic改變組術(shù)后的臨床效果,分析終板Modic改變面積比例的大小與腰椎滑脫程度及臨床癥狀之間的關(guān)系及Modic改變對手術(shù)療效的影響。結(jié)果:共有52例患者,其中男15例,女37例,平均年齡55.48歲,L3/4滑脫2例,發(fā)生率3.8%,L4/5滑脫44例,發(fā)生率84.6%,L5-S1滑脫6例,發(fā)生率11.5%;Modic改變31例,非Modic改變21例,Modic改變發(fā)生率59.6%;modic1型13例,發(fā)生率17.3%;modic2型15例,發(fā)生率19.2%;modic3型3例,發(fā)生率9.5%。發(fā)生腰椎Modic改變的節(jié)段為L3/4 1例;L4/5 26例;L5/S1 4例,L4/5是腰椎退變性滑脫好發(fā)部位,也是腰椎Modic改變最常發(fā)生節(jié)段,Modic改變在滑脫節(jié)段發(fā)生率高,在穩(wěn)定節(jié)段的發(fā)病率低,差別有意義(P0.05);Modic面積改變率與Taillard指數(shù)明顯相關(guān)(P0.05),有統(tǒng)計學意義;Modic面積改變率與術(shù)前VAS及ODI評分相關(guān)(P0.05),有統(tǒng)計學意義;Modic改變組與非Modic改變組術(shù)后改善率有顯著差異(P0.05)。結(jié)論:1腰椎終板Modic改變在退變性腰椎滑脫中發(fā)病率較高,主要發(fā)生在滑脫節(jié)段。2腰椎終板Modic改變面積比例大小與退變性腰椎滑脫程度呈正相關(guān)。3腰椎終板Modic改變面積比例大小與患者臨床癥狀呈正相關(guān)。4 PLIF是治療退行性腰椎滑脫的有效方法,但伴有終板Modic改變者術(shù)后恢復療效較沒有終板Modic改變者差。
[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.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3

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