骨质疏松和Modic改变的相关性分析

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。

Correlation analysis of osteoporosis and Modic changes

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.