颈椎终板Modic改变分布特点与退变的关系

背景：关于Modic改变在腰椎中分布及特点的相关性研究比较多,而在颈椎中的相关研究则较少。目的：分析颈椎终板Modic改变的临床分布特点,并探讨其发生与颈椎退变的相关性。方法：随机抽取因颈肩痛行颈椎MRl和常规X射线榆查的患者共200例,年龄20-83岁。记录MRl颈椎Modic改变发生的节段,改变类型,改变的位置等,并分析其发生与性别、年龄、椎间盘退变节段及程度、椎间隙高度、颈椎曲度的相关性。结果与结论：200例共计1200个颈椎椎间盘中23例（11.5％）,29个（2.4％）个椎间盘邻近终板发生Modic改变。I型8例（4％）,10个椎间盘（0.8％）;II型13例（6.5％）,16个椎间盘（113％）;III型2例（1.0％）,3个椎间盘（O.25％）。按照各个椎间盘节段发病数统计,C2/3节段O个,C3/4节段4个,C4／5节段6个,C5/6节段12个,C6/7节段7个,C6/7T1节段0个,发病率分别为O％,0.33％,O.5％,1.0％,O.58％,0％。结果表明颈椎终板也存在Modic改变的现象,但发生率较腰椎低,II型最多见,I型次之,III型最为少见,多发生于C5/6椎间盘,多位于邻近终板的后方。50岁以上为其好发年龄,其发生与年龄、椎间盘退变、椎间盘节段及颈椎曲度之间存在相关性。     

下腰痛患者中腰椎终板Modic改变的分布情况及与腰椎间盘退变的关系

目的探讨下腰痛患者中腰椎终板Modic改变的分布情况及与腰椎间盘退变的关系。方法选取2011年10月至2013年10月因下腰痛在我院行腰椎MRI检查的患者942例。统计Modic改变在不同性别、年龄、节段、终板位置中的分布情况。参照Pfirrmann分级标准来评估腰椎间盘的退变程度,分析Modic改变与腰椎间盘退变程度的相关性。结果 942例下腰痛患者4 710个腰椎间盘中,405例(42.99%)患者的560个(11.89%)腰椎间盘邻近终板发生了Modic改变。在560处Modic改变中,Ⅰ型70处(12.5%),Ⅱ型478处(85.36%),Ⅲ型12处(2.14%)。男、女性患者Modic改变的发生率分别为40.08%(196/489)和46.14%(209/453),差异无统计学意义(P>0.05)。Modic改变发生在40岁以上年龄段的比率明显高于40岁以下年龄段(P<0.05)。L4/5和L5/S1节段Modic改变的发生率高于L1/2~L3/4节段(P<0.05)。Modic改变发生在终板前部的比率明显高于中、后部(P<0.05)。腰椎间盘从1级退变至5级退变中,Modic改变的发生率分别为0(0/162)、1.01%(11/1 084)、6.70%(152/2 267)、30.37%(338/1 113)和70.24%(59/84),差异有统计学意义(P<0.05)。Spearman相关性检验表明,Modic改变与椎间盘退变程度呈正相关(P<0.01)。结论下腰痛患者中腰椎终板Modic改变发生率较高,且以Ⅱ型最常见。Modic改变主要发生在下腰段,且常累及终板的前1/3区域。Modic改变不存在性别差异但和年龄及腰椎间盘退变有较强的相关性。     

腰椎间盘突出症磁共振成像下终板形态及其与椎间盘退变的关系

目的研究腰椎间盘突出患者下腰椎MRI 终板形态的分布规律,分析终板形态和椎间盘突出、Modic 改变的关系。方法回顾分析110 例腰椎间盘突出患者术前腰椎MRI。根据正中矢状面T1像将终板形态分型。根据Pfirrmann 法评定椎间盘退变等级。结果下腰椎终板最常见形态为凹面型。随着节段的下降,平坦型终板逐渐多见,L5~S1节段主要为平坦型。不规则型终板最少,且主要集中在L5~S1节段。终板形态由凹面型到平坦型再到不规则型,对应的间盘退变程度逐渐加重(P<0.05)。椎间盘突出节段以平坦型和不规则型终板多于凹面型多见,无突出节段则以凹面型多见(P<0.01),而平坦型和不规则型间无显著性差异(P>0.01)。不规则型终板比凹面型和平坦型更容易伴发Modic 改变(P<0.01),凹面型和平坦型间无显著性差异(P>0.01)。结论终板形态变化能在一定程度上反映椎间盘突出时间盘的退变情况。不规则型终板更容易伴发Modic 改变。     

颈椎退变对终板倾斜角的影响

目的：探讨颈椎退变对终板倾斜角的影响及其临床意义。方法：随机选取21-30岁正常人和51～60岁颈椎退变性疾病患者各40例，将其颈椎侧位X线片扫描至计算机，使用Sigma Scan Pro 5软件测量C3～C7终板倾斜角，比较其差异。结果：51-60岁颈椎退变性疾病患者的C3～C7上、下终板倾斜角均明显〉21～30岁正常人组，且差别显著（P〈0.01）。结论：C3～C7上、下终板倾斜角随颈椎退行性改变均明显增大。     

颈椎Modic改变与血脂、血糖水平的相关性分析

目的 探讨颈椎Modic改变（Modic change,MC）与血脂、血糖水平的相关性。方法 选取2015年1月-2021年1月在川北医学院附属医院因颈肩痛住院的患者,根据颈椎椎体终板在MRI上是否发生信号改变分为MC组和不伴MC组。比较两组患者的一般资料（年龄、性别、吸烟史、饮酒史）、血脂指标（高密度脂蛋白、低密度脂蛋白、脂蛋白a、总胆固醇、甘油三酯）、血糖指标（糖化血红蛋白、空腹血糖）。采用多因素logistic回归分析探讨MC与各指标的相关性。结果 最终纳入患者160例,其中MC组48例,不伴MC组112例。MC组患者的年龄[（61.46±12.10）vs.(56.22±10.65)岁]、总胆固醇[（5.06±1.17）vs.(4.44±1.31)mmol/L]、甘油三酯[（1.61±0.64）vs.(1.38±0.58)mmol/L]、糖化血红蛋白（6.78%±1.27%vs. 5.79%±0.85%）、空腹血糖[（7.84±1.51）vs.(6.93±1.47)mmol/L]高于不伴MC组,差异有统计学意义（P<0.05）。两组患者的性别、吸烟比例、饮酒比例、高密度脂蛋...     

颈椎间盘退变对生理曲度影响的MRI研究

颈椎间盘退变对生理曲度影响的ＭＲＩ研究张光，韩邕本文旨在利用ＭＲＩ能同时显示颈椎全貌和间盘状况的优势，对间盘退变和颈椎曲度二者之间的关系作初步探讨，以期了解间盘退变对颈椎稳定性的影响及颈椎病症状上的意义。１资料和方法本文系我院１９９２年１０月～１９９...     

中老年腰腿痛患者腰椎终板Modic改变与腰椎不稳的相关性研究

目的 探讨中老年腰腿痛患者腰椎终板Modic改变的分布情况及其与腰椎不稳的相关性.方法 选择195例因腰腿痛在本院行腰椎MRI检查的中老年患者,统计各型Modic改变在中老年腰腿痛患者中的发生率及在椎间盘节段中的发生率,分析Modic改变与腰椎间盘退变、腰椎不稳定之间的关系.结果 中老年腰腿痛患者中Modic改变分型为Ⅱ型的患者所占比率最高,Modic改变发生率最高的腰椎间盘位置为L5 ～S1.腰椎间盘退变程度越高,Modic改变发生率越高.腰椎不稳定患者发生腰椎终板Modic改变发生率明显高于腰椎稳定患者.腰椎稳定者中腰椎曲度异常患者Modic发生率明显高于腰椎曲度正常患者.结论 中老年腰腿痛患者腰椎终板Modic改变以Ⅱ型多见,其与腰椎稳定性及腰椎曲度之间存在相关关系.     

腰椎终板各型Modic改变的病理组织学观察

目的观察Modic各型腰椎间盘髓核与终板的病理组织学改变,探讨慢性下腰痛与其结构特点的关系。方法70例腰椎间盘退行性疾病患者行椎间盘手术,术中收集椎间盘髓核、椎体终板部分组织进行病理切片和HE染色,观察病理组织结构。结果Modic各型病理学改变如下：ModicⅠ型软骨下血管化的纤维组织,软骨终板出现裂隙或破裂;ModicⅡ型脂肪组织替代正常的软骨或骨组织;ModicⅢ型：硬化骨组织替代正常的软骨或骨组织;Modic混合型：同一终板可见黄骨髓和血管化;无Modic改变则病理学无上述变化。结论腰椎间盘髓核与终板的病理组织学改变与Modic各型的特点相联系。     

腰椎终板Modic的改变:生化组织学特点

背景:1988年Modic等系统描述了在退变的腰椎间盘终板及终板下骨质MRI信号改变的类型、分型标准及组织学变化,并将其命名为Modic改变.各型Modic改变的退变程度尚不清楚.目的:通过对各型Modic改变的组织学观察和生化成分的检测,了解各型终板组织学特点及生化成分,研究各型Modic改变退变程度.方法:手术取得所需终板36例,手术时根据影像定位,取出所需终板,按Modic改变分型分组:无Modic改变的12例,Modic Ⅰ型12例,ModicⅡ型12例.将标本行苏木精-伊红染色,在光镜下观察软骨终板组织学特点,用免疫组织化学方法观察Ⅱ型胶原表达,用间苯三酚法测定蛋白多糖的含量.结果与结论:免疫组织化学染色结果显示,各组在腰椎终板基质中可见棕黄色细颗粒状阳性表达,在有Modic改变的椎体终板中,Ⅱ型胶原积分灰度值比无Modic改变者明显升高(P＜0.05),Modic Ⅰ型积分灰度值明显高于ModicⅡ型(P＜0.05).蛋白多糖检测:在有Modic改变的椎体终板中,蛋白多糖的含量比无Modic改变者明显升高(P＜0.05),Modic Ⅰ型蛋白多糖的含量高于ModicⅡ型(P＜0.05).组织学特点:Modic Ⅰ型(水肿型)软骨下血管化的纤维组织以及与此相关的软骨终板出现裂隙或破裂;ModicⅡ型(脂肪型)脂肪组织替代正常的软骨或骨组织;Modic(-)病理学无上述变化.结果可发现,Modic改变是腰椎终板退变逐渐加重的连续性过程.     

颈椎曲度变直对青年人颈椎间盘早期退变的影响:基于56例磁共振T2-mapping

目的应用磁共振T2-mapping成像技术研究颈椎曲度变直对某高校大学生颈椎间盘早期退变的影响。方法招募56名汕头地区在校大学生行颈椎X线侧位和颈椎磁共振T2-mapping成像检查,根据颈椎曲度弧弦距将其分为颈曲变直组（n=43）和颈曲正常组（n=13）,分析颈椎曲度弧弦距与颈椎间盘髓核T2值的相关性,并比较两组间对应节段颈椎间盘髓核T2值的差异。结果该校大学生颈椎间盘髓核的T2值与颈椎曲度弧弦距呈正相关（r=0.277,P < 0.05）;颈曲变直组与颈曲正常组仅在C2/3、C3/4节段颈椎间盘髓核T2值的差异有统计学意义（P < 0.05）,其它节段差异无统计学意义（P > 0.05）。结论颈椎曲度变直可能是加速大学生颈椎间盘髓核退变的因素之一,磁共振T2-mapping成像技术能检测颈椎间盘髓核退变早期的生化成分的变化,这将为颈椎间盘退变的预防和早期干预提供依据。      

Prevalence of hyperplastic articular pillars in the cervical spine and relationship with cervical lordosis.

BACKGROUND: Cervical lordosis is often used as an indicator for a number of clinical conditions ranging from traumatic to degenerative. Previous research has indicated that a number of factors may change the lordosis. However, the link between hyperplastic articular pillars and cervical lordosis measurements has never been studied. OBJECTIVE: To investigate the reliability of determining articular pillar hyperplasia, to determine its prevalence, and to compare lordosis measurements between persons with and without hyperplasia of the cervical articular pillars. METHODS: Twelve normal neutral lateral cervical radiographs were chosen for the reliability study. Two chiropractors independently evaluated the articular pillars of C3 through C6 by drawing lines along the planes of the superior and inferior articular surfaces of each pillar. Each pillar was categorized as "normal" or "hyperplastic" depending on the convergence or divergence of these lines. One examiner repeated this procedure after a 1-month interval. Percent agreement and kappa statistics were calculated for interexaminer and intraexaminer agreement. Forty-eight normal neutral lateral cervical radiographs with a horizontal Chamberlain's line were evaluated for the presence or absence of pillar hyperplasia. Two measurement techniques were used to assess the cervical lordosis: the method of Jochumsen and the "angle of the cervical lordosis." The unpaired t test was used to compare the angle of cervical lordosis measurements between the two groups. The Mann-Whitney U test was used to analyze data obtained with the method of Jochumsen. The prevalence of pillarhyperplasia was calculated on 100 normal lateral cervical radiographs. RESULTS: Interexaminer and intraexaminer reliability of determining pillar hyperplasia was fair to substantial (kappa = 0.4 to 0.61; 75% to 92%). Forty-six percent of the patients demonstrated pillar hyperplasia of at least one cervical level. Patients with pillar hyperplasia had a mean cervical curve of 31.52 degrees, whereas the curve in patients without pillar hyperplasia was 44.76 degrees (P = .0001). The method of Jochumsen also detected a significant difference in the curve measurements between the two patient groups (P = .0127). CONCLUSION: Articular pillar hyperplasia is common and significantly reduces the cervical lordosis measurements. Accepted normal values for lordosis evaluation need to be reassessed and articular pillar configuration considered when treatment plans include attempts to restore a "normal" cervical lordosis. Previous studies attempting to link lordosis measurements with pathologic conditions or symptoms may need to be reevaluated.     

枕颈融合角度与颅颈交界区畸形患者下颈椎退变的关系

背景：枕颈融合是颅颈交界区畸形的主要治疗方法。对于非骨质疏松症患者,颈椎的退变主要表现在椎间盘,而椎体的高度基本保持恒定不变,所以可用颈椎间盘高度和与颈椎体高度和的比值（S值）衡量颈椎的退变,S值越小则颈椎退变越严重。 目的：测量颅颈畸形枕颈融合内固定患者的颈椎侧位X射线片,分析融合过程中枕颈固定角度和融合后下颈椎退变的关系,确定最佳枕颈融合角度范围。 方法：纳入因颅颈畸形行枕颈融合患者21例,根据融合后即刻枕颈角度（0c-C2角度）,将颅颈畸形枕颈融合患者分为3组,即枕颈角9°-22°组、枕颈角〈9°组、枕颈角〉22°组,其中融合后即刻0c-C2角度在9°-22°属于正常范围。测量融合前及融合后终末随访时各组S值及JOA评分,并进行统计学比较。 结果与结论：融合前枕颈角9°-22°组、枕颈角〈9°组、枕颈角〉22°组JOA评分分别为（7.3±1.7）分、（7.2±1.6）分、（7.3±1.5）分,融合后随访分别为（14.2±1.5）分、（13.5±1.6）分、（13.3±1.5）分,3组JOA评分均有明显改善,枕颈角9°-22°组JOA改善程度明显较枕颈角〈9°组、枕颈角〉22°组好。融合前S值枕颈角9°-22°组、枕颈角〈9°组、枕颈角〉22°组分别为0.440±0.017,0.441±0.016,0.440±0.018,3组间差异无显著性意义。枕颈角9°-22°组融合后终末随访S值与融合前S值差异无显著性意义,枕颈角〈9°组、枕颈角〉22°组融合后终末随访S值均较其融合前S值明显减小。提示枕颈融合内固定时枕颈角应尽量在正常范围内,超过或小于正常范围均会加速下颈椎的退变进程。     

Analysis of amelioration of neurological function on cervical degeneration disease after treatment with cervical spine locking plate

Objective To discuss the clinical effect of treatment with anterior decompression,bone graft and cervical locking plate fixation for cervical degeneration disease.Method 23 patients with cervical spondylotic myelopathy and cervical ossification of the posterior longitudinal ligament have undergone the treatment of anterior cervical spine locking plate fusion,Neurological signs and symptoms were evaluated before and after surgery,and mean follow-up time was 11,3 months.Result In all cases,radiography demonstrated a solid bony fusion,Additional general complications include a large wound hematoma in one and hoarseness in one ,All patients‘ neurological function were improved.Conclusion The clinical effect of treatment with anterior decompression,bone graft and cervical locking plate fixation for cervical degeneration disease is satisfactory.     

颈椎带锁钢板内固定术对颈椎退变性疾病神经功能改善的分析

Thetreatmentswithcervicallockingplateforcervicalfractureanddislocationhavegainsatisfactoryeffects，buttherearesomedisputesonusingofplateduringthetreatmentwithanteriordecom－pressionandbonegraftforcervicaldegenerationdiseasebetween１or２interspaces．FromJune２０００toFebruary２００１，wehaveap－pliedanteriordecompression，bonegraftandinternalfixationwithcervicallockingplatetotreat２３patientswithcervicaldegenerationdisease，andtheeffectsaresatisfactory．１Subjectandmethod１．１SubjectAcohortof…     

Prevertebral soft tissue changes in cervical spine injury

Primary radiological diagnostics of cervical spine injuries is difficult. It can be improved by making observations on the signs which indicate a fracture, such as alterations in prevertebral soft tissue structures. Several authors have given different suggestions for normal values of prevertebral soft tissue width. It is influenced by the level of the measurement, the posture of the spine, and the patient's age. The soft tissue changes have been stated to often occur with injuries of the anterior parts of the cervical spine, but also with severe injuries in the upper and posterior parts. However, different authors have reported considerably varying figures of incidence of prevertebral soft tissue widening. The article will deal with these matters; it will be based on a material of 165 patients with cervical spine injury, a series of 70 noninjury patients, and the flexion-extension radiograms of the latter group.