颈椎病病人颈部疼痛的影响因素分析

目的探讨引起颈椎病病人颈部疼痛的影响因素,尤其是Modic改变在颈部疼痛中所起的作用。方法回顾分析2016年9月至2019年4月于我院就诊的261例颈椎病病人,其中男136例,女125例,年龄为(51.2±10.9)岁。纳入统计的因素包括年龄、性别、身体质量指数(body mass index,BMI)、吸烟史、受教育水平、颈椎曲度改变、颈椎滑脱、Modic改变、高级别椎间盘退变、椎间盘高度丢失和纤维环撕裂。通过数字化疼痛量表(numerical rating scale,NRS)评估病人的颈部疼痛程度,利用单因素分析及多因素Logistic回归分析分别计算上述因素对严重性颈部疼痛(SNP)和持续性颈部疼痛(PNP)的影响。另外,利用单因素分析及多因素Logistic回归分析计算颈椎滑脱、椎间盘退变分级、椎间盘高度丢失和纤维环撕裂对Modic改变的影响。结果共32例存在Modic改变。1型Modic改变病人的NRS评分明显高于2型(4.6±0.7 vs.3.7±1.1,P=0.003)。多因素Logistic回归分析显示颈椎后凸[OR=2.413,95%CI(1.329,5.180),P=0.009]、颈椎滑脱[OR=2.962,95%CI(1.592,5.665),P=0.001]和纤维环撕裂[OR=1.766,95%CI(1.087,2.765),P=0.021]是病人SNP的3个独立危险因素,而颈椎后凸[OR=2.738,95%CI(1.399,5.468),P=0.005]、颈椎滑脱[OR=2.565,95%CI(1.361,4.784),P=0.006]和Modic改变[OR=2.360,95%CI(1.264,4.275),P=0.010]是病人PNP的3个独立危险因素。Modic改变与椎间盘病变的回归分析提示高级别椎间盘退变[OR=2.512,95%CI(1.186,5.611),P=0.013]以及椎间盘高度丢失[OR=2.403,95%CI(1.160,5.721),P=0.025]是Modic改变的独立危险因素。结论颈椎后凸、颈椎滑脱和纤维环撕裂会加重颈椎病病人颈部疼痛的程度,而颈椎后凸、颈椎滑脱和Modic改变会延长颈椎病病人颈部疼痛的时间。此外,高级别椎间盘退变和椎间盘高度丢失是颈椎Modic改变的危险因素。

Influencing factors of neck pain in patients with cervical spondylosis

Objective To explore the factors associated with neck pain in patients with cervical spondylosis,especially the role of Modic changes in neck pain.Methods The patients with cervical spondylosis in our hospital from September 2016 to April 2019 were analyzed retrospectively.There were 261 patients,including 136 males and 125 females,with age of(51.2±10.9)years.Factors included in the statistics contained age,gender,body mass index(BMI),smoking history,education level,cervical curvature change,cervical spondylolisthesis,Modic change,high grade disc degeneration,disc height loss and annular tear.The degree of neck pain was evaluated by numerical rating scale(NRS).The correlation between the above factors and severe neck pain(SNP)and persistent neck pain(PNP)was calculated by univariate analysis and multivariate Logistic regression analysis.In addition,univariate analysis and Logistic regression analysis were used to assess the correlation between Modic changes and cervical spondylolisthesis,disc degeneration grade,disc height loss,annular tear.Results Among them,32 patients had Modic changes.The NRS of patients with Modic change in type 1 was significantly higher than that in type 2(4.6±0.7 vs.3.7±1.1,P=0.003).Multivariate Logistic regression analysis showed that cervical kyphosis[OR=2.413,95%CI(1.329,5.180),P=0.009],cervical spondylolisthesis[OR=2.962,95%CI(1.592,5.665),P=0.001]and annular tear[OR=1.766,95%CI(1.087,2.765),P=0.021]were independent factors associated with SNP.Cervical kyphosis[OR=2.738,95%CI(1.399,5.468),P=0.005],cervical spondylolisthesis[OR=2.565,95%CI(1.361,4.784),P=0.006]and Modic changes[OR=2.360,95%CI(1.264,4.275),P=0.010]were independent factors related to PNP.The Logistic regression analysis showed that high grade disc degeneration[OR=2.512,95%CI(1.186,5.611),P=0.013]and disc height loss[OR=2.403,95%CI(1.160,5.721),P=0.025]were independent factors related to Modic changes.Conclusion Cervical kyphosis,cervical spondylolisthesis and annular tear can aggravate the degree of cervical pain in patients with cervical spondylosis,while cervical kyphosis,cervical spondylolisthesis and Modic changes can prolong the duration of cervical pain in patients with cervical spondylosis.In addition,high grade disc degeneration and disc height loss are influencing factors of cervical Modic changes.