徐永立++赵小华　郝金华　潘剑岩　凌岳

[摘要] 目的 研究腰椎终板形态变化与椎间盘退变的相关性，探讨二者之间的因果关系。 方法 回顾性分析2010年1月～2015年12月广东省佛山市顺德龙江医院80例患者腰椎间盘MRI影像资料，观察患者L1～2至L5～S1 5个节段前后两次检查终板形态的变化和腰椎间盘退变程度的变化，分析两者的变化规律。 结果 所选80例患者共800个节段的终板和椎间盘，凹陷型终板对应的椎间盘退变程度大多在Ⅰ～Ⅱ级（79.9%），而不规则型终板多对应的椎间盘退变程度为Ⅲ～Ⅴ级（75.8%），平坦型终板对应的椎间盘退变程度无明显分布规律。从凹陷型到平坦型再到不规则型终板形态对应的椎间盘退变程度逐渐加重，差异有统计学意义（P < 0.05）。终板形态改变优先于腰椎间盘退变程度改变者共25对（6.3%），而腰椎间盘退变程度改变先于终板形态变化者有207对（51.8%），剩余的168对相应的终板形态和腰椎间盘退变程度无法准确判定何种改变在先。腰椎间盘退变程度的改变占优势的节段明显多于终板形态改变占优势的节段，两者差异有高度统计学意义（P < 0.01）。 结论 腰椎终板形态与椎间盘退变程度存在一定的相关性，并且腰椎间盘退变程度的变化大多要早于终板形态的变化，腰椎间盘退变可能是导致终板形态改变的重要原因。

[关键词] 终板形态；腰椎间盘退变；核磁共振成像；動态变化

[中图分类号] R814.42 [文献标识码] A [文章编号] 1673-7210（2016）12（a）-0130-04

Imaging study of the correlation between the morphological changes of the lumbar end plate and the intervertebral disc degeneration

XU Yongli ZHAO Xiaohua HAO Jinhua PAN Jianyan LING Yue

Department of Radiology， Shunde Longjiang Hospital of Foshan City， Guangdong Province， Foshan 528318， China

[Abstract] Objective To study the correlation between morphological changes of lumbar end plate and intervertebral disc degeneration， in order to explore the causal relationship between them. Methods The lumbar disc MRI image data of 80 cases of patients from January 2010 to December 2015 in Shunde Longjiang Hospital of Foshan City were analyzed retrospectively. The changes of the morphology of the end plates and the lumbar intervertebral disc degeneration of L1-2 to L5-S1 segments in the two times detection were observed， and the change rule was analyzed. Results The 80 patients had a total of 800 segments of end plates and intervertebral disc. The intervertebral disc degeneration degree of depression type was mostly the Ⅰ-Ⅱ level （79.9%）， and the corresponding degree of intervertebral disc degeneration of irregular type was Ⅲ-Ⅴ level （75.8%）， the corresponding degree of intervertebral disc degeneration of flat type had no regularities of distribution. The degeneration degrees of intervertebral disc in the depression type， flat type and irregular type gradually increased， with statistically significant difference （P < 0.05）. The morphological changes of end plate prior to disc degeneration changes had 25 pairs （6.3%）， and there were 207 pairs （51.8%） the changes of intervertebral disc degeneration in advance of the morphological changes of end plate， the remaining 168 pairs could not unable to accurately determine the changes sequence of morphology of end plates and the intervertebral disc degeneration. The dominant segments of changes of intervertebral disc degeneration degree were more than the dominant segments of the morphological changes of end plate， with statistically significant difference （P < 0.01）. Conclusion There is a correlation between the morphology of lumbar end plate and intervertebral disc degeneration degree. The changes of lumbar disc degeneration are earlier than the end plate morphology. The lumbar disc degeneration may be an important cause of the endplate morphology change.

[Key words] End plate shape； Lumbar disc degeneration； MRI； Dynamic change

腰椎间盘退变是导致腰腿痛的常见原因，也是临床常见病和多发病。腰椎终板包括骨性终板和软骨终板，其与椎间盘紧密相邻，是椎间盘生物力学的直接传导部位。临床工作中发现腰椎间盘退变常伴随终板形态或信号的改变。目前对于腰椎终板形态和椎间盘退变的关系仍不十分清楚，对于两者之间关系的动态研究还未见有明确报道。本研究观察腰椎终板形态的变化情况与椎间盘退变程度的对应关系，探讨两者之间的动态变化规律及其临床意义。

1 资料与方法

1.1 一般资料

回顾性分析2010年1月～2015年12月于广东省佛山市顺德区龙江医院行腰椎MRI检查的患者的影像学资料，选取其中具有前后两次或以上MRI检查资料的患者80例进行纵向对比研究，要求两次检查时间间隔为1～3年，排除外伤或肿瘤、发育异常等患者。……