本文選題：腰椎 + Modic改變　； 參考：《天津醫(yī)科大學》2011年碩士論文

【摘要】：目的：探討腰椎終板Modic改變患者的分布特點。評估性別、體重、勞動量、吸煙量等影響因素與Modic改變整體發(fā)生率以及Modic改變各個分型之間發(fā)生率的相關性。探討Modic改變的發(fā)病機制,進一步理解力學因素以及自身免疫反應在Modic改變中的作用。 方法：回顧分析2009年2月～2010年10月間我院因腰痛和／或坐骨神經(jīng)痛行腰椎MRI檢查的患者210例,分析腰椎Modic改變的發(fā)生率、類型以及在椎間盤節(jié)段、性別、體重、勞動量、吸煙量中的分布特點,并利用逐步回歸分析法評估Modic改變與上述因素之間的相關性。 數(shù)據(jù)用SPSS 16.0版本軟件進行處理,組間比較采用χ2檢驗,相關性使用Binary Logistics回歸方程。P0.05為差異具有統(tǒng)計學意義。 結果：210例1050個腰椎間盤中,共有47例患者的58個椎間盤鄰近椎板存在Modic改變,占入選患者的22.4%。其中男16人；女31人,Modic改變Ⅰ型、Ⅱ型和Ⅲ型的人數(shù)分別為16人、25人、6人,其發(fā)生率分別為7.6%、11.9%、2.9%。最常出現(xiàn)Modic改變的節(jié)段為L5-S1(28個),其余節(jié)段為：L4-5(17個)、L3-4(9個)、L2-3(4個)、L1-2(0個)。其發(fā)生率分別為：48.3%、29.3%、15.5%、6.9%、0%。 ①性別方面：男性99人,女性111人。其中出現(xiàn)Modic改變的男性有16人,發(fā)生率為16.2%；女性為31人,發(fā)生率為27.9%。兩者差異有統(tǒng)計學意義(P0.05)。 ②體重方面：正常組有98人,其中17人出現(xiàn)了Modic改變,81人無Modic改變,發(fā)生率為17.3%；超重組有80人,14人出現(xiàn)了Modic改變,66人無Modic改變,發(fā)生率為17.5%；肥胖組有32人,16人出現(xiàn)Modic改變,16人無Modic改變,發(fā)生率為50%。Modic改變在正常組和超重組之間的差異無統(tǒng)計學意義(P0.05),正常組與肥胖組之間的差異具有統(tǒng)計學意義(P0.05),超重組與肥胖組之間的差異具有統(tǒng)計學意義(P0.05),Modic改變在肥胖組中發(fā)生率最高。 ③勞動量方面：輕體力勞動組54人,其中8人出現(xiàn)了Modic改變,46人無Modic改變,發(fā)生率為14.8%；中等體力勞動組有99人,16人出現(xiàn)了Modic改變,83人無Modic改變,發(fā)生率為16.2%；重體力勞動組有57人,23人出現(xiàn)Modic改變,34人無Modic改變,發(fā)生率為40.4%。Modic改變在輕體力勞動組與重體力勞動組之間的差異具有統(tǒng)計學意義(P0.05),中等體力勞動組與重體力勞動組之間的差異具有統(tǒng)計學意義(P0.05)。Modic改變在重體力勞動組中發(fā)生率最高。 ④吸煙量方面：不吸煙組138人,其中35人出現(xiàn)了Modic改變,103人無Modic改變,發(fā)生率為25.4%；輕度嗜煙組有53人,6人出現(xiàn)了Modic改變,47人無Modic改變,發(fā)生率為11.3%；重度嗜煙組有19人,6人出現(xiàn)Modic改變,13人無Modic改變,發(fā)生率為31.6%。Modic改變在各組間的差異不具有統(tǒng)計學意義(P0.05)。 ⑤勞動量和體重與ModicⅢ型改變密切相關(P0.05),與其他分型無明顯相關性(P0.05)�；貧w方程為Y=-4.288+0.560S+0.606W+0.775L(Y為Modic改變,S為性別,W為體重,L為勞動量),F=32.51,P=0.00,EXP值：L=2.171,W=1.833,S=1.750。 結論：腰腿痛患者中Modic改變以Ⅱ型最多,以L5-S1節(jié)段最為常見；女性多于男性,Modic改變在肥胖人群中發(fā)生率高于正常體重和超重人群。患者的性別、體重及勞動量等因素與Modic改變的發(fā)生具有相關性。力學因素可能在Modic改變中發(fā)揮著重要作用。 目的：研究通過終板下椎體穿刺、髓核置入法,建立兔自身免疫反應動物模型的可行性,并通過影像學、組織學和分子生物學等實驗來分析Modic改變的發(fā)病機制。旨在通過建立動物模型,為相關研究提供實驗依據(jù),進一步理解自身免疫反應在Modic改變中的作用。 方法：54只新西蘭大白兔隨機分為正常對照組、肌肉置入組和髓核置入組,利用腰椎前外側手術入路暴露的腰4/5、腰5/6椎間盤右前外側,使用16G骨穿針在腰5/6椎間盤緊鄰骺板的椎體處鉆孔,深度約3毫米；利用5毫升空針刺入腰4/5椎間盤中,抽取髓核。按照各實驗組的要求,分別將髓核、肌肉推入至已鉆孔的椎體內(nèi),止血、沖洗后縫合各層組織和皮膚。對照組除不置入任何組織外,其操作與其它兩組相同。在術后12周、16周和20周行MRI檢測后分批處死各組動物,行HE染色、實時熒光定量PCR及Western blot觀察其實驗部位炎癥因子的表達。 結果：實驗后的12周、16周和20周,MRI顯示髓核置入組T1WI上可見有低信號出現(xiàn),T2WI上則在低信號的背景下出現(xiàn)了不同程度的混雜高信號,而正常對照組及肌肉置入組均未見明顯信號改變。大體觀察及HE染色結果也證實了在髓核置入部位會出現(xiàn)組織的異常增殖。Rt-PCR及、Vestern blot則檢測到了IL-4、IL-17及IFN-γ在髓核置入組的高表達現(xiàn)象。 結論：終板下椎體穿刺,髓核置入法可以建立Modic改變的動物模型,自身免疫因素很有可能在Modic改變中發(fā)揮著重要的作用。
[Abstract]:Objective : To study the distribution characteristics of lumbar vertebral endplate Masked , and to evaluate the relationship between the factors such as sex , body weight , labor intensity , smoking amount , and the incidence of Masks .

Methods : 210 patients with lumbar spine pain and / or sciatica were analyzed retrospectively from February 2009 to October 2010 . The incidence , type and distribution of lumbar intervertebral disc segment , sex , body weight , labor intensity and smoking amount were analyzed .

The data was treated with SPSS 16.0 software , and 蠂2 test was used to examine the correlation between the two groups .

Results : In 210 cases of 1050 lumbar intervertebral discs , there were 47 cases of 58 intervertebral discs adjacent to the vertebral lamina , which accounted for 22.4 % of the patients , including 16 men ;
Among 31 women , there were 16 persons , 25 persons and 6 persons , respectively , and the occurrence rate was 7.6 % , 11.9 % and 2.9 % , respectively . The most frequently occurring segments were L4 - 5 ( 17 ) , L3 - 4 ( 9 ) , L2 - 3 ( 4 ) , L1 - 2 ( 0 ) . The occurrence rates were 48.3 % , 29 . 3 % , 15.5 % , 6.9 % , 0 % , respectively .

( 1 ) Gender : 99 men and 111 women . Among them , there were 16 males and 16.2 % in females .
The incidence rate was 27 . 9 % in 31 women ( P 0 . 05 ) .

( 2 ) Body weight : 98 in the normal group , 17 of them had Masked change , 81 had no Masked change , the incidence was 17.3 % ;
There were 80 people in the supergene group , 14 had Masks change , 66 had no Masked change , the occurrence rate was 17.5 % ;
There were 32 persons in the obese group , 16 had Masked change , 16 had no Masked change , the incidence was 50 % . The difference between the normal group and the obese group was not statistically significant ( P0.05 ) . The difference between the normal group and the obese group was statistically significant ( P0.05 ) .

( 3 ) labor intensity : 54 people in the light manual labor group , 8 of them had Masks changed , 46 had no Masks change , the incidence rate was 14.8 % ;
There were 99 people in the medium - sized labor group , 16 in the middle - manual labor group , 83 in the middle - manual labor group , and the incidence rate was 16.2 % .
There were 57 persons in the heavy manual labour group , 23 had Masked change , 34 had no Masked change , the occurrence rate was 40.4 % . The difference between the group of light manual labour and the heavy labour force group had statistical significance ( P0.05 ) . The difference between the middle and heavy labour groups was statistically significant ( P0.05 ) .

( 4 ) Smoking quantity : 138 persons in the non - smoking group , 35 of them had Masked change , 103 had no Masked change , the incidence rate was 25.4 % ;
There were 53 patients in the mild smoke group and 6 in 6 patients , and 47 had no Masked change , and the incidence was 11.3 % .
There were 19 people in the severe smoke group , 6 in the group of Masks , 13 had no Masked change , the incidence rate was 31.6 % . The difference between the groups was not statistically significant ( P0.05 ) .

The regression equation is Y = - 4.288 + 0.560 S + 0.606W + 0.775 L ( Y is Midea change , S is sex , W is body weight , L is labor ) , F = 32.51 , P = 0.00 , EXP value : L = 2.171 , W = 1.833 , S = 1.750 .

Conclusion : The most common type 鈪，

本文編號：1819384