Association between Modic changes and endplate sclerosis: Evidence from a clinical radiology study and a rabbit model
Association between Modic changes and endplate sclerosis: Evidence from a clinical radiology study and a rabbit model
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Modic 变化与终板硬化之间的关联：来自临床放射学研究和兔子模型的证据
DOI：
10.1016/j.jot.2018.07.006
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发表时间：
2019-01-01
影响因子：
6.6
通讯作者：
Zhao, Fengdong
中科院分区：
文献类型：
--
作者：
Liu, Junhui;Huang, Bao;Zhao, Fengdong
目的：分析不同类型莫迪克改变（MCs）患者终板硬化的情况，并利用兔模型验证结果。
方法：临床研究的参与者包括2011年8月至2015年8月期间在骨科就诊的1023例连续的腰椎退行性疾病住院患者。所有患者均接受了腰椎的计算机断层扫描（CT）和磁共振成像检查。对于有MCs的患者，从矢状位重建的CT图像评估终板硬化情况。除临床研究外，利用先前建立的MCs兔模型诱发I型、II型和III型MCs。采集I型、II型和III型MCs以及正常终板的标本，利用微型CT评估“处理”椎骨的骨密度和骨体积/组织体积，并利用免疫组化染色评估runt相关转录因子2和成骨蛋白的表达。比较正常终板椎骨和不同类型MCs椎骨之间的测量结果。
结果：在1023例患者中，214例（20.9%）在一个或多个终板有MCs；这些改变累及10230个终板中的1044个（10.2%）。I型、II型和III型MCs分别在164个（1.6%）、838个（8.2%）和40个（0.4%）终板中可见。在1044个有MCs的终板中，274个（26.2%）在CT图像上显示有硬化迹象，包括：26/164个（15.8%）I型MCs终板、208/838个（24.8%）II型终板和40/40个（100%）III型终板。有MCs的硬化终板和非硬化终板的HU（CT值）比值分别为2.0±0.3和1.1±0.1。在动物研究中，I型和II型MCs终板的骨密度、骨体积/组织体积以及runt相关转录因子2和成骨蛋白的表达高于正常终板，但低于III型MCs终板。
结论：任何类型的MCs终板都可能发生硬化。然而，临床和动物研究表明，III型MCs终板的硬化程度最高。本文的转化潜力：研究表明I型、II型和III型MCs终板都可能发生硬化。在平片或CT扫描显示终板硬化的患者中，终板仍可能代表与慢性下腰痛相关的炎症过程。（C）2018作者。由爱思唯尔（新加坡）私人有限公司代表中华骨科医学会出版。这是一篇在CC BY - NC - ND许可（http://creativecommons.org/licenses/by - nc - nd/4.0/）下的开放获取文章。
Purpose: To analyse the presence of endplate sclerosis in patients with various types of Modic changes (MCs) and to confirm the results using a rabbit model.Methods: Participants in the clinical study included 1023 consecutive inpatients with lumbar degenerative disease who attended the Department of Orthopaedics between August 2011 and August 2015. All patients underwent computed tomography (CT) and magnetic resonance imaging of the lumbar spine. In those patients with MCs, endplate sclerosis was evaluated from sagittally reconstructed CT images. In addition to the clinical study, MCs type I, II and III were initiated using a previously developed rabbit model of MCs. Specimens of MCs type I, II and III and normal endplates were harvested, bone mineral density and bone volume/tissue volume of "treated" vertebrae were evaluated using mCT and osteogenic protein expressions of run-related transcription factor 2 and osteocalcin were assessed using immunohistochemical staining. Measurements were compared between vertebrae with normal endplates and those with different types of MCs.Results: Of 1023 patients, 214 (20.9%) had MCs in one or more endplates; these changes affected 1044 (10.2%) of 10230 endplates. Type I, II and III MCs were seen in 164 (1.6%), 838(8.2%) and 40 (0.4%) endplates, respectively. Of 1044 endplates with MCs, 274 (26.2%) showed evidence of sclerosis on CT images including: 26/164 endplates (15.8%) with type I MCs, 208/838 (24.8%) with type II and 40/40 (100%) with type III. HU (CT value) ratios for sclerotic and nonsclerotic endplates with MCs were 2.0 +/- 0.3 and 1.1 +/- 0.1, respectively. In the animal study, the bone mineral density, bone volume/tissue volume and expression of runt-related transcription factor 2 and osteocalcin of endplates with type I and II MCs were higher than those of normal endplates and lower than those of endplates with type III MCs.Conclusion: Sclerosis can occur in endplates with any type of MCs. However, the clinical and animal study suggests that sclerosis is greatest in endplates showing type III MCs. The translational potential of this article: The study showed that sclerosis can occur in endplates with MCs type I, II and III. In patients with endplate sclerosis on plain radiographs or CT scans, the endplate can still represent an inflammatory process associated with chronic lower back pain. (C) 2018 The Authors. Published by Elsevier (Singapore) Pte Ltd on behalf of Chinese Speaking Orthopaedic Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).