腰椎间盘退变MRI表现与病理学改变对照观察

本文以ＭＲＩ诊断的腰椎间盘退变分型与临床病理学改变加以对照 ,为正确选择治疗方案提供依据。1　临床资料与方法我院自 1999年 6月行ＭＲＩ检查明确诊断并经手术证实的腰椎间盘退变 2 16例。其中男 12 5例 ,女 91例 ;年龄最大78岁 ,最小 2 9岁 ,平均 42岁。腰腿痛等病史最长 15年 ,最短2周。其中 5 8人曾做腰部ＣＴ检查、12人曾做脊髓造影证实诊断。ＭＲＩ检查采用ＰＨＩＬＩＰＳＧＹＲＯＳＣＡＮ75 ＮＴ磁共振扫描机 ,常规采用ＳＥ序列 ,矢状位Ｔ1ＷＩ、Ｔ2 ＷＩ,层厚 4ｍｍ ,相应椎间隙横断位扫描 ,每一椎间隙四层 ,每层厚 4～ 5ｍｍ ,…     

腰椎间盘退行性变的改良MRI短时间反转恢复序列八级分级系统

目的建立一套在腰椎MRI短时间反转恢复(short time inversion recovery,STIR)序列图像上评价腰椎间盘退变程度的改良STIR序列八级分级系统,并检验其效度及可重复性。方法根据改良Pfirrmann八级分级系统及MRI检查结果建立并优化一套基于STIR序列图像的腰椎间盘矢状位分级系统。以2011年4月-2012年2月收治的60例腰椎间盘退行性变患者作为研究对象,其中男32例,女28例;年龄17～85岁,平均50岁。对每例研究对象5个腰椎间盘(L1、2～L5、S1)行T2加权像及STIR序列扫描。由3位分级者独立分级后再共同分级,分级者之间的效度及可重复性采用一致率和Kappa系数进行分析。结果共同分级示,所有椎间盘中无1级椎间盘,2级83个(27.7%),3级87个(29.0%),4级66个(22.0%),5级31个(10.3%),6级15个(5.0%),7级12个(4.0%),8级6个(2.0%)。分级者自身达极强一致性(Kappa值0.822～0.952),组间达高度至极强一致性(Kappa值0.749～0.843)。分级者两次分级与共同分级比较,分级一致率为82.7%～92.7%,平均85.6%;13.9%的分级差异发生于相邻1个级别,0.5%为相邻2个或以上级别。结论对于腰椎间盘退变程度可以采用改良STIR序列八级分级系统,提高了不同退变程度椎间盘分级的准确度。     

腰椎间盘退变动物模型评价方法的研究进展

腰椎间盘退变(IVD)和突出被认为是导致腰痛(low back pain)的主要原因[1、2]。建立动物模型为研究腰椎间盘退变机制和试验新治疗方案提供了一个良好的途径。目前构建腰椎间盘退变动物模型的方法主要分为自然诱发和实验诱发两种[3~6]。在模型构建后的评价方法多种多样,主要包括影像学、组织形态学和分子生物学评估。笔者对腰椎间盘退变模型建立后的退变评价方法综述如下。1影像学评价方法     

炎症与腰椎间盘退变

腰痛是临床最常见的疾病之一,椎间盘退变是腰痛的最常见病因。最近的研究表明纤维环损伤导致的炎症反应是导致椎间盘退变的主要发病基础。本文对椎间盘纤维环损伤后炎症反应相关的文献进行回顾,对炎症反应的特点、在椎间盘退变起始阶段的作用、细胞因子间信号转导、炎症与凋亡的关系等方面进行了归纳总结。     

青少年胸12腰1段椎体楔形变在下腰椎间盘退变发病中的意义

目的探讨胸12腰1段椎体楔形变在腰椎间盘退变发病中的意义,为预防青少年腰椎间盘早发退变 提供临床及理论依据。方法 随机选取腰痛青少年患者40例,均行腰椎X线和MRI检查,其中有胸12腰1段椎 体楔形变19例,无椎体楔形变21例;并根据T2加权像信号强度强弱将椎间盘分为以下三型:Ⅰ型:椎间盘呈强 信号;Ⅱ型:椎间盘呈不规则信号;Ⅲ型:椎问盘呈低信号。测量青少年腰骶角统计各型病例数,进行统计学处理。 结果 青少年胸12腰1段椎体楔形变组下腰椎间盘(L4-5、L5-S1)Ⅱ型、Ⅲ型椎间盘例数明显多于无椎体楔形变组 青少年患者,有显著性差异(P<0.01)。胸12腰1段椎体楔形变患者较无楔形变患者腰骶角明显增大,具有显著性 差异(P<0.01)。结论胸12腰1段椎体楔形变是青少年下腰椎间盘早发退变的重要诱因,防止胸12腰1段椎体楔 形变,是预防、减缓青少年腰椎间盘突出症发病的重要措施。     

骨质疏松与腰椎间盘退变相关性的研究进展

骨质疏松和腰椎间盘退变是骨科临床常见的退行性疾病,两者存在相似的发病机制,骨密度值反映了骨质疏松的严重程度,其与椎间盘退变程度的相关性一直是研究热点。一种观点认为骨密度值与腰椎间盘退变的严重程度呈正相关,有观点则认为是负相关,也有学者认为没有关联。本文将对近年来骨密度与腰椎间盘退变的相关性作一综述,并探讨两者之间相关联的发病机制。     

腰椎间盘髓核退变的MRI表现与病理学的相关性研究

目的探讨腰椎间盘髓核退变的MRI表现与病理学之间的相关性,为临床应用MRI相对信号强度评价腰椎间盘髓核退变提供病理学依据。方法病例组标本取自腰椎间盘疾患手术患者,共91例101个椎间盘;对照组标本取自既往无明显腰痛史的年轻腰椎骨折患者和新鲜脑死亡患者,共6例16个椎间盘。所有标本均于术前测量MRI相对信号强度,并予以HE染色、Alcianblue临界电解质浓度(CEC)染色和水分含量测定,分析MRI相对信号强度与硫酸软骨素指数、MRI相对信号强度与水分含量、硫酸软骨素指数与水分含量之间的相关性。结果两组间的MRI相对信号强度、硫酸软骨素指数和水分含量差异均有显著性,而硫酸角质素指数差异无显著性。MRI相对信号强度与硫酸软骨素指数、MRI相对信号强度与水分含量、硫酸软骨素指数与水分含量均有明显相关性,其r值分别为0.659、0.752和0.592,P值均<0.001。根据髓核的水分含量和病理学改变,可将髓核退变大致分为四个阶段,每个阶段的MRI相对信号强度依次为:>0.82,0.73~0.82,0.64~0.72,<0.64。结论MRI相对信号强度不仅能反映髓核的水分含量,而且还能反映髓核退变过程中的病理特征。MRI相对信号强度四级定量分级法是一种评价髓核退变较好的方法。     

腰椎间盘退变动物模型的建立

目的　建立腰椎间盘退变的动物模型并行组织学和MRI观察。　方法　健康成年恒河猴 8只 ,手术组 6只 ,在其腰4 ,5、腰5,6、腰6,7椎间盘分别作一 5mm× 3mm切口 ,分别于术前及术后 1、4、8、13、2 0周对手术椎间盘行MRI观察 ;8只恒河猴分别于术前 (对照组 )及术后 4、8、2 0周随机取 2只处死后行椎间盘组织学观察。　结果　正常成年恒河猴腰椎间盘组织学结构特点与人类相似 ;手术椎间盘高信号区域面积的百分比于术后 8、13、2 0周显著减少 (P <0 0 5 ) ;术后 4周椎间盘切口外被纤维组织覆盖 ,术后 8周 ,切口外层纤维样愈合 ,其内无愈合迹象 ,术后 2 0周 ,切口向椎间盘内延伸 ,部分髓核出现纤维化。　结论　恒河猴是一种生理特性与人类相接近的动物 ,以其为对象应用纤维环切开法可以获得可靠的腰椎间盘退变动物模型 ;通过测量MRI轴位T2加权像椎间盘高信号区域面积百分比的方法可于早期无损伤地发现椎间盘退变。     

腰椎间盘退变的流行病学和遗传学研究进展

在过去十年中，随着相关研究的不断深入，人们对椎间盘退变及其病因的认识有了巨大的进步。此前，人们认为身体的过重负荷，尤其是与职业相关的负荷是椎间盘退变的主要危险因素。椎间盘组织退变的过程被认为是一个不断磨损的过程，椎间盘营养状况不稳定加重了其进展。然而，在对双胞胎椎间盘退变的研究中发现，腰椎过大的体力负荷，尤其是与职业或者运动有关的腰椎负荷过大在椎间盘退变的过程中只起到一个很小的作用。新近的研究发现，遗传因素对椎间盘退变的过程影响很大，可用以解释成年人群中发生率高达74％的差异。自1998年开始，一些和腰椎间盘退变相关的基因型相继得到确认，这使遗传作用得到证实。此方面的研究，能够使我们更好地理解椎间盘退变的生物学机制，包括基因和环境因素间的特异性相互作用。与研究中使用DNA分析技术相比，使用表型或定义和测量来研究椎间盘退变和遗传学受到更多限制，标准的公认的椎间盘退变的定义尚未明确。常用的各种评价椎间盘退变程度的方法都是按照定性来进行轻重排序的，缺乏精确性。尽管椎间盘退变常见，但其特殊症状的普遍性还不清楚。通过对正常人和腰痛患者的流行病学研究可以评估椎间盘退变的各种症状，其范围极大。椎间盘退变的发生率有很大的差异，原因主要是缺乏统一的定义和评价标准，这阻碍了对椎间盘退变的流行病学研究。[编者按]     

Ⅱ型糖尿病与腰椎间盘退变的相关性

目的 :探讨Ⅱ型糖尿病(DM)与腰椎间盘退变的相关性。方法 :选择2013年因腰腿痛至我院脊柱外科门诊就诊并满足入选标准的390例50~60岁患者,详细记录患者DM病史,其中非DM患者123例(非DM组)、血糖控制较好患者140例(A组),血糖控制较差DM患者127例(B组);A组中DM≤10年68例(A1组),DM10年72例(A2组);B组中DM≤10年60例(B1组),DM10年67例(B2组)。用Pfirrmann评分系统对各组患者各节段腰椎间盘退变程度进行评分,用SPSS 19.0统计分析DM与腰椎间盘退变程度的相关性。结果:各组资料均服从正态分布(P0.05)。各组间一般资料无显著性差异(P0.05)。在L1/2~L5/S1每节段上,A1组Pfirrmann评分与非DM组无显著性差异(P0.05);A2、B1及B2组的Pfirrmann评分显著高于非DM组(P0.05)。A2、B2组Pfirrmann评分显著较A1、B1组高(P0.05);B1、B2组Pfirrmann评分均较A1、A2组高(P0.05)。在A、B组中,L1/2~L5/S1每一节段上腰椎间盘退变程度与DM病程呈显著性正相关(P0.05)。结论 :DM10年及血糖控制不良是腰椎间盘退变的危险因素,腰椎间盘退变程度与DM病程呈正相关。     

MRI diagnosis of intervertebral disk disease

Magnetic resonance imaging (MRI) is the leading diagnostic procedure for disk pathology and has overtaken other imaging modalities in frequency of use. However, one must be cautious not to overinterpret small abnormalities that are also frequent in asymptomatic subjects. There is conflicting evidence about the correlation of high-intensity zones with clinical symptoms. Bulging disks and protrusions are a common finding in asymptomatic individuals, whilst extrusions are almost always accompanied by back pain and sciatica. In patients with back pain or sciatica, MRI is indicated after failure of conservative management or neurological deterioration. Contrast-enhanced MRI is well suited to differentiate a recurrent disk extrusion from epidural fibrosis. In all cases suspicious of tumor or infection, MRI is indicated as a first-line investigation. The indications and pitfalls of the state of the art of MRI are delineated in this article.     

MRI classification of lumbar herniated intervertebral disc.

A consecutive series of 28 patients with lumbar herniated intervertebral disc (HIVD) who exhibited positive magnetic resonance imaging (MRI) findings was analyzed and compared with operative findings to define the type of disc herniation. This prospective study showed that the overall accuracy of MRI in predicting the types of HIVD was 80.6%. Proton density image was the most helpful in differentiating protruded discs from extruded ones. Disruption of "posterior longitudinal ligament line," defined on T2-weighted sagittal image, was reliable in differentiating a transligamentous disc from subligamentous one. Sequestered disc could be more accurately diagnosed with Gadolinium-DTPA enhancement, which showed anterior rim enhancement of the sequestered portion on T1-weighted axial image.     

Diagnostic tools and imaging methods in intervertebral disk degeneration

Low back pain has a negative impact on the economy and society. Intervertebral disk degeneration is linked to the occurrence of low back pain. MRI provides three-dimensional morphologic and biochemical information regarding the status of the disk. This article reviews new and evolving MRI disk-imaging techniques, including grading, relaxation-time measurements, diffusion, and contrast perfusion. In addition, high-resolution magic-angle spinning methods to correlate in vitro disk degeneration (with pain, etc) and in vivo spectroscopic results are discussed. With the potential for morphologic and biochemical characterization of the intervertebral disk, MRI shows promise as a tool to quantitatively assess disk health.     

经皮内窥镜下射频消融术治疗腰椎间盘突出症

目的:探讨经皮内窥镜下射频消融术治疗腰椎间盘突出症的安全性和疗效。方法:58例确诊为单纯性腰椎间盘突出症患者(其中L4/5突出44例,L5/S1突出13例,L3/4突出1例),在C型臂X光机透视监视下,采用经皮穿刺技术将同轴椎间盘内窥镜置入椎间盘内,摘除部分髓核后,在直视下采用ELLMAN射频机的双极可弯曲电极行髓核组织消融,完全去除镜下所见髓核组织。结果:采用MacNab标准评定,58例患者随访1~8个月,显效36例(62%),有效16例(28%),无效6例(10%),有效率为90%。所有病例均无严重并发症发生。结论:经皮内窥镜下射频消融术治疗单纯性腰椎间盘突出症安全、有效。     

Tissue engineering for intervertebral disk degeneration

Many challenges confront intervertebral disk engineering owing to complexity and the presence of extraordinary stresses. Rebuilding a disk of native function could be useful for removal of the symptoms and correction of altered spine kinematics. Improvement in understanding of disk properties and techniques for disk engineering brings promise to the fabrication of a functional motion segment for the treatment of disk degeneration. Increasing sophistication of techniques available in biomedical sciences will bring its application into clinics. This review provides an account of current progress and challenges of intervertebral disk bioengineering and discusses means to move forward and toward bedside translation.     

Gene therapy for intervertebral disk degeneration

Intervertebral disk degeneration is a common and potentially debilitating disease process affecting millions of Americans and other populations each year. Current treatments address resultant symptoms and not the underlying pathophysiology of disease. This has spawned the development of biologic treatments, such as gene therapy, which attempt to correct the imbalance between catabolism and anabolism within degenerating disk cells. The identification of therapeutic genes and development of successful delivery systems have resulted in significant advances in this novel treatment. Continued investigation of the pathophysiology of disk degeneration, however, and safety mechanisms for the application of gene therapy are required for clinical translation.     

Thoracic intervertebral disk prolapse

Prolapse the of thoracic intervertebral discs is very rare, and the symptoms are extremely ambiguous. If intradisk calcification can be seen in the X-ray pictures, a tentative diagnosis of thoracic intervertebral disc prolapse is possible, provided there are typical neurological deficits. Spinal computerized tomography is the best method of diagnosis, if it is possible to determine the segment level. Prolapse of the thoracic intervertebral disc must be operated upon if there are clinical signs. The operative results of laminectomy are poor; dorsolateral or ventrolateral surgical approaches have a much better prognosis.