同种异体颈椎间盘移植术后核磁共振成像分析

目的观察评估颈椎异体椎间盘移植后核磁共振成像的特征性表现，进一步了解移植椎间盘的生物学性能。方法13例患者因颈椎间盘突出（退变性、外伤性）行椎间盘移植手术，平均年龄45±8．1岁，术后平均6．4±3．4年随访。分别于术前、术后及定期进行临床JOA评分及颈椎MRI扫描。利用MRI工作站软件测量病变节段颈髓最狭窄处面积；依据改良Schneiderman’S灰度值评分标准，测量并计算移植椎间盘信号强度并予比较分析；另外，在本次研究终末随访时行钆喷酸增强MRI扫描，通过对比分析椎间盘内信号强度的变化，进一步了解移植椎间盘营养通道的建立情况及其存活状态。结果所有病例均获得了充分的颈椎管减压，病变节段脊髓横截面积由术前（112．7±20．5）ram。增大为072．2±29．6）mm。沪〈0．05），相应颈椎退变病例JOA分值由术前10．7±1．7增加为随访时15．1±1．5（P〈0．05）。与相邻正常椎间盘信号值比较，5例移植椎间盘信号值明显下降，1例移植节段发生了自发性融合。移植椎间盘内髓核T1像灰度分值呈降低趋势，由术后即刻0．36±0．17降至随访时0．21±0．15（P〈0．05）。通过T1加权像测量钆剂增强后椎间盘信号强度，移植间盘髓核T1像灰度分值由0．46±0．19增加至0．59±0．24（P〈0．05）。结论同种异体椎间盘移植是治疗颈椎间盘突出疾患的一种有效手段，安全可靠；虽然长期随访移植椎间盘发生了不同程度的退变，但术后椎间盘可以存活并有效重建其营养通道，进而参与宿主的机体代谢活动并承担一定的生理功能。

MRI analysis after allogeneic cervical intervertebral disc transplantation

Objective To observe and evaluate the characteristic performance of MRI after allogeneic cervical intervertebral disc transplantation, and further to investigate the biological properties of the transplanted discs. Methods 13 patients with degenerative or traumatic cervical disc herniation underwent disc transplantation, among whom the average age was 45＋8.1 years old, and the average postoperative follow-up period was 6.4±3.4 years. The clinical Japanese Orthopedic Association （JOA） scoring system and cervical MRI scanning were used preoperatively, postoperatively and at each follow-up time point respectively. MRI workstation software was used to measure the narrowest area on lesion segments of the cervical spinal cord. The modified Schneiderman＇s grayscale assessment system was applied to measure and calculate the signal intensity of the transplanted discs, and the results were further compared and analyzed. In addition, gadopentetic acid enhanced MRI scanning was also used to observe the nutrition passage across the transplanted discs and its surviving condition through comparing and analyzing the signal intensity changes in the latest follow-up. Results All patients had sufficient cervical spinal canal compression, with the cross-sectional area on lesion segments of the spinal cord improved from （112.7＋20.5）mm2 preoperatively to （172.2±29.6）mm2 （P〈0.05）. Accordingly, the JOA score in the patients with degenerative cervical disc herniation was improved from 10.7± 1.7 preoperatively to 15.1 ± 1.5 during the follow-up （P〈0.05）. Comparing with normal signal intensityon the adjacent segments, the signal intensity of the transplanted discs in 5 cases obviously decreased, and 1 transplanted segment had the spontaneous fusion. T2 MRI of the nucleus pulposus in the transplanted discs showed that the grayscale value decreased from 0.36±0.17 postoperatively to 0.21±0.15 during the follow-up （P〈0.05）. Tm enhanced MRI showed the gadopentetic enhanced disc signal intensity, and the grayscale value of T1 MRI of the nucleus pulposus in the transplanted discs increased from 0.46±0.19 to 0.59==0.24 （P〈0.05）. Conclusions Allogenic disc transplantation is one of the effective and safe methods in treating cervical disc herniation. Although degeneration in different degrees occurs in the transplanted discs in the long-term follow-up, the discs can still be alive and rebuild the nutrition passagesuccessfully, which is the evidence for the discs in participating in the metabolism of the host body and having certain biological function.