| 下腰痛患者MRI纤维环高信号区的病理特点及其临床意义 |
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Received:January 26, 2005
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| 作者 | Author | 单位 | Unit | E-Mail |
| 王扬生 |
WANG Yang-sheng |
鄞州人民医院骨科,浙江宁波315040 |
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| 陈其昕 |
CHEN Qi-xin |
浙江大学医学院附属第二医院骨科 浙江杭州310009 |
Department of O rthopaedics,the Second Hospital of Medic al College of Zhejiang University, Hangzhou 310009,Zhejiang,China |
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| 金群华 |
JIN Qun-hu a |
宁夏医学院附属医院骨科 |
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| 陈维善 |
C HEN Wei-shan |
浙江大学医学院附属第二医院骨科 浙江杭州310009 |
Department of O rthopaedics,the Second Hospital of Medic al College of Zhejiang University, Hangzhou 310009,Zhejiang,China |
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| 楼才俊 |
LOU Cai-jun |
浙江大学医学院附属第二医院骨科 浙江杭州310009 |
Department of O rthopaedics,the Second Hospital of Medic al College of Zhejiang University, Hangzhou 310009,Zhejiang,China |
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| 期刊信息：《中国骨伤》2005年18卷，第9期，第517-520页 |
| DOI：doi:10.3969/j.issn.1003-0034.yyyy.nn.zzz |
| 基金项目:浙江省科学技术厅资助项目(编号:001103273) |
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目的:探讨腰椎MRI纤维环高信号区(high-intensityzone,HIZ)的病理形态学变化及其对下腰痛疾病的临床意义。
方法:观察经手术治疗的101例(103个椎间盘)下腰痛患者术前腰椎MRIT2WI,发现36例(36个椎间盘)纤维环后部高信号区(HIZ),65例(67个椎间盘)纤维环后部无高信号。手术取病变椎间盘后外侧纤维环,HE染色后进行病理形态学观察,并与正常对照组进行比较。
结果:病理形态学检查结果显示下腰痛组纤维环层明显变薄,胶原纤维细胞少,排列不规则,分布不均匀。其中,高信号区(HIZ)组除一般表现外尚发现具特征性的三类变化:①纤维环中出现自内向外的血管腔隙样变化(血管腔内有或无红细胞),伴炎性细胞主要是淋巴细胞的浸润,并且有胶原纤维细胞的大量增生。②纤维环中增生的胶原纤维排列紊乱,肿胀明显,形成结节样团状结构。③纤维环中出现退变和增生并存的软骨样细胞,周围水肿,无淋巴细胞浸润。此3种病理变化经计数资料的χ2检验与无高信号区组(非HIZ组)比较差异有显著性意义。比较HIZ组和非HIZ组的临床表现发现:HIZ组L4,5节段常见;腿痛多限于大腿部;感觉、运动、反射改变和直腿抬高试验均较非HIZ组不典型。
结论:腰椎MRIT2WI纤维环出现的高信号区(HIZ)是椎间盘内部结构病理改变在影像学上的一种较具有特异性的表现;有HIZ表现的下腰痛是一类具有自身特点的腰痛类疾病。 |
| [关键词]:腰痛 磁共振成像 病理学 |
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| Pathological characteristics of high-intensity zone in lumbar disc annulus fibrosus on MRI and its clinical significance in patients of low back pain |
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Abstract:
Objective: To explore pathomorphologic variation and clinical sigi nificance of hig h-intensity zone (HIZ) in lumbar interve rtebral disc posterior annulus fibrosus on MRI in the patients with low back pai n.
Methods: The preoperative sagittal T2-weighted spin-ech o magne tic resonance imaging (MRI) sequences we re investigated in 101 patients (103 discs ),who suffered from low back pain and underwent oper ation.Among them,there were 36 patients (36 discs) with high-intensity zone (HIZ) in their posterior annulus f ibrosus,and 65 patients (67 discs) without such appearances. The posterior annulus fibros us was obtained in the surgery and stained with HE f or pathomorphologic examination,then compared w i th the normal discs obtained from fresh young cadavers (two hours after death).
Results: Pathomorphotogic examination indicated that the number of collagenous fibrocytes in the patients with low back pain was less,the a rrangement much more irregular,and the t hickness of annlus fibrosus thinner than the normal ones.Furthermore,pathologica l findings in patients with high-intensi ty zone (HIZ) revealed three characteris tics in fibrosus annulus:①capillary vess els with or without red c ells appeared through annulus fibrosus,w hich were surrounded by lymphocytes,and the collagenous fibrocytes hyperplasied measurably;②collagenous fibrocytes arr anged irregularly,and clustered into a lumping structure;③degenerative and prol iferative chond rocyte-like cells existed side by side a nd inserted in fibrosus annulus.There was statistica lly significant difference between HIZ and non- HIZ groups with χ 2 test. By comparing the clinical manifestation of two groups,it was found that high-intensity zone(HIZ) more often ap peared at L 4,5 discs;leg pain was oft en limited at the thigh;the pathologic reactions of sensatio n,motion,reflection and raising straight leg test in HIZ group were not so obvi o us as compared with non-HIZ group.
Conclusion: High-intensity zone in posterior annulus fibrosus on MRI is the indication of in trinsic pathological changes in interver tebral discs;low back pain with high-int ensity zone appearances is a kind of diseas e with its own characteristics. |
| KEYWORDS:Low back pain Magnetic resonance imaging Pathology |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 王扬生,陈其昕,金群华,陈维善,楼才俊.下腰痛患者MRI纤维环高信号区的病理特点及其临床意义[J].中国骨伤,2005,18(9):517~520 |
| 英文格式: | WANG Yang-sheng,CHEN Qi-xin,JIN Qun-hu a,C HEN Wei-shan,LOU Cai-jun.Pathological characteristics of high-intensity zone in lumbar disc annulus fibrosus on MRI and its clinical significance in patients of low back pain[J].zhongguo gu shang / China J Orthop Trauma ,2005,18(9):517~520 |
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