摘要
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。
Objective： To explore pathomorphologic variation and clinical siginificance of high-intensity zone （HIZ） in lumbar intervertebral disc posterior annulus fibrosus on MRI in the patients with low back pain. Methods：The preoperative sagittal T2-weighted spin-echo magnetic resonance imaging （MRI） sequences were investigated in 101 patients （ 103 discs）, who suffered from low back pain and underwent operation. Among them, there were 36 patients （36 discs） with high-intensity zone （HIZ） in their posterior annulus fibrosus,and 65 patients （67 discs） without such appearances. The posterior annulus fibrosus was obtained in the surgery and stained with HE for pathomorphologic examination, then compared with the normal discs obtained from fresh young cadavers （two hours after death）. Results： Pathomorphotogic examination indicated that the number of collagenous fibroeytes in the patients with low back pain was less, the arrangement much more irregular,and the thickness of annlus fibrosus thinner than the normal ones. Furthermore, pathological findings in patients with high-intensity zone （HIZ） revealed three characteristics in fibrosus annulus：①capillary vessels with or without red cells appeared through annulus fibrosus, which were surrounded by lymphocytes, and the coUagenous fibrocytes hyperplasied measurably;②coUagenous fibrocytes arranged irregularly, and clustered into a lumping structure;③degenerative and proliferative chondrocyte-like cells existed side by side and inserted in fibrosus annulus. There was statistically significant difference between HIZ and non-HIZ groups with x^2 test. By comparing the clinical manifestation of two groups, it was found that high-intensity zone（HIZ） more often appeared at L4,5 discs; leg pain was often limited at the thigh; the pathologic reactions of sensation,motion, reflection and raising straight leg test in HIZ gmup were not so obvious as compared with non-HIZ group.Conclusion：High-intensity zone in posterior annulus fibrosus on MRI is the indication of intrinsic pathological changes in intervertebral dises;low back pain with high-intensity zone appearances is a kind of disease with its own characteristics.
出处
《中国骨伤》
CAS
2005年第9期517-520,共4页
China Journal of Orthopaedics and Traumatology
基金
浙江省科学技术厅资助项目(编号:001103273)
