基于腰椎间盘退变的脊柱稳定性改变的MRI研究进展

来源 :中华骨科杂志 | 被引量 : 0次 | 上传用户:jessieharbin
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腰椎间盘是位于两个相邻椎体之间的圆盘状纤维软骨,是维持脊柱稳定性的重要解剖结构。目前,维持脊柱稳定性的解剖结构分为被动亚系、主动亚系和神经控制亚系,称为“三亚系模型”,腰椎间盘退变(intervertebral disc degeneration,IVDD)会引起该模型其它组织的病理学改变,且彼此相互作用导致脊柱稳定性下降,是下腰痛最常见的原因。IVDD患者常伴有椎小关节及韧带的退变、邻近椎体Modic改变、椎体血流量减少、椎旁肌肉脂肪浸润增加、神经轴向牵拉损伤的代偿性减少等。磁共振成像(magnetic resonance imaging,MRI)是评估脊柱稳定性首选的影像学方法,常规MRI能完整显示IVDD患者三亚系模型相关组织形态学变化,MRI功能成像能定量分析其病理生理学变化的程度。本文综述IVDD患者腰椎间盘、椎小关节、韧带、椎体、肌肉、神经的MRI形态学及定量值变化,阐述IVDD引起脊柱稳定性改变的相关机制,旨在为下腰痛患者的精准诊疗提供更全面的信息。“,”The lumbar intervertebral disc is a disc-shaped fibrocartilaginous structure located between the vertebral bodies and acts as an important anatomical structure in the spine for stability. The spinal stability system consists of three subsystems: passive subsystem, active subsystem, and neural control subsystem. Lumbar intervertebral disc degeneration (IVDD), the leading cause of low back pain, induces pathological changes in other tissues of the three subsystems and interacts to degrade spinal stability. IVDD is commonly accompanied by degeneration of facet joint and ligament, Modic change, decreased vertebral blood flow, increased paraspinal muscle fat infiltration, reduced axial tension injury of the nerve, et al. Magnetic resonance imaging (MRI) is the preferred imaging modality for assessing spinal stability. Conventional MRI could completely demonstrate the morphological changes of the three subsystems in IVDD patients, and functional MRI could quantitatively evaluate the degree of pathophysiological change. We summarized the morphological and functional changes of MRI in lumbar intervertebral disc, facet joint, ligament, vertebral body, paraspinal muscle, and nerve of patients with IVDD, and then analysed the changes in spinal stability caused by IVDD, aiming to provide more imaging information for improving diagnosis accuracy and developing appropriate management of patients with low back pain.
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