[1]汪小健,李少广,王彭禾,等.MRI腰椎间盘高信号区及其在椎间盘源性腰痛诊治中应用的研究进展[J].中医正骨,2020,32(05):31-34.
点击复制

MRI腰椎间盘高信号区及其在椎间盘源性腰痛诊治中应用的研究进展()
分享到:

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第32卷
期数:
2020年05期
页码:
31-34
栏目:
综 述
出版日期:
2020-05-20

文章信息/Info

作者:
汪小健1李少广1王彭禾1童培建2
(1.浙江中医药大学第一临床医学院,浙江 杭州 310053; 2.浙江省中医院,浙江 杭州 310006)
关键词:
腰痛 椎间盘 磁共振成像 综述
摘要:
MRI腰椎间盘高信号区(high-intensity zone,HIZ)曾被认为是诊断椎间盘源性腰痛(discogenic low back pain,DLBP)的一个重要征象,但近年来的研究发现腰椎间盘HIZ也可见于正常人的MRI,这使得其在DLBP诊治中的应用价值产生了争议。本文介绍了MRI腰椎间盘HIZ的概念、出现的位置与分型、受磁场强度的影响及其所对应的病理变化,对MRI腰椎间盘HIZ在DLBP诊治中的应用进行了综述。

参考文献/References:

[1] 沈兴潮,夏炳江,凌义龙,等.五福饮加减治疗盘源性腰痛的临床研究[J].中医正骨,2020,32(2):23-29.
[2] HOY D,BAIN C,WILLIAMS G,et al.A systematic review of the global prevalence of low back pain[J].Arthritis Rheum,2012,64(6):2028-2037.
[3] DIELEMAN J L,BARAL R,BIRGER M,et al.US spending on personal health care and public health,1996-2013[J].Jama,2016,316(24):2627-2646.
[4] GEURTS J W,WILLEMS P C,KALLEWAARD J W,et al.The impact of chronic discogenic low back pain:costs and patients’ burden[J].Pain Res Manag,2018,2018:4696180.
[5] MANCHIKANTI L,SOIN A,BENYAMIN R M,et al.An update of the systematic appraisal of the accuracy and utility of discography in chronic spinal pain[J].Pain Physician,2018,21(2):91-110.
[6] PENG B G.Pathophysiology,diagnosis,and treatment of discogenic low back pain[J].World J Orthop,2013,4(2):42-52.
[7] 赵凤东,陈欢欢,苏优乐图,等.腰椎椎间盘后方高信号区的临床意义[J].中华骨科杂志,2014,34(7):756-761.
[8] SHAN Z,CHEN H,LIU J,et al.Does the high-intensity zone(HIZ)of lumbar Intervertebral discs always represent an annular fissure?[J].Eur Radiol,2017,27(3):1267-1276.
[9] JHA S C,TAKATA Y,ABE M,et al.High intensity zone in lumbar spine and its correlation with disc degeneration[J].J Med Invest,2017,64(1.2):39-42.
[10] TAKEUCHI M,NAGAMACHI A,ADACHI K,et al.Prevalence of high-intensity zones in the lumbar spine according to age and their correlation with other degenerative findings on magnetic resonance imaging[J].Spine Surg Relat Res,2018,2(4):299-303.
[11] 王子轩,胡有谷.腰椎间盘前缘与后缘高信号区的临床对照研究[J].中华外科杂志,2009,47(9):689-692.
[12] TERAGUCHI M,SAMARTZIS D,HASHIZUME H,et al.Classification of high intensity zones of the lumbar spine and their association with other spinal mri phenotypes:the wakayama spine study[J].PloS one,2016,11(9):e0160111.
[13] 李永明,张向华,曹德生,等.腰椎间盘HIZ的低场MRI表现[J].甘肃医药,2017,36(1):39-41.
[14] PANDE K C,KHURJEKAR K,KANIKDALEY V.Correlation of low back pain to a high-intensity zone of the lumbar disc in Indian patients[J].J Orthop Surg(Hong Kong),2009,17(2):190-193.
[15] 王扬生,陈其昕,金群华,等.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.
[16] 彭宝淦,侯树勋,吴闻文,等.腰椎间盘MRI高信号区的组织病理学特点和临床意义[J].中华骨科杂志,2005,25(5):284-288.
[17] PENG B,CHEN J,KUANG Z,et al.Expression and role of connective tissue growth factor in painful disc fibrosis and degeneration[J].Spine(Phila Pa 1976),2009,34(5):E178-182.
[18] HAYASHI S,TAIRA A,INOUE G,et al.TNF-alpha in nucleus pulposus induces sensory nerve growth:a study of the mechanism of discogenic low back pain using TNF-alpha-deficient mice[J].Spine(Phila Pa 1976),2008,33(14):1542-1546.
[19] 彭宝淦,吴闻文,侯树勋,等.椎间盘源性下腰痛的发病机制[J].中华外科杂志,2004,42(12):19-23.
[20] CHOI Y S.Pathophysiology of degenerative disc disease[J].Asian Spine J,2009,3(1):39-44.
[21] 任东风,侯树勋,吴文闻,等.TNF-α和PGP9.5在椎间盘源性腰痛患者椎间盘MRI高信号区中的表达[J].中国脊柱脊髓杂志,2009,19(10):725-728.
[22] YANG G,LIAO W,SHEN M,et al.Insight into neural mechanisms underlying discogenic back pain[J].J Int Med Res,2018,46(11):4427-4436.
[23] WANG H,LI Z,ZHANG C,et al.Correlation between high-intensity zone on MRI and discography in patients with low back pain[J].Medicine(Baltimore),2017,96(30):e7222.
[24] GRUBER H E,RHYNE A L 3rd,HANSEN K J,et al.Deleterious effects of discography radiocontrast solution on human annulus cell in vitro:changes in cell viability,proliferation,and apoptosis in exposed cells[J].Spine J,2012,12(4):329-335.
[25] KIM K H,PARK J Y,PARK H S,et al.Which iodinated contrast media is the least cytotoxic to human disc cells?[J].Spine J,2015,15(5):1021-1027.
[26] KARAARSLAN N,YILMAZ I,SIRIN D Y,et al.Pregabalin treatment for neuropathic pain may damage intervertebral disc tissue[J].Exp Ther Med,2018,16(2):1259-1265.
[27] ZHAO L,MANCHIKANTI L,KAYE A D,et al.Treatment of discogenic low back pain:current treatment strategies and future options-a literature review[J].Curr Pain Headache Rep,2019,23(11):86.
[28] PROVENZANO D A.Diagnostic discography:what is the clinical utility?[J].Curr Pain Headache Rep,2012,16(1):26-34.
[29] HANCOCK M J,MAHER C G,LATIMER J,et al.Systematic review of tests to identify the disc,SIJ or facet joint as the source of low back pain[J].Eur Spine J,2007,16(10):1539-1550.
[30] FUJII K,YAMAZAKI M,KANG J D,et al.Discogenic back pain:literature review of definition,diagnosis,and treatment[J].JBMR Plus,2019,3(5):e10180.
[31] LIU C,CAI H X,ZHANG J F,et al.Quantitative estimation of the high-intensity zone in the lumbar spine:comparison between the symptomatic and asymptomatic population[J].Spine J,2014,14(3):391-396.
[32] ANDERSON J T,HAAS A R,PERCY R,et al.Chronic opioid therapy after lumbar fusion surgery for degenerative disc disease in a workers’ compensation setting[J].Spine(Phila Pa 1976),2015,40(22):1775-1784.
[33] WILKENS P,SCHEEL I B,GRUNDNES O,et al.Effect of glucosamine on pain-related disability in patients with chronic low back pain and degenerative lumbar osteoarthritis:a randomized controlled trial[J].Jama,2010,304(1):45-52.
[34] 龚萍,汪礼军,杨智,等.电针治疗伴HIZ椎间盘源性腰痛的临床观察[J].重庆医学,2016,45(22):3139-3140.
[35] 胡辉林,刘雄文,黎庆初,等.伴HIZ的椎间盘源性腰痛的诊断与治疗体会[J].颈腰痛杂志,2015,36(3):53-56.
[36] TOBERT D G,ANTOCI V,PATEL S P,et al.Adjacent segment disease in the cervical and lumbar spine[J].Clin Spine Surg,2017,30(3):94-101.
[37] BYDON M,DE LA GARZA-RAMOS R,MACKI M,et al.Lumbar fusion versus nonoperative management for treatment of discogenic low back pain:a systematic review and meta-analysis of randomized controlled trials[J].J Spinal Disord Tech,2014,27(5):297-304.
[38] ERBAS Y C,PUSAT S,ERDOGAN E.Percutaneous laser disc decompression:retrospective analysis of 197 cases and review of the literature[J].Turk Neurosurg,2015,25(5):766-770.
[39] WELCH W C,GERSZTEN P C.Alternative strategies for lumbar discectomy:intradiscal electrothermy and nucleoplasty[J].Neurosurg Focus,2002,13(2):E7.
[40] 闫京奎,刘智鹏,赵家瑜,等.射频消融微创治疗椎间盘源性下腰痛的疗效观察[J].实用骨科杂志,2010,16(9):46-47.

相似文献/References:

[1]宁兴明,伍亮,王廷,等.五禽戏配合核心肌力训练治疗非特异性腰痛的临床研究[J].中医正骨,2015,27(11):25.
 NING Xingming,WU Liang,WANG Ting,et al.Clinical study on five mimic-animal boxing combined with core muscular strength exercise for the treatment of nonspecific low back pain[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(05):25.
[2]金立昆,齐越峰,唐可,等.中药离子导入联合腰背部功能锻炼治疗 非特异性腰痛的临床研究[J].中医正骨,2016,28(01):20.
 JIN Likun,QI Yuefeng,TANG Ke,et al.Clinical study on iontophoresis of traditional Chinese medicine combined with lower back functional exercise for treatment of non-specific low back pain[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(05):20.
[3]杨勇,王雷生,张娟.经椎关节突关节温针治疗腰椎关节突关节源性腰痛[J].中医正骨,2016,28(02):67.
[4]袁启令,刘亮,马江涛,等.针刺治疗慢性非特异性腰痛的临床研究[J].中医正骨,2016,28(06):12.
 YUAN Qiling,LIU Liang,MA Jiangtao,et al.A clinical study of acupuncture therapy for treatment of chronic nonspecific low back pain[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(05):12.
[5]王栋,潘浩,朱杭,等.强筋壮骨祛风合剂对髓核致炎大鼠背根神经节中3型酸敏感离子通道的影响[J].中医正骨,2017,29(01):18.
 WANG Dong,PAN Hao,ZHU Hang,et al.Effect of Qiangjin Zhuanggu Qufeng Heji on acid-sensing ion channel 3 of dorsal root ganglia in rats with inflammation caused by nucleus pulposus[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(05):18.
[6]刘艳,谢新立,杜彪,等.SPECT全身骨显像在儿童和青少年腰痛诊断中的价值[J].中医正骨,2017,29(04):42.
[7]吴婷婷,杨京辉,汪亚群,等.针刺联合太极拳训练治疗慢性非特异性腰痛的临床研究[J].中医正骨,2017,29(06):32.
 WU Tingting,YANG Jinghui,WANG Yaqun,et al.Clinical study on acupuncture therapy combined with Taijiquan(太极拳)exercise for treatment of chronic nonspecific low back pain[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(05):32.
[8]熊国星,王鑫,程元辉,等.动推疗法与单纯推拿疗法治疗慢性非特异性腰痛的近期疗效对比研究[J].中医正骨,2017,29(11):33.
 XIONG Guoxing,WANG Xin,CHENG Yuanhui,et al.A comparative study of short-term clinical curative effect of massage during exercise versus monotherapy of TUINA for treatment of chronic nonspecific low back pain[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(05):33.
[9]李展新,刘建航,李锦威,等.韦氏脊柱整治手法结合核心肌群训练治疗非职业高尔夫运动者非特异性腰痛[J].中医正骨,2018,30(04):13.
 LI Zhanxin,LIU Jianhang,LI Jinwei,et al.Wei's spinal remediation manipulation combined with core muscle training for treatment of nonspecific low back pain in non-professional golfers[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(05):13.
[10]王雷生,杨勇.经膀胱经腧穴透刺关节突关节温针灸治疗腰椎关节突关节源性腰痛的临床研究[J].中医正骨,2018,30(05):6.
 WANG Leisheng,YANG Yong.A clinical study of acupuncture at zygapophysial joint with warmed needle that reaches there by penetrating acupoint of bladder meridian for treatment of low back pain originated from lumbar zygapophysial joints[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2018,30(05):6.
[11]沈锋,刘观燚,胡利华,等.椎间盘内注射亚甲蓝治疗椎间盘源性腰痛的研究进展[J].中医正骨,2021,33(01):48.
[12]李鉴,李德光,耿春梅,等.以右下肢放射痛为主要临床表现的椎间盘源性腰痛1例[J].中医正骨,2023,35(08):79.

备注/Memo

备注/Memo:
(收稿日期:2020-01-20 本文编辑:杨雅)通讯作者:童培建 E-mail:tongpeijian@163.com
更新日期/Last Update: 2020-08-15