中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (17): 3167-3170.doi: 10.3969/j.issn.1673-8225.2010.17.032

• 骨与关节学术探讨 academic discussion of the bone and joint • 上一篇    下一篇

不同脊柱植入材料临床相关应用及磁共振成像检查金属内置物的伪影分析

肖占州   

  1. 锦州市第二医院放射科，辽宁省锦州市  121003
  • 出版日期:2010-04-23 发布日期:2010-04-23
  • 作者简介:肖占州，男，1968年生，辽宁省锦州市人，满族，1995年锦州医学院毕业，副主任医师，主要从事影像诊断的研究。

Clinical application of various spinal implant materials and shadow analysis of metal implants by magnetic resonance imaging

Xiao Zhan-zhou   

  1. Department of Radiology, Jinzhou Second Hospital, Jinzhou   121003, Liaoning Province, China
  • Online:2010-04-23 Published:2010-04-23
  • About author:Xiao Zhan-zhou, Associate chief physician, Department of Radiology, Jinzhou Second Hospital, Jinzhou 121003, Liaoning Province, China

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584

被引次数

10

摘要：

目的：对不同脊柱植入材料临床相关应用进行归纳总结，探讨脊柱，四肢植入内固定物后对磁共振成像的影响。
方法：第一作者应用计算机检索PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)，检索关键词“spinal，implants，MRI”，限定语言种类为English；同时检索CNKI数据库(www.cnki.net/index.htm)，检索关键词“脊柱，植入体，磁共振成像”，限定语言种类为中文。选择文章内容与脊柱植入物及磁共振成像相关，同一领域文献则选择近期发表或发表在权威杂志文章。排除重复及较陈旧的文献。共纳入24篇文献。
结果：在脊柱重建过程中，移植骨常使用自体髂骨块和腓骨。但由于移植骨的获取而导致20%~30%的供骨区发生并发症，以及长期的供区疼痛。为避免供区并发症的发生，常采用同种异体骨和钛网取代自体骨移植，但同种异体骨移植又容易有融合率低和疾病传播的风险，所以钛网植骨作为一种新的置入方式逐步发展起来。磁共振成像检测显示镍，钴和铁伪影大，钛合金伪影最小。在矢状面T1和T2加权和轴位T1加权像上均可清晰显示脊髓和椎管内的结构。椎板勾的伪影较大，会影响对椎板附近结构的观察，在深入椎管内部分对脊髓观察有影响。椎弓根螺钉伪影较大，主要会影响对邻近部位椎管侧方、椎动脉、椎间孔、脊神经和后外突出椎间盘等的观察。
结论：到目前仍无公认的满意结果和统一的标准。多根据患者的病情、经济情况、不同的条件及医生的技术和经验而有所不同。而钛金属是最佳做磁共振成像的金属植入物，尽量使植入物长轴与主磁场一致，脊柱有钛合金植入体时最好用快速自旋回波，用短回波时间，尽量减少TE，在诊断时候应考虑伪影，以去伪存真，结合临床表现做出正确诊断。

关键词: 金属植入物, 钛, 内置物, 核磁共振, 伪影

Abstract:

OBJECTIVE: To summarize clinical application of various spinal implants to explore the effect of fixator implantation in spine or limbs on MRI.
METHODS: A computer-based online search of PubMed database (http://www.ncbi.nlm.nih.gov/PubMed) and CNKI (www.cnki.net/index.htm) was performed to search related articles with the key words “spinal, implants, MRI” in English and Chinese. Articles related with spinal implants and MRI were selected, published in recently or in authoritative journals in the same field. Repetitive or outdated articles were excluded. Finally, 24 articles were included.
RESULTS: During spinal reconstruction, autologous iliac bone block and fibula have been commonly used as bone graft. However, bone graft acquisition frequently causes 20%-30% donor region complication and long-term donor pain. Therefore, allogenic bone and titanium mesh have been used to replace autologous bone graft. However, due to low fusion rate and disease transmission caused by allogenic bone, titanium mesh bone graft has become a focus. MRI detection shows that nickel, cobalt and iron have large shadow, and titanium alloy has the smallest shadow. Spinal cord and intraspinal structures are clearly displayed on sagittal T1 and T2 weighted and axial T1-weighted images. Vertebral plate clamp has large shadow, which affects observation of structures around the vertebral plate and the intraspinal structures. Pedicle screws have large shadow, which mainly affects observations of lateral vertebral canal, vertebral artery, intervertebral foramen, spinal nerve and posterior-laterally exserted intervertebral disk.
CONCLUSION: There remain no uniform standards or favorable results, which are varied in patients with different disease conditions, economic conditions, and in different doctors. Titanium is the best implant for MRI, and implant long axis should be accordant with main field. Titanium alloy implant in the spine should utilize fast spin echo, short echo time, and minimize TE. The diagnosis should consider the shadow in combination with clinical manifestations.

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