特发性脊柱侧凸椎旁肌组织Bcl-2蛋白表达及细胞凋亡的研究

背景：特发性脊柱侧凸的病因学尚不十分清楚，已有几位学者发现在特发性脊柱侧凸的产生与进展中椎旁肌肉可能是重要的致病因素之一，因此，椎旁肌在脊柱侧凸中作用已经成为研究热点。目的：本研究通过比较脊柱侧凸患者胸弯顶点处凸侧、凹侧椎旁肌的Bcl-2，Caspase-3及bcl-x表达的差异，以从分子生物学角度探讨椎旁肌在脊柱侧凸中的可能的作用机制。设计：随机对照研究。地点和对象：在北京协和医院骨科完成。对照组为胸腰椎爆裂骨折患者2例。研究组为胸椎侧凸畸形患者10例，男2例，女8例；年龄12-17岁(平均14．3岁)。平均Cobb角57．7&;#176;(范围450&;#176;-850&;#176;)。干预：手术中，于T6-T11椎体水平的侧弯顶椎水平取双侧椎旁肌部分组织甲醛固定，行苏木精-伊红(HE)染色；其余组织冰冻，进行免疫组织化学及Western印迹杂交。主要观察指标：①脊柱侧凸凸侧、凹侧椎旁肌组织中Bcl-2的表达。②椎旁肌组织肌纤维形态。③椎旁肌肌细胞的凋亡情况。结果：脊柱侧凸患者凸侧肌肉组织Bcl-2蛋白的表达量降低。脊柱侧凸患者及正常对照椎旁肌肉组织均存在个别细胞的凋亡，二者无明显差异。凸侧肌纤维比其凹侧及正常对照的肌纤维明显变细。结论：神经-肌肉异常所致的椎旁肌的不对称有可能是特发性脊柱侧凸发生发展的一个重要因素，而这种不对称很可能与Bcl-2表达不对称相关。     

先天性与特发性脊柱侧凸患者椎旁肌病理对比分析

目的探讨椎旁肌在脊柱侧凸发病中的作用。方法对手术中留取的37例脊柱侧凸患者（先天性12例、特发性25例）椎旁肌进行冰冻切片、肌肉组织病理染色，分析光镜下的病理改变。结果光镜下可见普遍存在椎旁肌肌源性改变（包括肌肉组织纤维化、肌纤维变性坏死等），但肌纤维再生现象极为少见。先天性脊柱侧凸患者椎旁肌纤维化主要表现为弥漫性改变，同时伴有明显肌纤维走行紊乱；特发性脊柱侧凸患者主要以局灶性且不伴有坏死的纤维化为主。1例先天性脊柱侧凸及4例特发性脊柱侧凸患者椎旁肌显示神经源性改变，其中4例曾经历侧凸矫正术。脊柱侧凸患者椎旁肌肌梭囊壁增厚，肌梭内有结缔组织浸润。结论先天性脊柱侧凸患者椎旁肌的病理与特发性脊柱侧凸患者存在一定的差异，可能在特发性脊柱侧凸的发病中起着特殊的作用。     

特发性脊柱侧凸椎旁肌组织中神经型及诱导型一氧化氮合酶表达的研究

背景特发性脊柱侧凸病因不清楚,目前关于其病因及发病机制存在诸多争论.椎旁肌在脊柱侧凸中作用已经成为研究热点.目的比较特发性脊柱侧凸胸椎椎旁肌肉中神经型一氧化氮合酶和诱导型一氧化氮合酶表达与定位.设计以诊断为依据设立对照的实验研究.地点与对象北京协和医院骨科收治胸椎侧凸畸形患者10例,其中男8例,女2例;平均年龄14岁.胸腰椎爆裂骨折患者2例做对照.干预手术中,于T6～T11椎体水平的侧弯顶椎水平取双侧椎旁肌,部分组织甲醛固定,行苏木精-伊红(HE)染色;其余组织冰冻,进行免疫组织化学及Western印迹杂交.主要观察指标脊柱侧凸患者及正常椎旁肌组织中神经型一氧化氮合酶和诱导型一氧化氮合酶的表达情况.?结果脊柱侧凸患者脊柱凸侧椎旁肌组织与凹侧椎旁肌组织和正常对照相比,神经型一氧化氮合酶的表达明显下调,诱导型一氧化氮合酶的表达也有所下调,但诱导型一氧化氮合酶表达总量较低.Western印迹检测得到同样的结果.结论脊柱侧凸患者双侧椎旁肌神经型一氧化氮合酶蛋白表达不均衡,可能与特发性脊柱侧凸发生存在密切关系,诱导型一氧化氮合酶可能在特发性脊柱侧凸的发生中不发挥作用.     

特发性脊柱侧凸患者椎旁肌结蛋白和波形蛋白的特征表达

目的:研究表明,结蛋白和波形蛋白可反映肌肉损伤再生的情况,同时结蛋白可反应肌力的大小。比较特发性和先天性脊柱侧凸患者顶椎处凹凸两侧椎旁肌形态和结蛋白及波行蛋白的表达,探讨椎旁肌在特发性脊柱侧凸发生发展中的作用。方法:①选择2005-07/2006-11间南方医科大学南方医院脊柱骨病科收治的部分特发性脊柱侧凸患者12例,Cobb角平均73.8°;先天性脊柱侧凸患者5例,Cobb角平均36.0°;腰椎间盘突出症患者2例和胸腰椎管内占位性病变患者3例作为正常对照。所有患者年龄均在10～20岁。②对脊柱侧凸患者顶椎凹凸两侧及正常对照组患者椎旁肌进行活检,术前均签署知情同意书。③采用光镜和电镜下观察椎旁肌的形态改变;SP法分别对光镜切片的结蛋白和波行蛋白进行免疫组织化学染色,在光镜下观察蛋白表达;应用图像分析系统测量结蛋白免疫组织化学染色后反应椎旁肌蛋白表达强弱的吸光度(A)。结果:22例患者全部进入结果分析。①椎旁肌组织形态:特发性脊柱侧凸患者椎旁肌在光镜及电镜下均有病变,凹侧椎旁肌病变较重,凸侧椎旁肌相对正常。②结蛋白免疫组织化学的阳性表达:结蛋白在各组椎旁肌中均有不同程度的表达,组间比较差别显著(P<0.01)。特发性脊柱侧凸及先天性脊柱侧凸患者椎旁肌在顶椎凸侧比正常组结蛋白表达稍强(0.2727±0.0478,0.2768±0.0372,0.2429±0.0272,P<0.05),特发性脊柱侧凸及先天性脊柱侧凸患者椎旁肌在顶椎凹侧相对于正常组表达减弱(0.1898±0.0258,0.1869±0.0306,0.2429±0.0272,P<0.05)。③波行蛋白免疫组织化学的阳性表达:各组间椎旁肌肌纤维内均无波形蛋白表达。特发性脊柱侧凸与先天性脊柱侧凸患者同侧椎旁肌两组间在形态和结蛋白及波行蛋白表达无明显差别(P>0.05)。结论:特发性脊柱侧凸患者椎旁肌内波形蛋白表达均为阴性,提示椎旁肌不存在再生现象。与先天性脊柱侧凸类似,特发性脊柱侧凸患者椎旁肌结蛋白表达凸侧增强及凹侧减弱为继发性改变。     

特发性脊柱侧凸椎旁肌组织中神经型及诱导型一氧化氮合酶表达的研究

背景：特发性脊柱侧凸病因不清楚，目前关于其病因及发病机制存在诸多争论。椎旁肌在脊柱侧凸中作用已经成为研究热点。目的：比较特发性脊柱侧凸胸椎椎旁肌肉中神经型一氧化氮合酶和诱导型一氧化氮合酶表达与定位。设计：以诊断为依据设立对照的实验研究。地点与对象：北京协和医院骨科收治胸椎侧凸畸形患者10例，其中男8例&;#183;女2例；平均年龄14岁。胸腰椎爆裂骨折患者2例做对照。干预：手术中，于T6～T11椎体水平的侧弯顶椎水平取双侧推旁肌，部分组织甲醛固定．行苏木精-伊红(HE)染色：其余组织冰冻．进行免疫组织化学及Western印迹杂交。主要观察指标：脊柱侧凸患者及正常椎旁肌组织中神经型一氧化氮合酶和诱导型一氧化氮合酶的表达情况。结果：脊柱侧凸息者脊柱凸侧椎旁肌组织与凹侧椎旁肌组织和正常对照相比，神经型一氧化氮合酶的表达明显下调，诱导型一氧化氮合酶的表达也有所下调．但诱导型一氧化氮合酶表达总量较低，Western印迹检测得到同样的结果。结论：脊柱侧凸患者双侧椎旁肌神经型一氧化氮合酶蛋白表达不均衡，可能与特发性脊柱侧凸发生存在密切关系．诱导型一氧化氮合酶可能在特发性脊柱侧凸的发生中不发挥作用。     

特发性脊柱侧凸的病因学研究:鸡脊柱侧凸模型椎旁肌中肌梭的形态学特征

目的观察鸡脊柱侧凸模型椎旁肌中肌梭结构、数量、密度及其分布,为特发性脊柱侧凸的病因提供理论依据. 方法对刚孵育出的鸡行松果体切除,获得脊柱侧凸动物模型;将鸡脊柱侧凸模型分为 Cobb角 10°～ 20°组及 Cobb角 >40°组,椎旁肌取下后切片,行 Masson三色染色,观察肌梭结构,对肌梭数量、密度进行统计学分析. 结果鸡脊柱侧凸模型椎旁肌中部分肌梭被囊呈"气球样变",梭内肌纤维有异常改变; Cobb角 10°～ 20°组肌梭密度为( 25± 5)个 /g肌肉. Cobb角 >40°组肌梭密度为( 23± 7)个 /g肌肉. 结论与正常对照组相比,鸡脊柱侧凸模型椎旁肌中部分肌梭结构异常,肌梭数量减少,密度降低.     

青少年特发性脊柱侧弯症患者椎旁肌表面肌电信号时域指标变化规律

目的:采用表面肌电图（sEMG）检测技术对青少年特发性脊柱侧弯症(AIS)患者脊柱旁凸、凹侧椎旁肌肌电活动时域指标变化规律进行初步探讨。方法:AIS患者25例,男7例,女18例,年龄11—21岁;正常对照组少年14例,男4例,女10例,年龄12—19岁;两组受试者均执行BST实验、抬物实验,采用ME6000型表面肌电仪记录受试者双侧椎旁肌表面肌电信号时域指标平均肌电值（AEMG）、频谱面积（SPA）。结果: AIS患者脊柱旁顶椎区凸、凹侧椎旁肌AEMG(凸侧106.76±47.73μV/s, 凹侧67.93±26.11μV/s,P<0.01),SPA（凸侧11.01±8.81 m2,凹侧4.38±3.14m2,P<0.01）,差异具有显著性意义;正常对照组椎旁肌左、右侧表面肌电值差异无显著性意义。结论: AIS患者脊柱旁顶椎区凸、凹侧椎旁肌肌电活动不对称,表面肌电图可用作评定AIS脊柱旁凸、凹侧肌电活动差别的客观检查之一,具有较好的临床应用价值。     

特发性脊柱侧凸椎旁肌中局灶性纤维化

目的通过对一组脊椎侧凸患者椎旁肌的病理分析，探讨局灶性纤维化是否为特发性脊柱侧凸所特有的病理改变。方法对手术中留取的37例脊柱侧凸患者（特发性25例，先天性12例）椎旁肌给予冰冻切片，肌肉组织病理染色，分析其病理改变。并将其纤维化与肌营养不良（3例Ullrich先天性肌营养不良及10例Duchenne型肌营养不良）的纤维化相比较。结果在12例先天性脊柱侧凸的凹侧椎旁肌中，2例出现局灶性纤维化，8例为弥漫性纤维化，而在25例特发性脊柱侧凸中，18例表现有局灶性纤维化，3例为弥漫性纤维化。两组间在纤维化类型上存在显著的差异，但这一差异在凸侧的椎旁肌中无显著统计学意义。在2例肌营养不良中没有出现这种局灶性的纤维化。结论局灶性纤维化是特发性脊柱侧凸中所特有病理改变，其在特发性脊柱侧凸发病中可能起着特殊的作用。     

特发性脊柱侧凸的病因学研究：鸡脊柱侧凸模型椎旁肌中肌梭的形态学特征

目的：观察鸡脊柱侧凸模型椎旁肌中肌梭结构、数量、密度及其分布，为特发性脊柱侧凸的病因提供理论依据。方法：对刚孵育出的鸡行松果体切除，获得脊柱侧凸动物模型；将鸡脊柱侧凸模型分为Cobb角10&;#176;-20&;#176;组及Cobb角&;gt;40&;#176;组，椎旁肌取下后切片，行Masson三色染色，观察肌梭结构，对肌梭数量、密度进行统计学分析。结果：鸡脊柱侧凸模型椎旁肌中部分肌梭被囊呈“气球样变”，梭内肌纤维有异常改变；Cobb角10&;#176;-20&;#176;组肌梭密度为(25&;#177;5)个／g肌肉。Cobb角&;gt;40&;#176;组肌梭密度为(23&;#177;7)个／g肌肉。结论：与正常对照组相比。鸡脊柱侧凸模型椎旁肌中部分肌梭结构异常，肌梭数量减少，密度降低。     

特发性脊柱侧凸患者椎旁软组织超声形态学研究

目的利用超声检测特发性脊柱侧凸患者(IS)椎旁软组织形态学参数,比较双侧软组织形态学差异,探讨与脊柱侧弯发生、发展的关系。方法纳入IS患者33例,应用超声于患者自然俯卧位下测量椎旁皮肤、浅筋膜及深筋膜厚度,测量竖脊肌厚度、周长及横截面积。结果上点和中点皮肤厚度、浅筋膜厚度、椎旁肌周长及椎旁肌面积凹侧与大于凸侧,且以中点浅筋膜厚度差异最为显著,下点浅筋膜厚度凹侧大于凸侧,差异具有统计学意义(P0.05)。结论特发性脊柱侧凸患者双侧椎旁软组织不对称,上点和中点皮肤厚度、浅筋膜厚度、竖脊肌周长及竖脊肌面积凹侧大于凸侧,下点浅筋膜厚度凹侧大于凸侧。双侧竖脊肌肌力不平衡是促使脊柱侧弯畸形进展恶化的重要因素之一。高频超声可清晰显示椎旁软组织形态,为临床对特发性脊柱侧凸患者全面评估病情、指导治疗及恢复健康提供重要依据。     

Idiopathic scoliosis: an electromyographic study

Thirty-one patients from 12 to 19 years of age having idiopathic scoliosis underwent electromyography of the paraspinal musculature using a Teflon-coated monopolar electrode. The studies conducted with the patients both prone and standing revealed no abnormalities on electrode insertion suggestive of a neuropathic process. In the prone position 29 patients had electrical silence on both the concave and convex side of the curvature. In the standing position most of the patients had asymmetrical activity with a preponderance of activity on the convex side. However, 33% of the patients in whom the spinal musculature was silent in the standing position had balanced curves. This observed correlation between a balanced curve and electrical silence warrants further study.     

Asymmetric biomechanical characteristics of the paravertebral muscle in adolescent idiopathic scoliosis

BackgroundWe sought to assess the biomechanical properties of the paravertebral muscles in adolescent idiopathic scoliosis patients with Lenke Type 1, 2, or 3 (Lenke 1-3) curves.MethodsThe MyotonPro® and shear wave elasticity imaging system were used to assess the biomechanical features of the thoracic paravertebral muscles on concave and convex side in adolescent idiopathic scoliosis patients with Lenke 1-3 curves. The Cobb angle of the main curve was measured using the anteroposterior whole spine radiograph in the standing position.FindingsA total of 40 adolescent idiopathic scoliosis patients with a mean Cobb angle of 66.49° (SD 32.8°) were included in this study. Muscle tone, stiffness and Deborah number on the concave side was significantly greater than that on the convex side. Relaxation time was significantly longer on the convex side than on the concave side. No statistically significant difference in muscle elasticity was observed between the concave side and the convex side (P > 0.05). Pearson correlation analysis demonstrated that stiffness on the concave side was moderately positively correlated with the Cobb angle (P < 0.05, r = 0.582); the Deborah number on both sides and the relaxation time on the concave side showed a moderate negative correlation with the Cobb angle (P < 0.05, r = −0.632; r = −0.432; r = −0.611).InterpretationConcave paravertebral muscle tone and stiffness were greater than those on convex side in adolescent idiopathic scoliosis patients. The asymmetric biomechanical characteristics of paravertebral muscles are closely related to the severity of scoliosis.     

单节段腰椎间盘突出继发腰椎侧凸患者间盘摘除后椎旁肌的表面肌电分析

背景：先天性及特发性脊柱侧凸患者椎旁肌肌电图改变已被广泛研究,而对腰椎间盘突出继发腰椎侧凸患者椎旁肌肌力肌电图的研究较少。目的：通过应用表面肌电图技术分析腰椎间盘突出继发腰椎侧凸患者两侧椎旁肌的肌电活动,评估两侧肌力,揭示腰椎侧凸的特殊临床特点并探讨其产生的机制。方法：回顾性分析2012年7月至2014年7月收治的单节段腰椎间盘突出继发腰椎侧凸的成人患者26例,均行腰椎侧路椎间孔镜下间盘摘除。治疗前后摄站立位全脊柱正侧位片,测量腰椎侧凸Cobb角及躯干偏移距离,行表面肌电图检查,测量两侧椎旁肌大力收缩募集电位值,评估腰椎间盘突出水平两侧椎旁肌肌力。结果与结论：治疗后所有患者腰椎侧凸明显减少,脊柱冠状面平衡恢复。患者治疗前腰椎侧凸Cobb角为（11.81±3.50）°,治疗后为（2.65±3.10）°,腰椎侧凸明显减少,平均差值为（9.15±2.84）°,差异有显著性意义（P〈0.05）。治疗前躯干偏移距离为（5.92±3.20）cm,治疗后为（0.32±0.26）cm,平均差值为（5.59±3.08）cm,差异有显著性意义（P〈0.05）。治疗后疼痛明显缓解（P〈0.05）。治疗前Oswestry功能障碍指数平均为78%,治疗后平均为4%。突出节段水平治疗前凹侧屈曲时凹侧大力收缩募集电位为（0.21±0.12）m V,治疗后为（0.88±0.26）m V,平均差值为（0.59±0.27）m V;治疗前凸侧屈曲时凸侧大力收缩募集电位为（0.29±0.12）m V,治疗后为（0.88±0.25）m V,平均差值为（0.67±0.27）m V,差异均有显著性意义（P〈0.05）;治疗后两侧大力收缩募集电位平均差值为（0.003±0.020）m V,差异无显著性意义（P〉0.05）。随访至少1年,所有患者均无并发症发生,无腰椎间盘突出复发。以上结果说明腰椎间盘突出症引起的腰椎侧凸为代偿性侧凸,早期行腰椎侧路椎间孔镜下间盘摘除可以纠正腰椎侧凸。椎旁肌肌?     

矫形支具配合矫正体操对特发性脊柱侧弯的作用

目的:探讨脊柱矫形器配合矫正体操治疗特发性脊柱侧弯患者的疗效。方法:40例特发性脊柱侧弯患儿。均每天穿戴矫形支具时间23h并配合脊柱矫正体操练习,要求达到凸侧肌肉收缩,凹侧肌肉牵伸,每次30min,每天1-2次。穿戴期间定期X线片检查脊柱Cobb角。结果:1年后随访,40例患儿中33例能坚持穿戴矫形支具和进行矫正体操练习;胸椎、腰椎Cobb角与治疗前比较均降低(P<0.05)。单弧侧弯治疗的效果比双弧更明显(P<0.05)。结论:矫形支具配合矫正体操治疗能矫正脊柱侧弯畸形,是治疗特发性脊柱侧弯的一种有价值的方法。     

Impact of multilevel facetectomy on segmental spinal flexibility in patients with thoracic adolescent idiopathic scoliosis

BackgroundThe aim of this study was to intraoperatively assess the effects of multilevel facetectomy on segmental spinal flexibility in patients with thoracic adolescent idiopathic scoliosis.MethodsTwenty patients who underwent posterior thoracic adolescent idiopathic scoliosis curve correction were evaluated. Compressive or distractive loaded force of 50N was applied on the handle of a compressor or distractor connected to the necks of pedicle screws inserted at T7 to T11. Segmental spinal flexibility rates were calculated based on the distance between screw heads under the loaded and unloaded conditions. In addition, the flexibility rates were obtained before and after multilevel facetectomy.FindingsAbsolute flexibility rates of all segments significantly increased after multilevel facetectomy under both compressive and distractive forces (P < 0.01). The absolute change in the flexibility rate was significantly higher at the concave side than at the convex side under both compressive (P < 0.01) and distractive loaded forces (P = 0.046). No significant correlation was found between change in the flexibility rates and preoperative Cobb angle or preoperative curve flexibility.InterpretationFrom a biomechanical point of view, multilevel facetectomy provides proper spinal flexibility to improve the correction rate of posterior adolescent idiopathic scoliosis surgery. The effects are higher at the concave side than at the convex side.     

Assessment of Paraspinal Muscle Hardness in Subjects With a Mild Single Scoliosis Curve: A Preliminary Myotonometer Study

Objective

The purpose of this study was to evaluate the hardness of the paraspinal muscles in the convexity and concavity of patients with scoliosis curvatures and in the upper trapezius (UT) muscle in subjects with mild idiopathic scoliosis (IS) and to observe the correlation between the myotonometer (MYO) measurements and the value of body mass index (BMI) and the Cobb angle.

Methods

The sample included 13 patients with a single-curve mild IS (Risser sign ≤ 4) at thoracic, lumbar, or thoracolumbar level (mean Cobb angle of 11.53º). Seven females and 6 males were recruited, with a mean age of 12.84 ± 3.06 (9-18) years. A MYO was used to examine the differences in muscle hardness on both sides of the scoliosis curvature at several points: (a) apex of the curve, (b) upper and lower limits of the curve, and (c) the midpoint between the apex and the upper limit and between the apex and the lower limit. The UT was also explored.

Results

Although the MYO recorded lower values in all points on the concave side of the scoliosis, there were no significant differences in the comparison between sides (P > .05). No association was observed between BMI and MYO values, whereas the Cobb angle negatively correlated with muscle hardness only at 2 points on the convex side.

Conclusion

The preliminary findings show that, in subjects with a single-curve mild IS, muscular hardness in the UT and paraspinal muscles, as assessed using a MYO, was not found to differ between the concave and the convex sides at different reference levels.     

青少年特发性脊柱侧凸的胸椎旋转和椎弓根径线变化CT特点及临床价值

目的：探讨16层螺旋CT图像后处理技术对青少年特发性脊柱侧凸的胸椎旋转和椎弓根径线变化特点及临床价值。方法：收集经临床诊治的青少年特发性脊柱侧凸20例,运用16层螺旋CT扫描及图像后处理技术,进行相关CT数据测量统计。结果：（1）脊柱胸椎侧凸的顶椎及邻近椎体均向凸侧旋转、后份向凹侧旋转,以顶椎旋转最重,且凹侧椎弓根径线小于凸侧,与侧凸程度及方向具有相关性。（2）上、下终椎椎体旋转及椎弓根径线变化则较复杂,其椎体无旋转或向相反方向旋转,椎弓根径线可凸侧小于凹侧,以上终椎明显。结论：16层螺旋CT及图像后处理技术,对显示青少年特发性脊柱侧凸胸椎旋转及椎弓根径线变化特征,可提供临床拟订手术方案的重要影像学依据。