特发性脊柱侧凸椎旁肌组织bcl-2等蛋白表达及细胞凋亡的研究

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可能的作用机制.方法选择2001年8月至2001年12月间于我院收治的胸椎侧凸畸形患者10例,采用免疫组织化学和Western杂交检测脊柱侧凸凸侧、凹侧椎旁肌组织中bcl-2、Caspase-3及bcl-x基因的表达,采用HE染色和SA染色检测椎旁肌组织肌纤维形态,TUNEL原位检测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、Caspase-3及bcl-x蛋白的表达量均降低,以bcl-2降低最为明显.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、Caspase-3及bcl-x的表达不对称相关.     

特发性脊柱侧凸竖脊肌组织中神经元型和诱导型一氧化氮合酶的表达

目的通过比较脊柱侧凸患者胸弯顶点处凸侧、凹侧竖脊肌的神经元型一氧化氮合酶(nNOS)及诱导型一氧化氮合酶(iNOS)表达,探讨竖脊肌在脊柱侧凸中的可能的机制.方法选取2001年8～12月间我院收治的胸椎侧凸畸形患者10例,于术中取顶椎凸侧、凹侧竖脊肌组织各一块,另有2例胸腰椎爆裂骨折行后路固定融合的患者作为正常对照,于T10处取正常竖脊肌组织,采用免疫组织化学和Western印迹检测竖脊肌组织中nNOS、iNOS的表达和定位.结果脊柱侧凸患者脊柱凸侧竖脊肌组织与凹侧竖脊肌组织和正常对照相比,10例患者中9例nNOS的表达明显下调,8例iNOS的表达也有所下调,但iNOS表达总量较低.结论脊柱侧凸患者双侧竖脊肌nNOS、iNOS蛋白表达不均衡,可能对特发性脊柱侧凸发生起促进作用.     

脊柱侧凸关节突中Ⅰ、Ⅱ型胶原和转化生长因子β1表达的研究

目的观察脊柱侧凸患者关节突中Ⅰ、Ⅱ型胶原和转化生长因子-β1(TGF-β1)表达的特点.方法收集9例特发性脊柱侧凸(IS)患者和10例先天性脊柱侧凸(CS)患者的顶椎、上下端椎凸凹侧下关节突,采用苏木素-伊红(HE)染色方法和免疫组化方法染色,免疫组化染色结果采用图像分析系统处理.结果 IS、CS顶椎凹侧关节突中Ⅰ型胶原的表达均高于凸侧,分别为193±64对151±45和199±86对179±78(P<0.05),顶椎高于端椎,IS下端椎凹侧高于凸侧,而CS顶椎凸侧高于IS.CS下端椎凹侧的Ⅱ型胶原表达高于凸侧,IS和CS顶椎高于端椎.IS及CS顶椎凹侧TGF-β1的表达高于凸侧,分别为145±43对112±50和120±61对89±32(P<0.05),IS下端椎凹侧高于凸侧;IS顶椎、上端椎、下端椎三组凹侧中顶椎最高,IS顶椎凸侧高于上端椎,CS顶椎凹侧高于端椎;IS顶椎高于CS. 结论脊柱侧凸患者顶椎关节突关节软骨呈现退变征象,Ⅰ、Ⅱ型胶原和TGF-β1在IS、CS凹侧关节突中的表达增高和顶椎的表达增高,异常压应力可能起着非常重要的作用.     

实验性脊柱侧弯椎旁肌肌纤维型分布的观察

目的通过脊柱侧弯动物模型,观察脊柱侧弯对椎旁肌肌纤维型分布的影响, 探讨肌纤维型分布不对称现象的原因.方法选用6～8周龄家兔36只,随机分为3个实验组(每组各7只),3个对照组(每组各5只).实验组兔右侧肩胛骨与股骨之间用钢丝牵拉固定,制成脊柱侧弯模型.于固定后3,4,5个月分批处死,取其椎旁肌,用肌球蛋白ATP酶法染色,光镜观察肌纤维型分布并计数.结果实验组脊柱侧弯角度从平均18°逐渐增至77.7°,凸侧椎旁肌Ⅰ型肌纤维含量明显高于凹侧,且随侧弯角度增加而增加.凸侧椎旁肌Ⅱ型肌纤维含量低于凹侧,凹侧变化相反.结论特发性脊柱侧弯椎旁肌肌纤维型分布凸凹侧不对称现象为脊柱侧弯继发改变的结果.     

青少年特发性脊柱侧凸患者顶椎关节突中Ⅰ型胶原的表达

目的比较青少年特发性脊柱侧凸(AIS)患者顶椎凸、凹侧关节突中Ⅰ型胶原的表达.方法选取11例AIS患者顶椎凸、凹侧下关节突,HE染色观察顶椎关节突的病理改变.分别培养从患者顶椎凸、凹侧下关节突获得的成骨细胞,鉴定后,In-cell Western法比较患者顶椎凸、凹侧下关节突成骨细胞合成分泌Ⅰ型胶原的差异.结果AIS患者顶椎关节突关节软骨呈现退变征象,软骨下骨形态学无明显改变.顶椎凹侧关节突成骨细胞分泌的Ⅰ型胶原(112.00±7.26)较凸侧(106.36±8.63)多(P＜0.05).结论AIS患者顶椎凸、凹侧关节突中成骨细胞基因表达存在差异,值得进一步从基因水平进行研究.     

青少年特发性脊柱侧凸椎旁肌的病理特征

目的：研究青少年特发性脊柱侧凸(adolescent idiopathic scoliosis, AIS)患者椎旁肌病理改变，并进一步探讨抗肌萎缩蛋白(Dystrophin)在该病中的表达情况及其与病因的关系。方法：收集2018年11月至2019年8月于北京大学第三医院诊断为AIS并接受后路侧弯矫形手术，术中行凹侧顶椎椎旁肌活检患者18例。对肌肉活检组织进行规范化处理并切片进行常规苏木精-伊红(hematoxylin-eosin, HE)染色、多种组织化学染色以及抗肌萎缩蛋白各亚型、肌球蛋白、主要组织相容性复合体1(major histocompatibility complex 1,MHC-1)、CD4、CD8、CD20、CD68抗体的免疫组织化学染色及结果判读分析。此外，根据Cobb角大小(≥55°或<55°)和Nash-Moe分类将活检标本分为不同组别，进行相应病理改变的组间差异统计学比较。结果：18例患者中，重度AIS组(Cobb角≥55°)8例，轻度AIS组(Cobb角<55°)10例，两组患者椎旁肌均出现不同程度萎缩、变性，Dystrophin-3的免疫组织化学...     

特发性脊柱侧凸椎旁肌改变研究进展

特发性脊柱侧凸患者椎旁肌构成、影像学、肌电图等存在不同程度的改变,且双侧椎旁肌肌力不平衡,其与脊柱侧凸的程度和时间密切相关。早期的监测和治疗可以控制病变的发展。本文综述了近年有关特发性脊柱侧凸椎旁肌改变的特点。     

青少年特发性脊柱侧凸脊柱关节突骨组织差异基因表达的研究

目的构建青少年特发性脊柱侧凸脊柱小关节突骨组织抑制消减cDNA文库,以研究特发性脊柱侧凸的基因表达变化。方法取特发性脊柱侧凸患者顶椎凸凹侧下关节突骨组织提取mRNA,经反转录后,利用抑制消减杂交（SSH）方法,通过两轮杂交和两次抑制PCR构建了两种组织间差异表达基因的cDNA消减文库。筛选差异表达基因并测序,将结果与核酸数据库进行同源性比较。并进一步收集11例特发性脊柱侧凸患者的顶椎和上下端椎凸凹侧下关节突,采用免疫组织化学方法和原位杂交方法对发现的差异表达基因进行验证,将所得的免疫组化和原位杂交图像输入图像分析系统,进行半定量分析。结果对600个克隆测序结果初步分析,并从蛋白水平和基因水平进行检验,获得2个表达差异明显的基因：微球蛋白基因（B2M）和钙结合蛋白基因（calgranulin A,S100A8）。结论应用消减杂交的方法,经适当地改进,在去除相同遗传背景的条件下,可以建立较特异的特发性脊柱侧凸脊柱小关节突骨组织cDNA消减文库,该文库可进一步批量筛选与特发性脊柱侧凸的发生和发展相关的基因群,并克隆特发性脊柱侧凸相关表达基因,研究其与特发性脊柱侧凸发生的分子机理与生物学特性间的关系。差异表达的基因可能与青少年脊柱侧凸呈密切相关。     

伴发脊髓空洞的脊柱侧凸患者竖脊肌肌纤维及运动终板的酶组化特征

目的观察伴发脊髓空洞的脊柱侧凸患者竖脊肌肌纤维及运动终板的酶组化特征,探讨其与脊柱侧凸发病可能存在的关系。方法选取伴发脊髓空洞的脊柱侧凸患者20例,以16例青少年特发性脊柱侧凸(AIS)患者和10例非脊柱侧凸患者为对照。术中切取两侧竖脊肌组织,分别进行HE染色、还原型辅酶I-四氮唑还原酶染色及非特异性酯酶染色。观察3组患者竖脊肌肌纤维的病变特征及神经肌肉接头运动终板的分型。结果脊髓空洞组中12例(60%)有神经源性肌纤维病变;AIS组和非脊柱侧凸组均未见神经源性肌纤维病变。脊髓空洞组凸侧竖脊肌T0型终板和病变终板数均显著多于凹侧(P<0·05);AIS组凹侧竖脊肌T0型终板和病变终板数均显著多于凸侧(P<0·05);非脊柱侧凸组左、右侧竖脊肌T0型终板和病变终板数差异均无显著性(P>0·05)。结论脊髓空洞组竖脊肌肌纤维及运动终板的病理特征与AIS组明显不同。AIS患者竖脊肌可能为继发性的病理改变,而伴发脊髓空洞的脊柱侧凸患者竖脊肌存在原发性失神经支配,这种失神经支配可能是脊柱侧凸发生的始动因素之一。     

特发性脊柱侧凸患者椎间盘中X型胶原基因的表达

目的研究特发性脊柱侧凸(IS)患者椎间盘内X型胶原基因表达的特点.方法用半定量RT-PCR的方法检测21例IS患者的顶椎与下端椎椎间盘、16例先天性脊柱侧凸(CS)患者的顶椎椎间盘以及3例正常人(符合医学伦理学要求)的腰椎椎间盘凸、凹两侧的软骨终板和纤维环组织中X型胶原基因的表达情况.结果IS顶椎椎间盘凹侧X型胶原基因的表达高于凸侧(P＜0.05),IS下端椎椎间盘凸侧和凹侧的表达差异无显著性(P＞0.05),IS顶椎椎间盘中X型胶原基因的表达高于下端椎(P＜0.05),CS顶椎椎间盘凹侧X型胶原基因的表达高于凸侧(P＜0.05).结论IS顶椎椎间盘中X型胶原基因的表达增加,凹侧的表达高于凸侧,其改变可能是继发性的.     

重度特发性脊柱侧凸胸椎椎弓根螺钉徒手置入精确性的CT评价

目的：应用CT分析重度特发性脊柱侧凸胸椎椎弓根徒手螺钉置入的精确性。方法：选择1996年6月至2006年12月有完整术后CT资料的重度特发性脊柱侧凸患者20例。术前主胸弯冠状面Cobb角82°～142°（96.3°±14.3°）,主弯后凸角66.2°±12.4°。术中采用徒手直视下胸椎椎弓根螺钉置入,术后根据轴位CT扫描评价螺钉置入椎弓根的精确性。结果：共置入174枚胸椎椎弓根螺钉,术后CT密扫157枚螺钉（90.2%）完全在椎弓根皮质骨内,9例17枚螺钉（9.8％）发生错置：11枚螺钉（6.3％）偏外侧,其中9枚穿破皮质≤2 mm,2枚穿破皮质在2～4 mm;6枚螺钉（3.5％）偏内侧,其中3枚穿破皮质≤ 2 mm,3枚穿破皮质在2～4 mm。凸侧共置入椎弓根螺钉94枚,其中错置6枚,准确率为93.6%,凹侧共置入80枚,其中错置11枚,准确率为86.3%,凹侧与凸侧螺钉置入准确率比较无统计学差异（P>0.05）。所有病例未发生神经并发症。结论：应用徒手法行重度特发性脊柱侧凸胸椎椎弓根螺钉置入精确度较高,但有一定的误置率。     

直立姿势对脊柱侧凸易感性及侧凸曲线进展规律的影响

目的 探讨直立姿势对不对称应力下脊柱侧凸易感性及侧凸曲线进展规律的影响。方法 实验分为双足鼠组、四足鼠组、双足鼠假手术对照组。倚重双足鼠模拟人类直立姿势的特点,采用肩胛间区后正中切口,沿竖脊肌与躯干肌间隙,以4号丝线行左侧肋骨根部高（T2-3或T34）、低位（T10-11或T11-12）栓系,造成不对称应力,模拟原发性胸弯。术后1、2、3、4、6、8周跟踪拍摄X线脊柱正位片,动态观察各组侧凸转归及曲线进展趋势在双足鼠与四足鼠中的差别。结果 手术造成双足鼠、四足鼠组凸向右的初始胸弯或胸腰段单弯。术后1～4周,所有不对称栓系均因栓系点肋骨骨折或骨溶解吸收而松脱。四足鼠组于栓系松脱后1～4周脊柱侧凸全部消失,脊柱曲线恢复正常。栓系1周断裂的双足鼠同样侧凸消失,但随着不对称栓系时间的延长,侧凸进展率显著增长,栓系持续3～4周即出现不可复性脊柱侧凸。双足鼠侧凸的进展规律呈现多样化特点,包括稳定性单胸弯、进展性胸腰段单弯、进展性双弯,侧凸形态与人类特发性脊柱侧凸相似。空白手术对照双足鼠无侧凸形成。结论 直立姿势增加脊柱对不对称应力的致弯易感性;直立姿势改变脊柱侧凸的进展规律,导致原发性胸弯进展过程中侧凸形态变化的多样性,并诱发脊柱侧凸的曲线代偿现象。     

Surgical Treatment of Scoliosis in Patients with Charcot-Marie-Tooth Disease

Objective： Apparently, scoliosis occurs in approximately one-third of patients with Charcot-Marie-Tooth disease. Little is known about the response of these curves to treatment. The purpose of this study was to evaluate the results of spinal surgery in these peculiar patients. Methods： We retrospectively evaluated the results of spinal surgery in eight patients who had scoliosis due to clinically and electrophysiologicaUy proven Charcot-Marie-Tooth disease. Radiographs were reviewed. The location and direction of the curve pattern, the age at the time of surgery, type of surgery, number of levels fused, instrumentations used, intra or postoperative complications, and results and need for reoperation were recorded. Results： Eight patients associated with Charcot-Marie-Tooth disease who underwent scoliotic surgery were identified. The average age and curve at the time of surgery were 21.1 years and 56.4° respectively. 62.5% of the curves had left thoracic component and more than one third was associated with thoracic hyperkyphosis. Long posterior spinal fusion was performed most often, with an average of 11.5 spinal segments fused. Instrumentation was used in all posterior fusions. At an average of 39 months （range, 24 to 72 months） postop- eratively, the fusion appeared to be solid in all patients. Conclusion： Scoliosis in patients with Chareot-Marie-Tooth disease differs from that in patients with idiopathic scoliosis in regarding to the etiology and the prevalence of thoracic hyperkyphosis, but the surgical management appears to be similar. Spondylodesis does not appear to be associated with a high rate of complications.     

中华多用脊柱内固定装置的研制及在脊柱外科中的应用

目的 报道本院研制的中华多用脊柱内固定装置应用于脊柱外科的原理及早期结果。方法 随诊为1998年9月到2000年6月期间用本装置治疗脊柱侧弯70例（男性19例,女性51例）,平均年龄14.8岁（3-34岁）,其中先天性侧弯30例,特发性侧弯36例,其它4例,此外,还随诊用本装置矫治后凸畸形16例,脊柱侧弯前路去旋转融合5例,所有病例均进行手术前后临床及X线片检查分析。结果 脊柱侧弯病例平均随诊8.9个月。侧弯Cobb角由术前平均70.5度（40-103度）矫正至平均32.5度,平均矫正率55.6%,身高平均增加6.5cm,矫正范围内的脊柱增长5mm。由本院首次治疗的22例特发性脊柱侧弯。平均矫正率73%。最好者达87.2%。后凸畸形病例平均随诊5.3个月,后凸由术前平均80.5度（40-103度）矫正至平均31.8度,矫正率50%。结论 中华多用脊柱内固定装置是矫治脊柱侧弯,尤其是生长发育中儿童侧弯的较理想的新7方法,不需植骨融合,能允许矫正范围内脊柱节段继续生长。合并症较少,本装置还可广泛用于治疗脊柱后凸,前路去旋转融合,脊柱滑脱和脊柱骨折等。     

Soft tissue release on the concave side in the treatment of scoliosis. A preliminary report of 23 cases.

Since February 1982, 23 patients with scoliosis were treated by releasing the soft tissues on the concave side and plaster spinal fusion jacket. Of these patients, 13 had congenital scoliosis and 10 idiopathic scoliosis. Follow-up for 1 to 8.5 years showed that the results of correction were satisfactory. The maximum degree of correction of the main curve in this series was from 74 degrees (Cobb method) before treatment to 3 degrees after treatment. The maximum rate of correction was 97.3%.

     

Intervertebral disc degeneration and bone density in degenerative lumbar scoliosis: a comparative study between patients with degenerative lumbar scoliosis and patients with lumbar stenosis

Background  Degenerative lumbar scoliosis is common in older patients. Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis. A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed. The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study.

Methods  From January 2001 to August 2010, 96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls. Cobb angle, height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group. The height of L2/L3, L3/L4, L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group. The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups. The bone density of lumbar vertebrae was measured with dual-energy X-ray.

Results  In scoliosis group, the intervertebral disc height on the convex side was greater than the height on the concave side (P <0.001). The vertebral body height on the convex side was greater than the height on the concave side (P=0.016). There was a significant difference between the scoliosis group and the control group (P=0.003), and between T-value and the rate of osteoporosis between the two groups (both P <0.001). Results were verified using multiple linear regression analysis.

Conclusions  Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces. There is a positive correlation between the angle of scoliosis and the disc index, the degree of degeneration of the intervertebral disc, and a negative correlation between the angle of scoliosis and bone density.