锁孔技术治疗神经根型颈椎病的研究进展

<正>颈椎病分为神经根型、脊髓型、椎动脉型、食管气管型、神经肌肉型，以神经根型颈椎病为最多^[1]。神经根型颈椎病常导致一侧上肢疼痛、麻木、肌力下降等症状，严重影响患者的生活质量。通常采用保守治疗，主要包括药物治疗(抗炎镇痛药、三环类抗抑郁药、硬膜外类固醇注射)和物理治疗(按摩、针灸、颈椎牵引固定等),但均存在复发甚至加重病情的可能。20世纪40年代Scoville等提出采用颈椎后路切除突出椎间盘的手术方式治疗神经根型颈椎病，     

应力诱导椎间盘退变的研究进展

腰背痛是一种常见的脊柱退行性疾病,目前已经发展成为严重的社会问题。近期研究表明,椎间盘退变（intervertebral disc degeneration, IDD）是导致腰背痛的首要原因,抑制IDD是防治腰背痛的重要靶点。导致IDD的原因包括老龄、遗传、机械负荷、营养缺乏等。近年来,越来越多的研究报道了机械应力（mechanical stress, MS）导致的IDD,MS诱导IDD的分子机制复杂多变,包括调控凋亡、焦亡、铁死亡、衰老、自噬、氧化应激、内质网应激、炎性反应和ECM降解等,但其确切机制尚不明确。本文拟对MS诱导IDD的机制进行综述,为临床预防和治疗腰背痛提供理论参考。     

丁香苷抑制大鼠椎间盘退变

背景:椎间盘退变是由于椎间盘内部髓核和纤维环组织发生损伤和退化导致的椎间盘结构和功能发生变化,目前尚无有效的治疗药物。目的:探讨丁香苷抑制大鼠椎间盘退变的作用。方法:取10只雄性SD大鼠,将每只大鼠的尾椎Co_(4)/Co_(5)椎间盘设为模型组、Co_(5)/Co_(6)椎间盘设为丁香苷组、Co_(6)/Co_(7)椎间盘设为对照组,对照组不进行任何处理,模型组、丁香苷组采用微型穿刺针进行纤维环全层穿刺建立椎间盘退变模型,造模后即刻,模型组、丁香苷组椎间盘分别注射2.5μL的生理盐水、丁香苷溶液(5μmol/L)。注射4周后取材,采用苏木精-伊红和番红O-固绿染色观察大鼠椎间盘退变程度,免疫组化染色分析大鼠椎间盘组织内Ⅱ型胶原、聚集蛋白聚糖及基质金属蛋白酶3,13的表达。结果与结论:①苏木精-伊红染色显示,模型组椎间盘高度降低,软骨终板变薄且有裂隙出现,纤维环结构紊乱且出现裂隙,髓核消失;丁香苷组椎间盘高度正常或略低于对照组,软骨终板退变程度较模型组轻,纤维环排列较模型组相对规整且无裂隙,髓核部分皱缩。②番红O-固绿染色显示,模型组椎间盘软骨终板出现缺损且软骨钙化层变薄,出现明显退变;丁香苷组椎间盘软骨终板结构形态有一定程度恢复。③免疫组化染色显示,与对照组比较,模型组椎间盘软骨组织内Ⅱ型胶原、聚集蛋白聚糖的表达降低(P<0.0001),基质金属蛋白酶3,13的表达升高(P<0.0001);与模型组比较,丁香苷组椎间盘软骨组织内Ⅱ型胶原、聚集蛋白聚糖的表达升高(P<0.001,P<0.0001),基质金属蛋白酶3,13的表达降低(P<0.001,P<0.0001)。④结果表明,丁香苷可通过抑制基质金属蛋白酶3,13的表达、提高Ⅱ型胶原和聚集蛋白聚糖的表达来改善椎间盘的结构和功能,预防和减缓椎间盘退变过程。     

胰酶联合Ⅱ型胶原酶分离培养髓核细胞：培养基中葡萄糖浓度的选择

BACKGROUND: Intervertebral disc degeneration is the pathological basis of degenerative spinal diseases. Studies on the influential factors of intervertebral disc degeneration contribute to the prevention and treatment of degenerative spinal disease. OBJECTIVE: To observe the growth and proliferation of nucleus pulposus cells isolated by trypsin plus type II collagenase digestion in complete medium with different glucose concentrations, exploring the optimal glucose concentration for growth of nucleus pulposus cells. METHODS: Nucleus pulposus cells isolated and cultured by trypsin plus type II collagenase digestion method were observed under an inverted microscope, and the cell number was counted. Morphology of nucleus pulposus cells was observed after hematoxylin-eosin staining and toluidine blue staining. Collagen type II immunoreactivity was detected by immunohistochemical staining combined with immunofluorescent staining. Nucleus pulposus cells were incubated in complete medium containing various glucose concentrations (0, 6.25, 12.5, 17.5, and 25 mmol/L) for 24 hours, and then cell proliferation and apoptosis were determined. RESULTS AND CONCLUSION: The stained nucleus pulposus cells showed polygonal and short spindle, with one or two nuclei. Cellular pseudopod appeared gradually and then became slim with increased passage numbers. The isolated and cultured nucleus pulposus cells positively expressed collagen type II and aggrecan Proliferative activity of nucleus pulposus cells cultured in medium with 17.5 mmol/L glucose was significantly higher than that in medium with 0 and 25 mmol/L glucose (P < 0.05 or P < 0.01). There was no significant difference in cell apoptosis between these groups except for 0 mmol/L glucose (P < 0.05). These results confirm that a large number of nucleus pulposus cells can be harvested by trypsin plus type II collagenase digestion and the optimal glucose concentration is 17.5 mmol/L. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

经皮脊柱内镜手术治疗布氏杆菌病颈椎硬膜外脓肿一例

颈椎布氏杆菌病是布氏杆菌定植于颈椎椎体或椎间盘引起的感染性脊柱疾病，目前国内外文献对该病的报道逐渐增多。该病以多西环素等药物对症抗感染治疗为主，当出现脓肿压迫硬膜囊或神经根后，通过外科手术干预是治疗的有效手段。既往颈椎感染性疾病产生压迫症状后多采用开放手术进行脓肿清除，随内镜技术不断发展，经皮脊柱内镜对比开放手术具有临床效果确切，降低手术创伤，减少术中出血的优势。文章报道2021年1月在济宁市第一人民医院脊柱外科收治1例颈椎布氏杆菌病性硬膜外脓肿患者，并通过敏感抗生素及经皮脊柱内镜手术治疗该患者，结合该病例、最新相关理论知识进一步提高对该疾病的认识。