低温等离子体射频消融术应用于椎间松解的组织学观察

目的评价低温等离子体射频消融术应用在椎间松解及其自然转归的组织学变化。方法将12只2.0~2.5月龄的健康雌性山羊随机分为低温等离子体消融组(消融组,n=6)和传统胸椎椎间盘切除组(传统组,n=6)。每只动物均处理中段6个胸椎椎间盘(T_5/T_6/T_7/T_8/T_9/T_(10)/T_(11)),光镜下分别比较2种术式术后即刻和术后12周自然转归的组织学变化。结果消融组术后即刻椎间盘组织(纤维环,髓核和软骨终板)基本被去除,仅在软骨终板和骨性终板交界处残留一薄层软骨终板,表面光整,厚度均匀,周围组织细胞形态基本正常。传统组术后即刻纤维环、软骨终板有不同程度的剩余,骨性终板无明显破坏,松解面凹凸不平,刀痕周围的组织细胞形态正常。消融组术后12周显微镜下见椎间残留有部分薄层软骨终板已被不同程度的钙化,椎间前后缘融合稍差;椎间中部被大量成纤维细胞连接,软骨细胞增生更加明显,椎体骨小梁和终板下骨小梁之间无明确的界限,潮标前移变薄。传统术后12周显微镜下见软骨终板大部分消失,仅在近椎体后缘残留;终板下骨小梁排列不规则,上下终板下骨小梁之间未呈连续性生长,而是被大量由软骨细胞和成纤维细胞组成的组织连接,其中可见新生的毛细血管,上下潮标不对称并前移。结论采用低温等离子体消融术行椎间准备可以较好地去除软骨终板,处理后的终板面较传统组光整,且对周围健康组织影响小,和传统组都能获得早期的椎间融合倾向。

Histological observation of low temperature plasma radiofrequency ablation for intervertebral release

Objective To estimate the histological changes(instant and natural outcome) of low temperature plasma radiofrequency(LTPR) ablation for anterior intervertebral release of the thoracic spine in goats. Methods Twelve immature female goats(age ranged 2.0-2.5 months) were randomly divided into LTPR ablation group(ablation group,n=6) and traditional discectomy group(traditional group,n=6). Six thoracic intervertebral discs(T₅/T₆/T₇/T₈/T₉/T₁₀/T₁₁) of every goat were released anteriorly. The histological changes of the thoracic intervertebral discs/vertebral endplates were observed by the light microscopy instantly and 12 weeks after surgery. Results In the ablation group,immediately after the operation, intervertebral disc tissue(fibrous ring,nucleus pulposus and cartilage endplate) were almost completely removed;a thin layer of the cartilage endplate only resided at the junction of cartilage endplate and endplate with smooth surface and uniform thickness;the cells surrounding the tissue had the normal form. In the traditional group,immediately after the operation, fiber ring and cartilage endplate had different degrees of residual;bony endplate without obvious damage and surface was uneven;the cells surrounding the tissue had the normal form. In the ablation group,12 weeks after the operation,residual intervertebral cartilage endplate had varying degrees of calcification;intervertebral fusion was poor;connection of a large number of fibroblasts was in the central part of the intervertebral;the proliferation of cartilage cells was more obvious;no clear boundaries were seen between the vertebral trabecular bone and subendplate trabecular bone;tidemark was shifted forward and thinned. In the traditional group,12 weeks after the operation,cartilage endplate disappeared mostly,and there were residues only at posterior edge of vertebrae;endplate trabecular bone irregular arrangement;there was no a continuous growth between the upper and lower end plates of the trabecular bone,but connected by a large amount of organization consisting of cartilage cells and fibroblasts,which showed new capillaries. Upper and lower tidemarks were dissymmetric andshifted forward. Conclusion LTPR ablation for intervertebral preparation can effectively remove the cartilage endplate, and get more smooth endplate with less affection on the surrounding normal tissue than the traditional discectomy. And it also can get early intervertebral fusion as the traditional discectomy.