腰椎间盘纤维环切口不同修复方法的生物力学研究

【摘要】 目的：通过生物力学测试研究腰椎间盘纤维环切口不同修复方法的生物力学强度。方法：选取小牛腰椎标本制成50个脊柱功能节段,每个节段均在纤维环上作一10mm横切口。按照不同修复方法随机平均分为5组：粘合剂组（A组,选用DermaBond粘合切口）、简单缝合组（B组,采用常规U型缝合法处理切口）、MPSS组（C组,采用改良荷包缝合法处理切口）、粘合剂+简单缝合组（D组）及粘合剂+MPSS组（E组）,然后进行纤维环抗静水压强度测试及疲劳测试,根据各组的泄露压力和极限转数来评价其修复效果。结果：A～E组的泄露压力分别为（0.76±0.11）MPa、（1.66±0.11）MPa、（1.84±0.15）MPa、（1.88±0.13）MPa、（2.16±0.24）MPa。E组泄露压力明显高于其他组,差异有显著性（P＜0.05）。在疲劳测试中,从A～E组各组最后的极限转数分别为（4.42±0.59）万次、（8.06±0.75）万次、（8.44±1.01）万次、（9.76±0.23）万次、（9.88±0.21）万次。E组与D组比较差异无显著性（P＞0.05）,与其他各组比较差异均有统计学意义（P＜0.05）。结论：应用粘合剂+改良荷包缝合法处理纤维环切口,具有较高的生物力学强度。     

组织工程椎间盘纤维环的研究进展

椎间盘退变性疾病随着老龄化社会的到来而增加,已经成为骨科常见病、多发病.传统治疗椎间盘退变性疾病的方法往往只能针对产生疼痛或突出的椎间盘,虽能够缓解疼痛,但并不能阻止退变的进展.外科手术方法局限于摘除退交的椎间盘,然后对相关节段进行融合固定,这降低了脊柱的运动性能,降低了患者的生活质量.而人工椎间盘应用由于材料特性面临着磨损和疲劳受到限制.利用组织工程方法对椎间盘进行功能重建,是未来治疗椎间盘退变性疾病的趋势.     

椎间盘纤维环细胞的培养

目的　通过对椎间盘纤维环细胞的培养 ,观察细胞的演变 ,为研究椎间盘纤维环细胞的生物学特性、退变机理、组织工程、基因治疗等提供方法和体外模型。方法　采用胰蛋白酶、胶原酶分离大鼠椎间盘纤维环细胞 ,选择DMEM(体积分数 2 0 %的小牛血清 )培养基体外培养 ,行HE染色 ,甲苯胺蓝 ,免疫细胞化学染色分析细胞的生物学特性 ,透射电镜观察细胞的超微结构。结果　采用粗品胶原酶能充分消化纤维环组织 ;在含体积分数为 2 0 %小牛血清的DE TA培养液中细胞生长良好 ;原代纤维环细胞多为梭形 ,有伪足伸出 ,甲苯胺蓝染色 ,胞浆染为深蓝色 ;透射电镜下纤维环细胞内多见长条状粗面内质网 ,部分囊池扩张。线粒体较少 ,可见平行于细胞膜方向的微丝。免疫细胞学方法检测表明纤维环细胞有Ⅰ、Ⅱ型胶原表达。结论　本实验为椎间盘纤维环细胞的培养提供了简单、有效的方法 ,为进一步研究椎间盘纤维环细胞生物学功能和调控研究打下了基础。     

人工生物膜修复椎间盘纤维环的研究

目的 用不同方法处理椎间盘纤维环,观察人工生物膜对椎间盘纤维环缺损的修复作用.方法 成年山羊8只,雌雄各4只,对每只羊的腰椎(腰2/3、腰3/4、腰4/5)椎间盘纤维环进行随机处理,处理方法包括:(1)暴露出椎间盘纤维环,不作任何处理;(2)暴露出椎间盘纤维环后,将其切开,用人下生物膜填充缺口;(3)暴露出椎间盘纤维环,尖刀将其切开,作为对照组.12周后,通过生物力学测试、核磁共振(MRI)及脱钙病理切片染色观察椎间盘纤维环的修复效果.结果 12周后,测试纤维环承受最大压力,单纯暴露组为(4.92±0.17)MPa,纤维环单纯切开组为(2.48±0.39)MPa,人工生物膜修复组为(3.76±1.56)MPa.人工生物膜修复组与单纯切开组,椎间盘纤维环完整性及生物强度均不如单纯暴露组,人工生物膜修复组优于单纯切开组,两组间的差异有统计学意义(P＜0.05),人工生物膜可与椎间盘纤维环的胶原纤维良好融合.结论 人工生物膜可对椎间盘纤维环缺口起到修复作用,能使其生物力学强度平均恢复76.4%,人工生物膜可以促进椎间盘结构完整性的恢复.     

内镜椎间盘切除术是否修复纤维环比较

[目的]探讨采用全可视内镜下髓核摘除联合纤维环修复治疗腰椎间盘突出症（lumbar disc herniation, LDH）的临床疗效。[方法] 2019年1月—2021年1月共82例LDH患者纳入本研究，依据术前医患沟通结果，35例采用全内镜下髓核摘除联合纤维环修复，另外47例采用单纯全内镜下髓核摘除，未修复纤维环。比较两组围手术期、随访和影像资料。[结果]所有手术顺利完成，两组患者均无硬膜囊撕裂、神经根损伤、感染等严重并发症。修复组的手术时间显著长于未修复组[(66.8±11.2)min vs (58.4±12.9) min, P=0.034]，但是两组切口长度、手术出血量、术后下地时间、切口愈合等级和术后住院天数的差异均无统计学意义（P>0.05）。两组患者均获随访18个月以上。随访过程中，椎间盘突出复发，修复组为1例（2.8%），未修复组为2例（4.2%），两组复发率差异无统计学意义（P>0.05）。随时间推移，两组患者腰痛VAS和腿痛VAS评分，以及ODI评分均显著下降（P<0.05）。相应时间点，两组间腰痛VAS和腿痛VAS评分，以及ODI评分的差异均无...     

全内镜椎间盘摘除联合纤维环缝合治疗非包含型腰椎间盘突出症

目的 探讨全内镜椎间盘摘除联合纤维环缝合治疗非包含型腰椎间盘突出症(lumbar disc herniation, LDH)的临床疗效。方法 选择2018年2月～2020年4月本院收治的38例非包含型LDH患者,L_3-4 4例,L_4-5 24例,L₅-S₁ 10例;脱出型25例,游离型13例。所有患者均采用全内镜椎间盘摘除联合纤维环缝合治疗,随访12个月以上,评价手术疗效。结果 所有患者均顺利完成手术,手术用时(48.85±6.01)min,住院时间(4.29±0.71)d,无继发神经损伤、脑脊液漏等并发症;术后1例残余症状;直至末次随访无病例复发;术后3个月、12个月时ODI指数、VAS评分均显著低于术前(P<0.05);末次随访时,手术优良率为94.74%。结论 全内镜椎间盘摘除治疗非包含型LDH微创、安全、有效,镜下纤维环缝合能够降低术后复发风险。     

脱细胞纤维环基质对兔纤维环源干细胞分化的影响

目的观察脱细胞纤维环基质(DAFM)对纤维环源干细胞(AFSC)分化行为的影响,为新型纤维环组织工程支架材料的开发提供依据。方法将从新西兰大白兔获得的AFSC接种于由猪纤维环组织制备的DAFM膜和无DAFM膜培养皿,分别进行成脂、成骨、成软骨分化诱导,考察DAFM对AFSC分化行为的影响。结果 AFSC在DAFM膜上生长良好。DAFM膜上AFSC成脂、成软骨诱导分化水平低于无DAFM膜者,而成骨诱导分化水平显著高于无DAFM膜者;DAFM膜上的成脂、成骨及成软骨诱导比值(诱导组基因表达量/对照组基因表达量)均高于无DAFM膜者。结论猪DAFM有利于促进兔AFSC成骨分化,抑制其成脂及成软骨分化,较好地维持AFSC的差异性分化潜能。     

锁式肌腱缝合的生物力学研究

目的本实验通过比较Strickland、Augmented Becker、Savage及Tang法四种锁式缝合的生物力学特性,以期指导临床肌腱修复.方法将40根新鲜成年猪后蹄Ⅱ区屈肌腱随机分成4组,分别用Strickland、Augmented Becker、Savage及Tang法进行修复.用材料力学测定仪测定2-mm间隙形成负荷、最大负荷、弹性模量及断裂功耗,同时记录中心缝合的操作时间.结果Tang法的2-mm间隙形成负荷、最大负荷、断裂功耗与Savage法相近,弹性模量为各组中最高,中心缝合的操作时间明显短于Augmented Becker及Savage法.结论Tang法能提供较大的抗张强度、有效抵御间隙形成、操作简便,有利于肌腱早期活动.     

锁式肌腱缝合的生物力学研究

目的本实验通过比较Strickland、augmented Becker、Savage及Tang法四种锁式缝合的生物力学特性,以期指导临床肌腱修复.方法将40根新鲜成年猪后蹄Ⅱ区屈肌腱随机分成4组,分别用Strickland、augmented Becker、Savage及Tang法进行修复.用材料力学测定仪测定2-mm间隙形成负荷、最大负荷、弹性模量及断裂功耗,同时记录中心缝合的操作时间.结果Tang法的2-mm间隙形成负荷、最大负荷、断裂功耗与Savage法相近,弹性模量为各组中最高,中心缝合的操作时间明显短于augmented Becker及Savage法.结论Tang法能提供较大的抗张强度、有效抵御间隙形成、操作简便,有利于肌腱早期活动.     

Biomechanical analysis of the lumbar spine on facet joint force and intradiscal pressure - a finite element study

Background  

Finite element analysis results will show significant differences if the model used is performed under various material properties, geometries, loading modes or other conditions. This study adopted an FE model, taking into account the possible asymmetry inherently existing in the spine with respect to the sagittal plane, with a more geometrically realistic outline to analyze and compare the biomechanical behaviour of the lumbar spine with regard to the facet force and intradiscal pressure, which are associated with low back pain symptoms and other spinal disorders. Dealing carefully with the contact surfaces of the facet joints at various levels of the lumbar spine can potentially help us further ascertain physiological behaviour concerning the frictional effects of facet joints under separate loadings or the responses to the compressive loads in the discs.     

Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure

Interspinous implants are used to treat lumbar spinal stenosis or facet joint arthritis. The aims of implanting interspinous devices are to unload the facet joints, restore foraminal height and provide stability especially in extension but still allow motion. The aim of this in vitro study was to compare four different interspinous implants––Colfex, Wallis, Diam and X-Stop––in terms of their three-dimensional flexibility and the intradiscal pressure. Twenty-four human lumbar spine specimens were divided into four equal groups and tested with pure moments in flexion/extension, lateral bending and axial rotation: (1) intact, (2) defect, (3) after implantation. Range of motion and the intradiscal pressure were determined.In each implant-group the defect caused an increase in range of motion by about 8% in lateral bending to 18% in axial rotation. Implantation had similar effects with all four implants. In extension, Coflex, Wallis, Diam, and X-Stop all overcompensated the instability caused by the defect and allowed about 50% of the range of motion of the intact state. In contrast, in flexion, lateral bending and axial rotation the values of the range of motion stayed about the values of the defect state. Similarly the intradiscal pressure after implantation was similar to that of the intact specimens in flexion, lateral bending and axial rotation but much smaller during extension. All tested interspinous implants had a similar effect on the flexibility: they strongly stabilized and reduced the intradiscal pressure in extension, but had almost no effect in flexion, lateral bending and axial rotation.     

纤维环修补技术在腰椎髓核摘除术中临床疗效的Meta分析

[目的]评价纤维环修补技术在腰椎髓核摘除术中的应用价值。[方法]通过计算机检索Pub Med、Embase和中国期刊全文数据库CNKI等中英文数据库以及手工检索有关腰椎髓核摘除术中应用纤维环修补技术的相关研究和文献,将应用纤维环修补技术的髓核摘除术与传统单纯髓核摘除术的术后疼痛评分、术后神经功能、复发率、椎间高度、手术相关并发症发生率等进行比较。[结果]共纳入5篇符合纳入标准的近期文献,累计病例1 118例。Meta分析表明,应用纤维环修补技术的腰椎髓核摘除术在术后并发症发生率、复发率、ODI指数、VAS评分、JOA评分和椎间隙高度与传统单纯髓核摘除术相比无显著差异。[结论]目前尚无法证明在腰椎髓核摘除术中应用纤维环修补技术可以改善患者预后,鉴于目前纤维环修补技术相关的高质量临床研究仍较少,仍需进一步评估该技术的临床价值。     

Influence of a follower load on intradiscal pressure and intersegmental rotation of the lumbar spine.

STUDY DESIGN: Intradiscal pressure and intersegmental rotation of human lumbar spines were measured in vitro. OBJECTIVES: To determine the effect of a follower load on mechanical behavior at all levels of the lumbar spine. SUMMARY OF BACKGROUND DATA: Different loads have been proposed for studying the mechanical behavior of the lumbar spine. The influence of a follower load on intradiscal pressure at the different levels is unknown. METHODS: Ten human cadaveric lumbar spines were loaded in the three main anatomic planes with pure moments of 3.75, 7.5, and 7.5 Nm plus a follower load of 280 N. Intradiscal pressure and intersegmental rotation were measured at all levels. RESULTS: An additional follower load increased the intradiscal pressure, slightly reduced the intersegmental rotation for axial rotation, and hardly affected intersegmental rotation for lateral bending and flexion-extension. CONCLUSIONS: A superimposed follower load renders spinal loading with pure moments more physiologic.     

Shear mechanical properties of human lumbar annulus fibrosus.

Function, failure, and remodeling of the intervertebral disc are all related to the stress and strain fields in the tissue and may be calculated by finite element models with accurate material properties, realistic geometry, and appropriate boundary conditions. There is no comprehensive study in the literature investigating the shear material properties of the annulus fibrosus. This study obtained shear material properties of the annulus fibrosus and tested the hypothesis that these properties are affected by the amplitude and frequency of shearing, applied compressive stress, and degenerative state of the tissue. Cylindrical specimens with an axial orientation from seven nondegenerated and six degenerated discs were tested in torsional shear under dynamic and static conditions. Frequency sweep experiments over a physiological range of frequencies (0.1-100 rad/sec) at a shear strain amplitude of 0.05 rad were performed under three different axial compressive stresses (17.5, 25, and 35 kPa). At the largest compressive stress, shear strain sweep experiments (strain amplitude range: 0.005-0.15 rad at a frequency of 5 rad/sec) and transient stress-relaxation tests (shear strain range: 0.02-0.15 rad) were performed. The annulus fibrosus material was less stiff and more dissipative at larger shear strain amplitudes, stiffer at higher frequencies of oscillation, and stiffer and less dissipative at larger axial compressive stresses. The dynamic shear modulus, /G*/, had values ranging from 100 to 400 kPa, depending on the experimental condition and degenerative level. The shear behavior was also predominantly elastic, with values for the tangent of the phase angle (tandelta) ranging from 0.1 to 0.7. The annulus material also became stiffer and more dissipative with degenerative grade; however, this was not statistically significant. The results indicated that nonlinearities, compression/shear coupling, intrinsic viscoelasticity, and, to a lesser degree, degeneration all affect the shear material behavior of the annulus fibrosus, with important implications for load-carriage mechanisms in the intervertebral disc. These material complexities should be considered when choosing material constants for finite element models.     

腰椎间盘前缘与后缘高信号区的临床对照研究

目的 通过与腰椎间盘后缘高信号区(HIZ)比较,探讨前缘HIZ的发生规律、分布及临床意义.方法 根据HIZ的诊断及定位,将610例有完整临床资料的腰椎MRI,依据有无HE及其发生部位分为对照组(无HIZ),前缘组,后缘组和前后缘组.统计总样本中HIZ发生率,对比分析各组性别比例、年龄、体重、腰痛发生率及HIZ分布规律.结果 610例患者中,对照组315例(51.6%),前缘组95例(15.6%,119个椎间盘),后缘组159例(26.1%,189个椎间盘),前后缘组41例(6.7%,96个椎间盘).前、后缘组发生率间存在显著的统计学差异(P<0.01).各组的性别构成和体重载明显差异(P>0.05),年龄间存在显著的统计学差异(P<0.01,对照组<后缘组<前后缘组<前缘组).前缘组多见于L1,2～L4,5,后缘多位于L3,4～L5S1对照组、前缘组、后缘组和前后缘组腰痛发生率分别为40.0%,52.6%,55.4%和65.8%,对照组明显低于其他三组(P<0.05),后三组间差异无统计学意义(P>0.05).结论 与纤维环后缘HIZ相比,前缘HIZ发生率较低,患者年龄较大,发生节段较高,与腰痛症状亦明显相关.     

腰椎间盘纤维环修复的研究进展

<正>椎间盘是脊柱的重要组成部分,它包括髓核、纤维环和软骨终板,在脊柱的功能活动中起着重要的作用,共同承受由脊柱的压缩、伸展、弯曲和旋转引起的复杂压力。腰椎间盘退变是一个复杂的过程,年龄、氧化应激、生化平衡失调、炎症和创伤都会引起椎间盘的退变^[1]。纤维环作为包绕髓核的重要组织结构,其损伤会进加速椎间盘退变,