Computed tomorgaphy diagnostic of lumbar spondylolysis

Background. Low back pain is the main reason of reduction in physical activity. The aim of this study was to determine lumbar spine changes in patients with spondylolysis using computed tomography (CT) completed with multiplanar (MPR) and three-dimensional (3D) reconstructions. Material and methods. The investigation was performed on 35 patients at the age from 13 to 79 years suffering from chronic low back pain with recognised lumbar spondylolysis. All these patients were subjected to anteroposterior and lateral radiography, and computed tomography (CT) and CD reconstructions Results. Spondylolysthesis was diagnosed as grade I in thirty patients, grade II in two patients and grade IV in other two patients. No signs of spondylolysthesis observed in three cases. The deformations of intervertebral foramina were confirmed in 26 patients (74.29%) and their craniocaudal narrowing was present in 22 cases (62.86%). The osteophytes around fissure margin of lumbar spondylolysis were found in 20 patients (57.14%). The herniation of nucleus pulposus of intervertebral disc was shown in 11 patients (31.43%). The degenerative changes of L4-L5 and L5-S1 intervertebral joints were present in 9 cases (25.71%), whereas the spina bifida of S1 vertebra was stated in four patients (11.43%). Conclusions. 1. High percentage of deformations and narrowing of the intervertebral foramen and the osteophytes around fissure margin of lumbar spondylolysis, and the intervertebral disc herniation were diagnosed in patients with low back pain and spondylolysis using computed tomography completed with MPR and 3D reconstructions. 2. The axial scans completed with multiplanar and three-dimensional reconstructions are very usefull in diagnostic of spondylolysis and spondylolisthesis.     

腰椎间盘髓核退变的MRI研究(英文)

Objective The purpose of this study was to correlate T2 signal intensity values in nucleus pulposus of lumbar discs with patient age,gender and stage of nucleus pulposus degeneration.Methods Lumbar imaging findings of 422 cases subjects were retrospectively reviewed through T2 signal intensity values of nucleus pulposus evaluated based on the signal intensity values of MR T2-weighted mid-sagittal images of the lumbar spine,the t2 signal intensity values at all five lumbar levels (from L5-S1 to L1-L2) between male and female were used independent sample t-test and the Spearman correlation analysis.The age and grade of nucleus pulposus of disc degeneration and T2 signal intensity values were estimated by calculating and Chi-square test and the Spearman correlation analysis.The t-test was used to correlate the different anatomic levels of disc degeneration;T2 signal intensity values among the five different anatomic levels using non-parametric correlation analysis.Results There were significantly differences in T2 signal intensity values of nucleus pulposus at the same grade and anatomic level between male and female.Advanced with age,T2 signal intensity values of nucleus pulposus decreased and stage of disc degeneration increased accordingly.T2 signal intensity values may represent the nucleus pulposus degeneration of interverterbral disc.L4-L5 was the highest incidence among the nucleus pulposus degeneration of intervertebral disc.Conclusions The T2 signal intensity values based approach may be a feasible and practical tool to determine nucleus pulposus degeneration.T2 signal intensity values of nucleus pulposus of lumbar intervertebral disc are correlated with grade of degeneration and patient age.     

Foraminal encroachment syndrome in true lumbosacral spondylolisthesis: a preliminary report

The source of pain in isthmic spondylolisthesis is uncertain. Some authors believe that spondylolysis and/or spondylolisthesis is not a predisposing factor to low back pain and that the mere presence of isthmic spondylolisthesis may, indeed, not be the cause of low back pain in the patient. This study explores a possible source of biomechanical dysfunction as an origin of pain in isthmic spondylolisthesis. One hundred and twenty lumbar intervertebral disc angles were measured, 60 of which had spondylolisthesis and the remaining 60 without spondylolisthesis for comparison of the effect that spondylolisthesis has on intervertebral disc angulation of the lumbar spine. The results reveal that the L4-L5 joint has the greatest biomechanical stress placed upon it by virtue that it had the highest intervertebral disc angulation when the component of spondylolisthesis was a factor at L5-S1. Therefore, due to increased intervertebral disc angles at L4-L5, a biomechanical stressing and resulting hyperextension of the facet articulation at L4-L5 may represent a source of symptomatology in isthmic spondylolisthesis of L5-S1.     

MRI影像测量腰椎黄韧带厚度与退变性椎间盘的关系

背景：腰椎间盘退变和黄韧带增厚都被认为是与老化的变化相关。然而,却很少见用MRI评价黄韧带肥厚自然病程的报道。目的：用MRI评价黄韧带厚度与年龄、椎间隙水平及椎间盘退行性变的关系。方法：MRI测量178例患有腰腿痛的患者的L2/3、L3/4、L4/5、L5S1水平712条黄韧带的厚度。并检验黄韧带厚度与年龄和椎间隙水平及椎间盘退行性变的关系。结果与结论：黄韧带的厚度随着年龄的增加而增加。然而,L4/5、L5S1水平黄韧带厚度的增加要比L2/3、L3/4水平明显。在L4/5水平,在20～29岁年龄段的患者黄韧带厚度已超过3mm。所有的患者如果L2/3水平黄韧带肥厚（〉3.0mm）,那么其余个水平的黄韧带均肥厚。在老年患者中,黄韧带的厚度和椎间盘的退行性变没有相关性。提示在20～29年龄段的患者黄韧带已经开始变厚,而黄韧带的增厚不是随着椎间盘的退变屈曲凸入椎管内的。L2/3水平黄韧带的厚度可以作为一个多水平腰椎管狭窄的指示剂。     

The risk of disc prolapses with complex loading in different degrees of disc degeneration - a finite element analysis

BACKGROUND: Disc prolapses can result from various complex load situations and degenerative changes in the intervertebral disc. The aim of this finite element study was to find load combinations that would lead to the highest internal stresses in a healthy and in degenerated discs. METHODS: A three-dimensional finite element model of a lumbar spinal segment L4-L5 in different grades of disc degeneration (healthy, mild, moderate, and severe) were generated, in which the disc height reduction, the formation of osteophytes and the increasing of nucleus' compressibility were considered. The intradiscal pressure in the nucleus, the fiber strains, and the shear strains between the annulus and the adjacent endplates under pure and complex loads were investigated. RESULTS: In all grades of disc degeneration the intradiscal pressure was found to be highest in flexion. The shear and fiber strains predicted a strong increase under lateral bending+flexion for the healthy disc and under axial rotation and lateral bending+axial rotation for all degenerated discs, mostly located in the postero-lateral annulus. Compared to the healthy disc, the mildly degenerated disc indicated an increase of the intradiscal pressure and of the fiber strains, both of 25% in axial rotation. The shear strains showed an increase of 27% in axial rotation+flexion. As from the moderately degenerated disc all measurement parameters strongly decreased. INTERPRETATION: The results support how specifically changes associated with disc degeneration might contribute to risk of prolapse. Thus, the highest risk of prolapses can be found for healthy and mildly degenerated discs.     

Lumbar intraspinal synovial cyst containing gas as a cause for low-back pain

OBJECTIVE: To discuss intraspinal synovial cysts caused by degenerative changes involving the posterior articular facets in the lumbar spine and to provide differential considerations for patients with low-back pain. Clinical Features: A 70-year-old man with low-back and gluteal pain demonstrating eventual progression of radiating pain into the left thigh, calf, ankle, and foot over a 5-month period. Radiographs of the lumbar spine revealed mild degenerative disk disease at L5-S1 with associated vacuum phenomena of the L5 disk. Degenerative osteophytes were present at L3, L4, and L5. Moderate posterior joint arthrosis was evident at L4-L5 and L5-S1. Computed tomography and magnetic resonance imaging studies revealed an intraspinal gas-containing synovial cyst at the left lateral aspect of the central canal at the level of the left L4-L5 facet articulation. Intervention and Outcome: The patient underwent surgical excision of the synovial cyst with remission of symptoms. CONCLUSION: Gas-containing intraspinal synovial cysts can be a significant finding and a causative factor in patients with low-back pain and pain radiating into the lower extremities. Both computed tomography and magnetic resonance imaging are important in defining intraspinal synovial cysts as a cause of back pain in patients whose low-back pain does not respond to chiropractic care.     

Computational modeling of lumbar disc degeneration before and after spinal fusion

BackgroundAdvancing age and degeneration frequently lead to low back pain, which is the most prevalent musculoskeletal disorder worldwide. Degenerative changes in intervertebral discs and musculo-ligamentous incapacity to compensate sagittal imbalance are typically amongst the sources of instability, with spinal fusion techniques being the main treatment options to relieve pain. The aims of this work were to: (i) assess the link between ligament degeneration and spinal instability by determining the role of each ligament per movement, (ii) evaluate the impact of disc height reduction in degenerative changes, and (iii) unveil the most advantageous type of posterior fixation in Oblique Lumbar Interbody Fusion to prevent adjacent disc degeneration.MethodsTwo L3-L5 finite element models were developed, being the first in healthy condition and the second having reduced L4-L5 height. Different degrees of degeneration were tested, combined with different fixation configurations for Oblique Lumbar Interbody Fusion.FindingsFacet capsular ligament and anterior longitudinal ligament were the most influential ligaments for spinal stability, particularly with increasing degeneration and disc height reduction. Pre-existent degeneration had lower influence than the fusion procedure for the risk of adjacent disc degeneration, being the highest stability and minimal degeneration achieved with bilateral fixation. Right unilateral fixation was more suited to reduce disc stress than left unilateral fixation.InterpretationBilateral fixation is the best option to stabilize the spinal segment, but unilateral right fixation may suffice. This has direct implications for clinical practice, and the extension to a population-based study will allow for more efficient fusion surgeries.     

夹脊电针对兔退变腰椎间盘组织中decorin蛋白表达的影响

目的：观察夹脊电针对兔退变腰椎间盘组织中核心蛋白聚糖(decorin)蛋白表达的影响,探讨夹脊电针防治腰椎间盘退变的作用机制。方法：将40只新西兰大白兔随机分成4组：正常组、模型组、假模型组和电针组,每组各10只。正常组：自然饲养,不予任何处理;模型组：在实验兔L4、L5椎体间横穿克氏针,并施以轴向加压造模器加压28d,不做治疗;假模型：同模型组,但不予椎体间加压,不做治疗;电针组：于造模成功后第1天开始进行电针治疗,疗程为28d。各组实验兔在术后第28d、第56d两个不同的时间点取出腰椎间盘组织,通过Western blot检测其中decorin蛋白表达的情况。结果：模型组术后第28天、第56天及电针组术后第28天核心蛋白聚糖含量与正常组及假模型组术后第28、56天相比明显下降（均P<0.05）;模型组术后第56天较本组术后第28 天核心蛋白聚糖含量进一步下降（P<0.05）;电针组术后第56天核心蛋白聚糖含量与本组术后第28天时及模型组术后第56d天明显上升（均P<0.05）。结论：decorin参与了腰椎间盘退变的进程,随着腰椎间盘的退变的发生而表达下调;夹脊电针治疗可以使兔退变椎间盘组织中decorin的蛋白表达上调,通过纠正基质降解与合成代谢之间的失衡来达到延缓椎间盘退变的作用。     

腰椎小关节不对称与椎间盘及小关节退变的关系

背景：腰椎小关节不对称与椎间盘退变程度之间的关系一直存在争议,并且国内在下腰痛患者中对小关节不对称与小关节退变程度之间关系的研究较少.目的：调查分析腰椎小关节不对称在腰椎间盘退变与小关节退变过程中的作用.方法：测量312例下腰痛患者共936个脊柱功能单位的小关节角度差值,差值〈7°定义为小关节对称,差值≥7°定义为小关节不对称.对936个脊柱节段的椎间盘退变程度及小关节退变程度进行分级.结果与结论：①小关节是否对称在年龄及性别上差异无显著性（P 〉 0.05）.②小关节不对称与椎间盘退变程度之间无显著关联（P 〉 0.05）.③在L4～L5节段小关节不对称组比小关节对称组的小关节退变程度更重（P 〈 0.01）.提示小关节不对称与椎间盘退变无明显影响,但在腰椎活动度最大的L4～L5节段,小关节不对称可能会引起小关节的退变.     

Digital tracking algorithm reveals the influence of structural irregularities on joint movements in the human cervical spine

BackgroundDisc height loss and osteophytes change the local mechanical environment in the spine; while previous research has examined kinematic dysfunction under degenerative change, none has looked at the influence of disc height loss and osteophytes throughout movement.MethodsTwenty patients with pain related to the head, neck or shoulders were imaged via videofluoroscopy as they underwent sagittal-plane flexion and extension. A clinician graded disc height loss and osteophytes as “severe/moderate”, “mild”, or “none”. A novel tracking algorithm quantified motions of each vertebra. This information was used to calculate intervertebral angular and shear displacements. The digital algorithm made it practical to track individual vertebrae in multiple patients through hundreds of images without bias.FindingsCases without height loss/osteophytes had a consistent increase in intervertebral angular displacement from C2/C3 to C5/C6, like that of healthy individuals, and mild height losses did not produce aberrations that were systematic or necessarily discernable. However, joints with moderate to severe disc height loss and osteophytes exhibited reduced range of motion compared to adjacent unaffected joints in that patient and corresponding joints in patients without structural irregularities.InterpretationDigitally-obtained motion histories of individual joints allowed anatomical joint changes to be linked with changes in joint movement patterns. Specifically, disc height loss and osteophytes were found to influence cervical spine movement in the sagittal plane, reducing angular motions at affected joints by approximately 10% between those with and without height loss and osteophytes. Further, these joint changes were associated with perturbed intervertebral angular and shear movements.     

3D CT imaging of the lumbo-sacral spine after surgical treatment of L5-S1 spondylolisthesis by postero-lateral spondylodesis

Background. The aim of the study is the evaluation of the spatial imaging computed tomography (3D CT) of lumbo-sacral spine after surgically treated spondylolistesis L5-S1 with the postero-lateral spondylodesis using autogenic bone grafts.
Material and methods. Material comprises 9 patients treated surgically due to I degrees spondylolistesis caused by the L5 vertebra spondylolysis. In all cases postero-lateral spondylodesis was performed using autogenic bone grafts, taken from the iliac crest, placed on the transverse processes of the L5 vertebra and the sacral bone. The CT examination was performed in the period between 6 months up to 2 years after operation due to overloading lumbar pain.
Results. The bone grafts was localized correctly in 8 patients. In 1 person the upper side of the one bone graft was localized incorrectly, on the prominent transverse processus of the S1 vertebra, instead of the L5 one. The spatial reconstruction reveal the presence of osteophytes surrounding the ends of the bone grafts or the localization the fissure of the arch. In 2 cases the bone grafts were bigger on the left side, and the wide lower ends were connected with the dorsal surface of the sacral bone and were connected with the shorten due to surgery iliac crest
Conclusions. The CT examination with the use of the spatial option is very valuable in the lumbo-sacral spine imaging in patients treated with the postero-lateral spondylodesis due to spondylolisthesis L5-S1. The spatial images 3D CT are especially useful in imaging of the localization of the bone grafts, assessment of the wide of spinal canal and intervertebral foramens. The use of spatial imaging 3D is valuable supplement of standard CT examination in diagnosis of the patients complaining of the lumbar pain, treated surgically due to spondylolistesis.     

MRI影像测量腰椎黄韧带厚度与退变性椎间盘的关系

背景:腰椎间盘退变和黄韧带增厚都被认为是与老化的变化相关。然而,却很少见用MRI评价黄韧带肥厚自然病程的报道。目的:用MRI评价黄韧带厚度与年龄、椎间隙水平及椎间盘退行性变的关系。方法:MRI测量178例患有腰腿痛的患者的L2/3、L3/4、L4/5、L5S1水平712条黄韧带的厚度。并检验黄韧带厚度与年龄和椎间隙水平及椎间盘退行性变的关系。结果与结论:黄韧带的厚度随着年龄的增加而增加。然而,L4/5、L5S1水平黄韧带厚度的增加要比L2/3、L3/4水平明显。在L4/5水平,在20～29岁年龄段的患者黄韧带厚度已超过3mm。所有的患者如果L2/3水平黄韧带肥厚(>3.0mm),那么其余个水平的黄韧带均肥厚。在老年患者中,黄韧带的厚度和椎间盘的退行性变没有相关性。提示在20～29年龄段的患者黄韧带已经开始变厚,而黄韧带的增厚不是随着椎间盘的退变屈曲凸入椎管内的。L2/3水平黄韧带的厚度可以作为一个多水平腰椎管狭窄的指示剂。     

3.0TMRI弥散加权成像评价腰椎间盘退变原因的价值

背景：MR 弥散加权成像对水分子的扩散运动敏感,能早期了解椎间盘纤维环和髓核的含水量改变,从而明确其退变程度。 目的：通过对109例腰椎间盘的弥散加权成像进行前瞻性研究,旨在提高应用MRI中弥散加权成像序列对椎间盘退变程度和早期变性诊断的认识。 方法：采用Siemens Verio 3.0T 超导磁共振仪。常规平扫包括矢状位T1WI序列及T2WI抑脂序列;弥散加权成像采用SE-EPI序列行矢状位扫描,取b值为800s/mm2,层厚、间距和显示野同T2WI抑脂序列扫描。根据Pfirrmann等的椎间盘退变分级标准,采用盲法在矢状位T2WI上对符合纳入标准的109例545个腰椎间盘进行分级。将弥散加权成像数据传至工作站,并对表观扩散系数图像进行测量,得到表观扩散系数值。分别画出L1/2-L5/S1椎间盘的感兴趣区,记录数据。 结果与结论：年龄与椎间盘退变分级存在明显相关性,年龄越大高级别数量越多。椎间盘表观扩散系数值影响因素分析：男性与女性各椎间盘表观扩散系数值之间差异无显著性意义（P〉0.05）。L1-S1各椎间盘年龄与表观扩散系数值之间存在负相关（P 〈0.05）;椎间盘评级与表观扩散系数值之间存在负相关（P 〈0.05）。提示通过对表观扩散系数值的研究,弥散加权成像将会成为椎间盘退行性变诊断、特别是椎间盘早期退变、无创评价治疗效果及预后判断的重要技术手段。     

年轻患者腰椎间盘Pfirrmann分级与椎间盘膨出及突出的相关性研究

目的通过磁共振成像,观察30岁以下腰痛患者腰椎间盘退行性改变的Pfirrmann分级特征以及相关的其他改变,并评价Pfirrmann分级与椎间盘膨出及突出的相关性。材料与方法回顾性分析83例30岁以下因腰痛行腰椎MRI检查的患者,其中男50例,女33例,平均年龄25岁。由2名影像科医师对MR图像进行分析,观察L1~S1椎间盘信号、椎间盘形态、纤维环撕裂、椎间盘膨出、椎间盘突出、椎体终板及许莫氏结节的改变。椎间盘退行性改变采用Pfirrmann分级。观察指标的相关性分析采用Pearson多元相关分析。结果纳入研究的椎间盘共415个,其中Pfirrmann分级Ⅰ~Ⅱ级退变322个(77.6%),Ⅲ级退变56个(13.5%),Ⅳ级退变33个(7.9%),Ⅴ级退变4个(1.0%);103个椎间盘出现膨出或突出;椎间盘膨出以L4~5椎间盘最多(42.2%),且多合并Ⅲ级退变(51.1%);椎间盘突出以L5~S1椎间盘最多(51.7%),且多合并Ⅳ级退变(46.6%);17例患者出现椎间盘后方高信号区(HIZ),且均位于L4~5、L5~S1椎间盘水平;3例患者出现终板退变。多元相关分析结果显示PfirrmannⅢ级退变与椎间盘膨出有明显相关性(r=0.972;P=0.006),与椎间盘突出无明显相关性(r=0.639;P=0.245);PfirrmannⅣ级退变与椎间盘突出(r=0.999,P=0.000)及HIZ(r=0.919,P=0.028)有明显相关性,与椎间盘膨出无明显相关性(r=0.769,P=0.128)。HIZ与椎间盘膨出(r=0.919,P=0.027)及突出(r=0.935,P=0.020)均有相关性。结论腰椎MRI成像能够清晰显示年轻患者椎间盘早期退行性改变的不同病理阶段;PfirrmannⅢ退变与PfirrmannⅣ级退变分别与椎间盘膨出和椎间盘突出有相关性;年轻患者应及早发现椎间盘早期退变,以对临床评价提供更有价值信息。     

Effects of lumbar spinal disorders on the vertical ground reaction force and Spatio-temporal parameters in gait

BackgroundGround reaction forces are biomechanical data, providing information to investigate pathological gait. The vertical component of ground reaction force introduces the upward thrust force within gait progression. Although alterations in the vertical component in patients with spinal disorders were addressed in the literature, still the corresponding effect on spinal disorders is a major issue to scrutiny. In this study, the effects of two different anatomical spinal disorders on the vertical component pattern were investigated.MethodsTwo groups of patients with lumbar spine stenosis and lumbar intervertebral disc degeneration with lesions at L4-L5 and/or L5-S1 levels, were recruited. The vertical component of ground reaction force and spatio-temporal parameters were obtained and analyzed using one-way analysis of variance.FindingsThe results indicated that all spatio-temporal parameters differed significantly (P < 0.05) except step lengths and stride times (P > 0.05). In a similar test, the Fz2 in patients with lumbar stenosis was higher than that of those with disc degeneration (P < 0.05). Besides, the vertical ground reaction force pattern showed lower slopes in stenosis patients.InterpretationThis study showed that the vertical component of ground reaction force alterations and spatio-temporal parameters could be employed as indicators for certain spinal lesions. The results of this study could implement as an adjunct diagnostic method to help clinicians to differentiate between stenosis and disc degeneration patients and plan for their rehabilitation purposes.     

兔腰椎间盘退行性病变模型的建立及影像学改变

背景:建立最佳的椎间盘退行性病变动物模型对了解椎间盘退行性病变的发生机制、预防与治疗均具有重要意义.目的:以针刺损伤制备兔椎间盘退行性病变模型,通过X射线及MRI分析针刺损伤对椎间盘高度及退行性病变的影响.设计:随机对照观察.单位:解放军第二军医大学长海医院骨科.材料:实验于2005-06/2006-04在解放军第二军医大学长海医院动物中心完成,选用6只健康新西兰大白兔,雌雄不拘,平均6月龄,体质量平均为2.5 kg,均来自解放军第二军医大学长海医院动物中心,许可证号码为SCXK (hu) 2002-0006.实验过程中对动物的处置符合动物伦理学标准.方法:①采用腹膜后入路对实验兔腰椎进行手术,以L3～4椎间盘为正常对照, 不做处置;L4～5椎间盘作为假手术,只进行暴露;L5～6椎间盘暴露后用24 G针头从椎间盘的前外侧针刺3次.②分别于术前及术后4周采用Simens公司CR机拍摄腰椎正侧位X射线片,测量L3～4,L4～5及L5～6椎间隙高度,计算与术前椎间隙高度比值;采用Simens Avanto 1.5 T 医用超导型磁共振扫描仪检测各节段腰椎间盘T2加权信号,根据信号强度记分,4分为正常椎间盘,髓核内信号均匀、明亮;3分为轻微退行性病变椎间盘,T2加权信号部分降低;2分为中度椎间盘退行性病变,T2加权信号明显降低;1分为重度椎间盘退行性病变,其T2加权信号明显降低,而且伴有椎间隙狭窄.主要观察指标:①腰椎X射线侧位片椎间盘高度变化.②椎间盘退行性病变程度.结果:纳入实验兔6只,均进入结果分析,无脱落.①椎间盘高度变化:L3～4及L4～5术后与术前椎间盘高度比分别为0.982 5±0.017 08,0.972 5±0.017 08,均高于L5～6椎间盘高度比(0.550 0±0.025 82),差异有统计学意义(P ＜ 0.01).②腰椎MRI的T2加权像上观察椎间盘退行性病变程度:L3～4及L4～5椎间盘T2加权像信号得分分别为(4.00±0.0),(3.75±0.5)分,均高于L5～6椎间盘,差异有统计学意义(P ＜ 0.01).结论:针刺损伤实验兔椎间盘4周后可造成椎间盘高度降低,并使椎间盘出现明显退行性病变.     

电针夹脊穴对兔退变腰椎间盘Actin、Tubulin表达的影响

目的:观察电针夹脊穴对兔腰退变椎间盘肌动蛋白(actin)、微管结合蛋白(tubulin)表达的影响,探讨电针夹脊穴防治腰椎间盘退变的作用机制。方法:40只新西兰大白兔分为正常组、模型组、假模型组、电针组4组,每组各10只。模型组采用轴向加压法建立腰椎间盘退变模型,电针组给予L_4、L_5双侧夹脊穴电针治疗28d。各组于术后第28天和56天取出椎间盘组织,通过Western blot检测不同时间点椎间盘细胞中actin、tubulin的表达。结果:模型组术后第28天、第56天及电针组术后第28天actin、tubulin表达与正常组及假模型组术后第28天、第56天相比均有明显下降(均P0.05);电针组经电针治疗56d后actin、tubulin表达与该组术后第28天及模型组术后第56天相比均有明显升高(均P0.05)。结论:电针夹脊穴可通过上调模型兔退变腰椎间盘细胞中actin、tubulin的表达,促进退变腰椎间盘细胞骨架恢复,从而起到延缓椎间盘退变的作用。     

退变椎间盘的细胞培养

背景:目前尚未见成熟的成年人退行性变椎间盘的细胞培养模型报道,而此模型为建立椎间盘组织工程的细胞学基础.目的:建立成人椎间盘细胞培养模型,奠定椎间盘组织工程研究的细胞学基础.设计及地点:对比观察的细胞学实验,在山东省创伤骨科研究所完成.材料:标本来源于青岛大学附属医院骨科5例确诊为退行性椎间盘病变患者.L2..椎间盘1例,L4～5椎间盘3例,L5～S1椎间盘1例.方法:对5例取自腰椎间盘突出症退变椎间盘的手术标本,采用系列酶消化法细胞培养和组织块细胞培养两种方法,应用HAMF12培养基加体积分数为10%和20%的胎牛血清分别进行了细胞培养,均获得了传代,并对培养细胞进行了光镜和电镜的形态学观察.主要观察指标:①细胞生长状况.②光镜下细胞形态观察.③透射电镜超微结构观察.结果:酶消化法和组织块法均能获得大量的退变椎间盘细胞,并成功地进行细胞传代.培养细胞的分泌物质可能对细胞的生长起一定的限制作用,去除该物质后细胞可迅速增生.但在细胞生长及增殖过程中,体积分数为20%胎牛血清下细胞增殖速度明显高于体积分数为10%胎牛血清时的速度.全部退变椎间盘标本中均发现了脊索细胞.结论:成人退变椎间盘可以用来获得椎间盘组织工程所需的细胞.     

人工椎间盘置换术后脊柱节段运动范围及有关参数变化的相关评价

背景由于生理老化和病理损害,常导致椎间盘破坏,而椎间盘是脊柱运动功能单位中最关键的结构,其破坏后不但可引起椎间盘退变性疾病,还将引起脊柱的生物力学紊乱,因此最好是重建椎间盘,即可治疗椎间盘疾病,又能部分恢复椎间盘的功能.目的探讨人工腰椎间盘置换术后腰椎间盘退变性疾病患者相应脊柱节段的运动范围及有关解剖参数的变化.设计前后对照研究.单位中山大学附属第三医院骨科、附属第二医院骨科.对象1999-02/2002-06中山大学附属二院确诊为腰椎间盘退变性疾病患者34例,41个椎间盘进行了人工椎间盘置换,术后均按要求完成了研究全过程.方法所有的患者均在气管内麻醉下行腹直肌旁切口经腹膜外入路进行人工腰椎间盘置换术,采用德国Link公司生产的SB ChariteⅢ型人工腰椎间盘,并进行相关评价.主要结局观察①患者术后的脊柱运动节段的稳定性、椎间关节的活动范围、椎间隙高度及椎间孔面积的变化.②术后的临床效果.结果单节段置换L3-4 2例,L4-5 18例,L5S1 7例;双节段置换L3～4和L4-51例,L4-5合并L5S1 6例.所有患者均进行了随访,时间3～38个月,平均随访时间18.6个月,总优良率90%.腰椎间盘突出伴腰椎不稳4例,术后腰椎动力位摄片证实手术节段椎体间无异常位移,重建了腰椎的稳定性.其余的手术节段未见不稳现象.手术后L4-5椎间的屈伸范围与对照组比较,差异无显著性意义(P＞0.05).仅对施行椎间盘置换的L4-5节段伴椎间隙Ⅰ～Ⅱ°狭窄的15例进行了测量,证明手术前后椎间盘高度和椎间孔面积差异有显著性意义(t=2.547,2.634,P＜0.05).结论对腰椎间盘源性疾病进行人工间盘置换,除能恢复腰椎节段的运动功能外,还可以重建椎间隙高度,扩大椎间孔面积,加大脊柱节段的运动范围.     

骨密度对腰椎矢状位力线和椎间盘退变程度的影响分析简

目的 研究骨密度对腰椎椎体矢状位力线及椎间盘退变程度的影响情况.方法 回顾性分析46例老年腰椎病患者的术前腰椎MRI资料,根据双能X线吸收仪（DXA）测量的左侧股骨颈骨密度结果将患者分为三组：骨密度正常组（17例）、骨量减少组（19例）和骨质疏松组（10例）,从腰椎矢状位MRI上测量和比较各组患者的腰椎椎体前、中、后高以及各椎间盘的前、中、后高,记录和比较各组患者腰椎各椎间盘退变程度（采用Pfirrmann分级）.结果骨质疏松组和骨量减少组腰椎各椎体高度无显著统计学差异（P＜0.05）,但都明显低于骨量正常组,其中椎体前高、中高的降低具有显著性差异（P＜0.05）.骨质疏松组在下腰段椎间盘（腰3-4、腰4-5、腰5-1）中高有增加趋势,但骨质疏松组各椎间盘的后高都显著低于骨量减少组及骨量正常组（P＜0.05）.骨质疏松组椎间盘信号退变程度要明显优于骨量减少组及骨量正常组（P＜0.05）.结论 骨密度情况不仅对腰椎椎体矢状位形态产生影响,而且还对椎间盘矢状位形态和退变程度产生影响,骨质疏松症患者有椎间盘退变减缓的趋势.