转化生长因子β1和胰岛素样生长因子1对体外培养人退变髓核细胞生物学活性的影响

目的：观察在体外培养条件下转化生长因子β1（TGF-β1）和胰岛素样生长因子1（IGF—1）对人退变髓核细胞生物学活性的影响。方法：体外培养人退变髓核细胞，台盼蓝染色法测定活细胞率。将每份髓核细胞样本分为对照组、TGF-β1组和TGF-β1＋IGF—1组。采用考马斯亮蓝法测定TGF—β1和IGF—1干预后第0、2、4、6天细胞内总蛋白含量。采用免疫组织化学和免疫荧光化学染色方法测定细胞在TGF-β1和IGF-1干预后0～6d合成Ⅱ型胶原的情况。结果：体外培养人退变髓核细胞的活细胞率为90％～95％。干预后第4、6天TGF-β1组和TGF-β1＋IGF—1组与对照组比较、TGF-β1＋IGF—1组与TGF-β1组比较细胞内总蛋白含量均显著增加（P〈0.05），TGF—β1＋IGF—1组Ⅱ型胶原的合成较对照组显著增加（P〈0．05）；干预后第6天TGF—β1组和TGF-β1＋IGF—1组与对照组比较、TGF-β1＋IGF—1组与TGF-β1组比较Ⅱ型胶原均显著增加（P〈0.05）。结论：一定浓度的TGF-β1能够促进人退变髓核细胞合成Ⅱ型胶原，改善其生物学活性，合用TGF-β1和IGF—1上述作用更加明显。     

BMP-2对人退变椎间盘髓核细胞影响的实验研究

[目的]探讨BMP -2对人退变髓核细胞合成细胞外基质的影响.[方法]分离、培养人退变椎间盘髓核细胞,取第2代髓核细胞,随机将退变推间盘髓核细胞分为2组.A组:加入100 ng/ml BMP -2,B组:加入200 ng/mlBMP -2,C组:对照组,不加干扰因素.通过对试验组和对照组髓核细胞采用光镜、电镜等形态学方法进行大体形态和超微结构观察,细胞Ⅱ型胶原和糖胺多糖的mRNA表达.ELISA检测细胞培养上清中人Ⅱ型胶原含量,DMMB比色法检测细胞培养上清中糖胺多糖含量.[结果]髓核细胞中Ⅱ型胶原、糖胺多糖表达水平实验组均高于对照组.[结论] BMP-2蛋白可促进退变腰椎间盘细胞分泌蛋白多糖和Ⅱ型胶原,增加细胞活性,恢复椎间盘的功能和活性,因此运用BMP-2椎间盘内注射有望成为椎间盘退变疾病生物治疗的方法之一.     

CDMP-1逆转人退变椎间盘髓核细胞的实验研究

[目的]通过CDMP-1促进退变髓核细胞外基质合成来逆转椎间盘退变.[方法]分离、培养人退变椎间盘髓核细胞,取第3代髓核细胞,应用CDMP-l分组进行干预实验.A组为对照组,B组和C组为实验组,B组加人100ng/ml CDMP-1,C组加入200ng/rnl CDMP-1.采用光学相差显微镜及透射电镜对对照组和实验组细胞形态和超微结构进行对比观察:XTT-PMS法检测各组髓核细胞12d的生长曲线,研究三组细胞间的生长动力学差异;实时荧光定量PCR检测髓核细胞,7,14,21d Ⅱ型胶原和糖胺多糖的mRNA表达.[结果]光学相差显微镜及透射电镜示:两剂量实验组形态学上没有明显差异,与对照组相比,CDMP-1实验组能较好的维持髓核细胞生物形态学特性,延长退变髓核细胞的衰老;三实验组12d的生长曲线一致,两剂量的CDMP-1没有增加退变髓核细胞的增殖;实时荧光定量PCR示100ng/ml CDMP-1组:Ⅱ型胶原mRNA表达总体均数及3个时间点均高于另外两组任一时间点(P<0.05);糖胺多糖mRNA表达总体均数及14、21d 2个时间点均高于另外两组相应时间点(P<0.05),且Ⅱ型胶原和糖胺多糖mRNA表达量随刺激时间增加而增加.200 ng/ml CDMP-1组:提高了糖胺多糖mRNA表达水平的同时,却降低了Ⅱ型胶原mRNA水平.[结论]100ng/ml的CDMP-l可以延长体外培养人退变髓核细胞的衰老,维持细胞生物形态学特性,提高退变髓核细胞Ⅱ型胶原和糖胺多糖mRNA表达水平,在一定程度逆转了椎间盘髓核细胞退变.     

人退变椎间盘髓核细胞体外平面培养的形态学及活性观察

[目的]观察平面培养体系内人退变椎间盘髓核细胞的形态及活性变化.[方法]收集20例人退变椎间盘髓核,分离髓核细胞行平面培养,倒置相差显微镜和HE染色观察髓核细胞的生长过程与形态变化,流式细胞仪量化细胞周期分布和凋亡率,甲苯胺蓝染色和免疫细胞化学染色髓核细胞聚集蛋白聚糖和Ⅱ型胶原的表达,观察平面培养传代对髓核细胞活性和基质合成能力的影响.[结果]原代髓核细胞呈类圆形或多角形,平均7d贴壁,31 d融合至95％,P1代髓核细胞呈长梭形或多角形,平均12h贴壁,6.6d融合至95％,两代细胞增殖能力的差异有统计学意义(P＜0.01).原代与P1代髓核细胞的细胞浆阳性染色聚集蛋白聚糖和Ⅱ型胶原,生长融合至95％后约90％的细胞分布于G1期,约16％的细胞凋亡,两代细胞的细胞活性和基质合成能力无统计学差异(P＞0.05).[结论]人退变椎间盘髓核细胞体外平面培养将经历显著的形态学变化.传一代后髓核细胞增殖能力提高,但能维持细胞活性以及蛋白聚糖和Ⅱ型胶原的合成能力.     

成人退变性椎间盘髓核细胞体外培养及形态学观察

目的通过对成人退变椎间盘髓核细胞的体外培养和形态学观察,进一步研究细胞因素在椎间盘退变中的作用机制。方法取5例患椎间盘突出症并行椎间盘摘除手术的成人髓核,分离后在培养基中进行髓核细胞培养,细胞染色、逆转录聚合酶链式反应、免疫荧光检测细胞Ⅰ、Ⅱ型胶原的表达。结果椎间盘髓核细胞可在体外培养,30d后方可进行传代,最佳的培养条件为胎牛血清/培养基体积分数为10%～20%,pH值7.0。髓核细胞中出现Ⅰ型胶原,并具有较高的表达,Ⅱ型胶原表达微弱。结论成人退变髓核细胞体外培养时间较长,细胞增殖能力低下,特定培养条件的摸索是成功与否的关键。     

腺相关病毒载体介导hTGFβ1、β3体外转染退变腰椎间盘细胞的生物学效应

目的比较研究腺相关病毒（adeno-associated virus,AAV）载体介导人转化生长因子β1（human transforming growth factor β1,hTGFβ1）与hTGFβ3逆转兔腰椎间盘细胞退变的生物学效应.方法分离、培养兔腰椎间盘髓核细胞和纤维环细胞,并传代建立退变早、晚期细胞模型.采用荧光标记的pSNⅡ型腺相关病毒（pSNAV2）,分别检测其对不同退变程度兔腰椎间盘细胞的转染效率,并在此基础上应用pSNAV2-hTGFβ1和pSNAV2-hTGFβ3转染不同退变程度的兔腰椎间盘细胞.通过细胞形态、胶原的免疫组织化学染色和35S标记蛋白多糖等方法,检测比较pSNAV2-hTGFβ1和pSNAV2-hTGFβ3对于退变早、晚期兔腰椎间盘细胞基质合成的影响.结果pSNAV2可高效转染退变早期兔腰椎间盘髓核细胞和纤维环细胞,而对于退变晚期兔腰椎间盘细胞的转染效率低.hTGFβ1和hTGFβ3可显著促进退变早期兔腰椎间盘细胞蛋白多糖和Ⅱ型胶原的合成,其中hTGFβ1的作用较hTGFβ3强.hTGFβ1可促进退变早、晚期兔腰椎间盘纤维环细胞Ⅰ型胶原的合成.hTGFβ3可促进退变晚期兔腰椎间盘髓核细胞Ⅱ型胶原的合成.结论pSNAV2-hTGFβ1和pSNAV2-hTGFβ3可促进退变早期兔腰椎间盘髓核细胞蛋白多糖和Ⅱ型胶原的合成以及纤维环细胞Ⅰ型胶原的合成,从而延缓和逆转椎间盘退变.对于退变晚期兔腰椎间盘髓核细胞,hTGFβ3可促进Ⅱ型胶原的合成.     

单纯Ⅱ型胶原酶消化法分离、培养人退变椎间盘髓核细胞的形态学观察

目的:探讨单纯Ⅱ型胶原酶消化法体外培养扩增人退变椎间盘髓核细胞的可行性。方法:收集20例人退变椎间盘髓核,单纯Ⅱ型胶原酶消化分离出髓核细胞并连续培养传代,倒置相差显微镜和HE染色观察细胞形态学变化,甲苯胺蓝染色检测髓核细胞内聚集蛋白聚糖的表达,免疫细胞化学法行Ⅱ型胶原染色,观察髓核细胞的类软骨表型表达情况。结果:单纯Ⅱ型胶原酶消化法可较好的分离培养人退变椎间盘髓核细胞,20例人退变椎间盘髓核,培养成功16例;原代髓核细胞平均7d贴壁,呈类圆形或多角形,P1代髓核细胞平均12h贴壁,呈大梭形或多角形,两代细胞融合95%所需时间分别为30d和7d,差异有统计学意义(P0.01);聚集蛋白聚糖和Ⅱ型胶原主要表达于原代和P1代髓核细胞浆内,被甲苯胺蓝染成天蓝色,免疫细胞化学染色主要表现为黄褐色沉淀,两代间聚集蛋白聚糖和Ⅱ型胶原的表达无统计学差异(P0.05)。结论:单纯Ⅱ型胶原酶消化法可简化髓核细胞分离步骤,提高培养效率;传一代后髓核细胞增殖速率提高,但仍维持类软骨表型,表达聚集蛋白聚糖和Ⅱ型胶原。     

腺相关病毒载体介导的TIMP1对人退变腰椎间盘髓核细胞蛋白多糖的影响

目的:探讨腺相关病毒(Adeno-associated virus;AAV)载体介导的基质金属蛋白酶组织抑制剂1(tissue inhibitor of metalloproteinases 1;TIMP1)对人退变腰椎间盘髓核细胞的生物学效应.方法:单层培养并鉴定人退变腰椎间盘髓核细胞.采用绿色荧光蛋白标记的腺相关病毒(rAAV2-EGFP)检测其对髓核细胞的转染效率.应用构建的rAAV2-TIMP1转染髓核细胞;通过细胞形态学观察、35S标记氨基酸整合法检测rAAV2-TIMP1对人退变腰椎问盘髓核细胞基质合成的影响.在35S检测中;以未转染的退变髓核细胞做为正常对照组.结果:光镜下观察所培养的细胞类型以成纤维样细胞为主;Ⅱ型胶原免疫组化和番红O染色鉴定培养细胞为髓核细胞.AAV转染人退变腰椎间盘髓核细胞的转染效率为12%.35S标记整合法检测rAAV2-TIMP1转染组每分钟计数值为341.43±42.85;正常对照组为224.20±29.26;两组间比较差异有统计学意义(P＜0.05).结论:TIMP1能够促进退变椎间盘髓核细胞蛋白多糖的合成.     

低强度脉冲式超声促软骨修复及其基因表达研究进展

细胞外基质中蛋白聚糖和Ⅱ型胶原合成减少、降解增加及X型胶原的出现.是血运差、自身修复能力低下的关节软骨伤痛及退变的主要原因.一定条件的低强度脉冲式超声波(LIPUS)可促进股骨骨折大鼠模型骨痂中软骨细胞聚合素与Ⅱ型胶原mRNA表达,但后期经骨膜诱导可发生骨化.LIPUS对关节软骨细胞及基质是否产生类似效应并抑制软骨细胞的成熟与退变.则成为关节软骨伤痛无创修复的研究热点.该文通过总结近年来相关文献,就LIPUS对关节软骨伤病动物在体模型的软骨组织学及基因改变.LIPUS对体外培养软骨一软骨细胞的细胞活性、增殖、表型分化及基质合成分泌功能的影响,LIPUS的临床应用研究.LIPUS促进软骨基质合成的调控机制等进行综述,并提出目前研究存在的问题及进一步研究方向.     

小鼠椎间盘退变模型的CBX8改变

[目的]探讨CBX8在小鼠椎间盘退变的表达以及其对椎间盘退变的影响。[方法]自小鼠椎间盘中分离出髓核细胞并行免疫组化鉴定,传代培养后用RT-PCR分别检测CBX8、Ⅱ型胶原、蛋白多糖m RNA的表达变化。分别建立正常对照、假手术和椎间盘退变动物模型,并分别于建模手术后8、12、16周进行检测,观察小鼠脊柱大体形态,Westblot检测Ⅱ型胶原和CBX8蛋白含量。[结果]体外实验表明,小鼠髓核细胞经过传代培养,在第5代时Ⅱ型胶原mRNA基本不表达(0.002±0.001),蛋白多糖的mRNA表达也明显下降(0.23±0.02),但是CBX8的mRNA表达却显著增加(1.68±0.26)。体内实验显示,椎间盘退变模型组发生一定程度的退变性侧弯,椎体的高度也明显下降。模型组Ⅱ型胶原蛋白的含量明显低于正常组及假手术组(P0.05);相反,模型组的CBX8的含量显著高于正常对照组和假手术组(P0.05)。[结论] CBX8在小鼠退变模型以及传代多次的髓核细胞中表达比在正常的椎间盘以及髓核细胞明显升高,CBX8与髓核细胞的衰老退变存在一定的关联。     

细胞自噬对腰椎间盘突出后重吸收的意义

细胞自噬作为细胞的一种自我保护性机制,可通过降解自身衰老物质而维持细胞稳定,且可被高度诱导,自噬对细胞的降解能力会随年龄的增加而减弱。腰椎间盘突出后的重吸收现象是临床保守治疗腰椎间盘突出症患者有效的机制之一,退行性病变是腰椎间盘突出的主要原因之一,细胞自噬又广泛参与了腰椎间盘的退行性病变,并延缓了退行性病变的发生,同时细胞自噬可潜在性诱导重吸收现象的发生。细胞自噬的研究对椎间盘退行性病变以及腰椎间盘突出后的重吸收现象意义重大,对临床保守治疗腰椎间盘突出症患者具有指导意义,因此应重视细胞自噬在重吸收现象中的研究。     

Low‐intensity pulsed ultrasound stimulation enhances TIMP‐1 in nucleus pulposus cells and MCP‐1 in macrophages in the rat

Recent studies have reported that low‐intensity pulsed ultrasound (LIPUS) stimulates cell proliferation and proteoglycan production in rabbit intervertebral disc cells, and moreover promotes the secretion of MCP‐1 (monocyte chemotaxis protein‐1) from macrophages in a disc organ culture model. These findings suggest the possible application of LIPUS for biological repair of disc degeneration and herniation. Although the mechanisms involved are not well understood, several cytokine pathways may play a role. Therefore, in order to evaluate the effect of LIPUS stimulation on cytokine production by nucleus pulposus cells and macrophages, in vitro culture studies were designed. Nucleus pulposus cells and macrophages were collected from Sprague‐Dawley rats, cultured separately in a monolayer, and stimulated with LIPUS for 7 days. After culture, the culture medium and the cells were analyzed by cytokine array, RT‐PCR, and ELISA. Cytokine array showed that LIPUS stimulation significantly upregulated TIMP‐1 (tissue inhibitor of metalloproteinase‐1) in the nucleus pulposus and MCP‐1 in macrophages in comparison with the control. This was confirmed at the gene level by RT‐PCR in nucleus pulposus cells and macrophages after stimulation with LIPUS. Quantitative evaluation of these proteins by ELISA showed higher levels in nucleus pulposus cells and macrophages stimulated by LIPUS than in controls. These results showed that LIPUS stimulation significantly activated TIMP‐1 and MCP‐1 in nucleus pulposus cells and macrophages at both the protein and gene levels, suggesting that LIPUS may be a promising supplemental treatment for intervertebral disc herniation. © 2008 Orthopaedic Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:865–871, 2008     

uPA、MMP-3在退变椎间盘中的表达及意义

目的探讨尿激酶型纤溶酶原激活剂（uPA）、基质金属蛋白-3（MMP-3）在人类退变椎间盘组织中的表达变化。方法对照组为取自脊柱侧凸患者的正常腰椎间盘组织；实验组为腰椎间盘突出患者的退变椎间盘组织。分别进行免疫组织化学染色，比较2组椎间盘组织中uPA及MMP-3的光密度值。结果uPA和MMP-3在突出椎间盘组织中平均光密度值较正常椎间盘组织中的平均光密度值表达明显升高；相关分析显示突出椎间盘中uPA、MMP-3呈正相关关系。结论uPA和MMP-3均可能参与了人椎间盘组织的退变过程，且MMP-3与uPA在人类退变椎间盘组织中有相同的增高趋势。     

退变性腰椎侧凸形成和发展的相关因素分析

目的 探讨退变性腰椎侧凸患者椎问盘的不对称指数、腰椎间盘退变程度以及骨密度降低对侧凸角度的影响.方法 采用回顾性研究的方法,选取2002年1月至2010年8月,共96例退变性腰椎侧凸患者为研究对象(侧凸组);2002年1月至2010年8月确诊为腰椎管狭窄症并且资料齐全的患者96例为对照组;两组间性别、年龄、体质量指数匹配.侧凸组:在腰椎正位X线片上测量凸凹侧顶椎间盘及其上下椎间盘的高度和顶椎及其上下椎体的高度,利用Adobe Photoshop 6.0软件,测量MRI图像T2WI顶椎及其上下椎间盘内髓核与脑脊液的相对信号强度.对照组:取2～3、L3-4、L4-5这3个椎间盘为研究对象测定上述指标.应用双能X线吸收法测定两组患者腰椎(L2-4)及股骨颈、股骨粗隆和Ward's三角的T值.结果 侧凸组凸侧椎间盘高度和为(40±7)mm高于凹侧的(28±7)mm(P<0.01),凸侧椎体高度和为(76±12)mm高于凹侧的(72±10)mm(P=0.016):两组之间的椎间盘退变程度差异有统计学差异(P=0.003);两组之间骨密度T值的平均值和骨质疏松的发生率差异有统计学意义(均P<0.01).通过多元线性回归分析结果 显示患者椎间盘的不对称指数、椎间盘的退变程度、骨密度T值影响退变性腰椎侧凸角度.结论 退变性腰椎侧凸常伴有凸凹两侧椎间盘高度以及椎体高度不对称.侧凸角度与椎间盘的不对称指数、椎间盘的退变程度呈正相关,与骨密度值T值呈负相关.

Abstract：

Objectives To investigate the correlation between scoliosis angle and the asymmetric index of degenerative lumbar scoliosis, the degree of intervertebral disc degeneration, decreased bone density. Methods As a retrospectively study, a total of 96 patients with degenerative lumbar scoliosis were retrospectively enrolled from January 2002 to August 2010 as scoliosis group, meanwhile % patients with lumbar spinal stenosis matched in gender, age and body mass index (BMI) were selected as control group.All patients were studied with plain radiographs, MRI and dual energy X-ray absorptiometry at presentation. Radiographic measurements include Cobb angle, the height of the convex and concave side of the apical disc and the contiguous disc superiorly and inferiorly, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly in scoliosis group, the height of L2-3, L3-4, L4-5 discs and the height of L2-4 vertebral body in control group. The average relative signal intensity of lumbar intervertebral disc and cerebrospinal fluid in T2WI sagittal image was measured in apex intervertebral disc and adjacent discs by Adobe Photoshop 6.0 in scoliosis group, which was measured in L2-3, L3-4, L4-5 disc in control group. The bone density of lumbar, femoral neck, trochanter, and Ward's triangle regions were measured with dual-energy X-ray absorptiometry. Results The intervertebral disc height in convex side was greater than the height in the concave side [(40 ± 7) mm vs. (28 ± 7) mm, P < 0. 01] , the vertebral body height in convex side was greater than the height in the concave side [(76 ± 12) mm vs. (72 ± 10) mm, P =0.016] in scoliosis group. There was significant statistically difference in the degenerative degree of intervertebral discs between two groups (P = 0. 003). There was significant statistically difference of the average T-value and the rate of osteoporosis between two groups (P < 0. 01). Multiple linear regression analysis showed that the asymmetric disc index, the degenerative degree of intervertebral disc and osteoporosis were the predominant correlative factors, which affected the development of degenerative lumbar scoliosis. Conclusions Degenerative lumbar scoliosis is always accompanied by the height asymmetry of intervertebral discs and vertebral body from convex and concavity sides. There is positive correlation between the angle of scoliosis and the asymmetric disc index, the degeneration of intervertebral disc, and negative correlation between the angle of scoliosis and the bone density (T-value).     

uPA、MMP-3在退变椎间盘中的表达及意义

目的探讨尿激酶型纤溶酶原激活剂（uPA）、基质金属蛋白-3（MMP-3）在人类退变椎间盘组织中的表达变化。方法对照组为取自脊柱侧凸患者的正常腰椎间盘组织；实验组为腰椎间盘突出患者的退变椎间盘组织。分别进行免疫组织化学染色，比较2组椎间盘组织中uPA及MMP-3的光密度值。结果uPA和MMP-3在突出椎间盘组织中平均光密度值较正常椎间盘组织中的平均光密度值表达明显升高；相关分析显示突出椎间盘中uPA、MMP-3呈正相关关系。结论uPA和MMP-3均可能参与了人椎间盘组织的退变过程，且MMP-3与uPA在人类退变椎间盘组织中有相同的增高趋势。     

微载体立体培养腰椎间盘细胞蛋白多糖表达的研究

目的研究腰椎间盘细胞在微载体培养与单层培养中细胞表达蛋白多糖含量的差别。方法椎间盘疾病手术病例的术中切除组织采用酶消化法分别进行微载体三维细胞培养和单层细胞培养；取胎儿椎间盘组织，显微镜下区分髓核细胞和纤维环细胞，分别进行培养，同成入组对照。利用^35S放射标记渗入放免定量测定的方法进行蛋白多糖含量的检测。结果①椎间盘细胞胞内的蛋白多糖含量（cpm），细胞单层培养组为101．909±11．439，微载体立体培养组为136．607±10．792，P〈0．05；②椎间盘细胞表达的蛋白多糖含量（cpm），细胞单层培养组为105．119±13．040，微载体立体培养组为174．231±17．676，P〈0．05；③各组椎间盘细胞表达的蛋白多糖含量均高于细胞内的含量；④胎儿腰椎间盘细胞蛋白多糖的含量及表达量均高于成人退变椎间盘细胞，胎儿髓核细胞蛋白多糖的表达量高于纤维环细胞的表达量。结论椎间盘细胞的微载体三维立体培养相对单层培养具有较高细胞蛋白多糖的表达量，是一种较好的细胞培养方式。     

In vitro evaluation of a manganese chloride phantom-based MRI technique for quantitative determination of lumbar intervertebral disc composition and condition

The application of MRI as a non-invasive, quantitative tool for diagnosing lumbar intervertebral disc degeneration is currently an area of active research. The objective of this study was to examine, in vitro, the efficacy of a manganese chloride phantom-based MRI technique for quantitatively assessing lumbar disc composition and degenerative condition. Sixteen human lumbar discs were imaged ex vivo using T2-weighted MRI, and assigned a quantitative grade based on the relative signal intensities of nine phantoms containing serial concentrations of manganese chloride. Discs were then graded macroscopically for degenerative condition, and water and uronic acid (glycosaminoglycan) contents were determined. MRI ranking exhibited significant and strong negative correlation with nucleus pulposus uronic acid content (r = −0.78). MRI grades were significantly higher for degenerate discs. The technique described presents immediate potential for in vitro studies requiring robust, minimally invasive and quantitative determination of lumbar disc composition and condition. Additionally, the technique may have potential as a clinical tool for diagnosing lumbar disc degeneration as it provides a standardised series of reference phantoms facilitating cross-platform consistency, requires short scan times and simple T2-weighted signal intensity measurements.     

Intervertebral Fusion with Mobile Microendoscopic Discectomy for Lumbar Degenerative Disc Disease

The aim of this article is to introduce a technique for lumbar intervertebral fusion that incorporates mobile microendoscopic discectomy (MMED) for lumbar degenerative disc disease. Minimally invasive transforaminal lumbar interbody fusion is frequently performed to treat degenerative diseases of the lumbar spine; however, the scope of such surgery and vision is limited by what the naked eye can see through the expanding channel system. To expand the visual scope and reduce trauma, we perform lumbar intervertebral fusion with the aid of a MMED system that provides a wide field through freely tilting the surgical instrument and canals. We believe that this technique is a good option for treating lumbar degenerative disc disease that requires lumbar intervertebral fusion.     

纤维粘连蛋白EDA+片段在退变椎间盘中的表达及其意义

[目的]检测退变椎间盘内EDA^＋ Fn的表达，探讨损伤在椎间盘退变中的作用。[方法]收集人腰椎间盘退变临床手术标本，经病理证实均发生退变，采用逆转录聚合酶链反应（RT-PCR）技术扩增目标条带。[结果]正常椎间盘内没有EDA^＋ Fn的表达，而退变椎间盘内均有EDA^＋Fn的表达；中重度退变者EDA^＋Fn的表达较轻度退变者为多（轻中度组间P=0．016〈0．05；轻重度组间P=0．007〈0．05），中重度之间则没有明显差别（P≥0．501）。[结论]EDA^＋Fn在退变椎间盘内有较高表达，直接证明损伤是椎间盘退变的重要的致病因素之一。     

Role of the tumor necrosis factor‐α, cyclooxygenase‐2, prostaglandin E2, and effect of low‐intensity pulsed ultrasound in an in vitro herniated disc resorption model

Spontaneous herniated disc resorption occurs via inflammatory reactions involving abundant neovascularization and macrophage phagocytotic activity. Nonthermal low‐intensity pulsed ultrasound (LIPUS) treatment might be effective in shortening the duration of disc resorption. We developed a rat in vitro resorption model in which a coccygeal intervertebral disc and peritoneal macrophages were cocultured. Secretion of tumor necrosis factor‐α (TNF‐α) from macrophages was promoted by LIPUS, and the process of disc degeneration was thus accelerated. In this study, we further examined the effects of LIPUS using this in vitro model focusing on whether LIPUS affects cyclooxygenase‐2 (COX‐2) signaling pathways. We found that the levels of COX‐2 and prostaglandin E2 (PGE2) secreted from macrophages were increased by LIPUS. However, these phenomena were not caused by LIPUS directly, as the levels of these substances were reduced by neutralizing TNF‐α activity. Moreover, the wet weights of the disc samples were not changed by addition of PGE2, but were reduced by recombinant TNF‐α. Our results suggest that the effects of LIPUS in enhancing the process of herniated disc resorption are caused mainly by TNF‐α. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1274–1278, 2008