犬同种异体腰椎间盘移植的手术技术

[目的]研究并描述一种在无内固定辅助条件下建立犬同种异体椎间盘移植模型的手术技术。[方法]选取1岁龄健康杂种犬25只,处死其中的5只,在无菌条件下取L1~6椎间盘共25个液氮保存,剩余20只犬用于建立L5、6椎间盘移植模型的研究。术中,术后1、4、6、8、12周进行X线检查,观察移植椎间盘的位置、高度变化以及相邻椎体的愈合情况。[结果]椎间盘移植术前选取合适大小的供体椎间盘,术中注意保留前、后纵韧带及对侧纤维环,可以实现在无内固定条件下成功建立同种异体椎间盘移植模型。本研究椎间盘移植成功17例,其余2例出现椎间盘脱出,1例出现椎间盘感染。术后3个月影像学检查示移植椎间盘的上下终板与相邻椎体形成骨性愈合。与术前相比,术后3个月随访椎间盘高度无明显变化(P>0.05)。[结论]采用恰当的手术技术,有助于在无内固定辅助下成功实施同种异体椎间盘移植手术。本研究提供了一种建立犬同种异体椎间盘移植模型的可行的手术方案。     

MRI evaluation of spontaneous intervertebral disc degeneration in the alpaca cervical spine

Animal models have historically provided an appropriate benchmark for understanding human pathology, treatment, and healing, but few animals are known to naturally develop intervertebral disc degeneration. The study of degenerative disc disease and its treatment would greatly benefit from a more comprehensive, and comparable animal model. Alpacas have recently been presented as a potential large animal model of intervertebral disc degeneration due to similarities in spinal posture, disc size, biomechanical flexibility, and natural disc pathology. This research further investigated alpacas by determining the prevalence of intervertebral disc degeneration among an aging alpaca population. Twenty healthy female alpacas comprised two age subgroups (5 young: 2–6 years; and 15 older: 10+ years) and were rated according to the Pfirrmann‐grade for degeneration of the cervical intervertebral discs. Incidence rates of degeneration showed strong correlations with age and spinal level: younger alpacas were nearly immune to developing disc degeneration, and in older animals, disc degeneration had an increased incidence rate and severity at lower cervical levels. Advanced disc degeneration was present in at least one of the cervical intervertebral discs of 47% of the older alpacas, and it was most common at the two lowest cervical intervertebral discs. The prevalence of intervertebral disc degeneration encourages further investigation and application of the lower cervical spine of alpacas and similar camelids as a large animal model of intervertebral disc degeneration. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1776–1783, 2015.     

猪腰椎-人颈椎异种椎间盘移植在组织结构和生物力学中的可行性初步研究

目的通过对猪腰椎-人颈椎椎间盘组织结构及生物力学进行对比研究,探讨椎间盘异种移植的可能性。方法采用普通HE和AZAN、Mallory特殊染色。并对特染的组织切片以Tigter图象分析系统进行图象分析,在电子万能实验机上对猪腰椎-人颈椎脊柱试件进行载荷-外移测试同时在脊柱试件施加人体颈椎所承受的极限载荷后观察椎间盘的改变。结果猪腰椎纤维环中弹力纤维所占的面积百分比较人的为多,人颈椎纤维环中胶原纤维的面积百分比较猪的为多,且有显著差异(P<0.01)。髓核中胶原纤维的平均密度,人颈椎椎间盘较猪腰椎椎间盘为大,有显著差异(P<0.01)。椎间盘的载荷-位移曲线近似于S形。其外移均随所受载荷的增大而呈递增关系。猪的腰段脊柱施以人体颈椎所承受的载荷极限值3400N,显微镜下观察猪腰椎椎间盘结构完整。结论猪腰椎椎间盘组织可能成为临床椎间盘损伤修复移植的材料来源。     

腰椎手法关节和椎间盘压力的力学研究

目的通过压力测量对新鲜脊柱标本进行生物力学实验,测量不同手法对椎间盘和关节的应力变化。方法本实验采用新鲜中年男性尸体,制作脊柱及骨盆标本(保存肌肉韧带),在不同力学状态下(脊柱关节冲击手法、关节松动手法和脊柱单纯旋转),应用压力测量技术获得腰椎L_1-L_5关节突内及椎间盘压力数据。结果实验发现松动手法主要作用点为腰椎关节,对椎间盘影响小。冲击手法对于腰椎关节、椎间盘压力影响较大,在扭力中心有明显的扭力集中现象。结论关节手法对腰椎关节产生明显的压力影响,冲击手法尤甚。如何把握这种压力影响,可能是发挥手法效应和控制副损伤的关键,这为进一步解释手法风险和副作用产生的机理,提供了良好的证据。     

人工腰椎间盘置换术在腰椎间盘突出症治疗中的应用

目的 探讨人工椎间盘置换术治疗腰椎间盘突出症的方法。方法 应用德国LINK公司的人工腰椎间盘置换手术治疗6例腰椎间盘突出症患者,其中腰4.5椎间盘置换5例,腰5骰1椎间盘置换1例,全部病例均有神经根压迫症状,经MR或CT确诊。结果 6例患者术后经半年以上随诊,腰腿痛症状完全消失,术后4天下床活动,术后3个月检查置换椎间盘恢复活动。结论 人工腰椎间盘置换术适合55岁以下1～2个腰椎间盘病变的治疗,具有临床症状缓解迅速、彻底,能保持脊柱稳定和恢复腰椎间的活动,但应严格掌握手术适应证及手术的操作方法。     

经皮激光汽化联合臭氧治疗腰椎间盘突出症的疗效及影响因素分析

目的观察经皮激光汽化联合臭氧治疗腰椎间盘突出症的手术疗效,并探讨影响疗效的相关因素。方法对经皮激光汽化联合臭氧治疗腰椎间盘突出症的86例患者进行回顾性分析,分别记录患者术后时间、年龄、性别、病程长短、症状表现、直腿抬高度数、突出间隙、是否合并骨性和韧带性椎管狭窄、影像上突出严重度各因素。临床疗效采用改良的Mac Nab评定标准。并对不同因素对疗效影响进行统计分析。结果采用改良的Mac Nab评定标准,优:30例;良:38例;可:16例;差:2例。年龄40岁的疗效比(含)40岁好,病程少于2年比多于(含)2年好,腰痛合并腿部症状比单纯腰痛好,直腿抬高度数60°比(含)60°好,差异有统计学意义(P0.05)。结论经皮激光汽化联合臭氧治疗腰椎间盘突出症手术疗效佳,手术疗效与年龄、病程长短、症状表现、直腿抬高度数有关,选择合适病例治疗可望取得更好疗效。     

外伤性颈椎间盘撕裂的诊断和治疗策略

目的 :探讨外伤性颈椎间盘撕裂的病例特点,MRI诊断特征和治疗策略。方法 :回顾分析我组自2015年6月～2018年6月收治的外伤性颈椎间盘撕裂伴脊髓损伤患者46例,男34例,女12例;年龄21～74岁,平均年龄(51.0±12.3)岁。其中车祸伤为27例,高处坠落伤11例,跌倒损伤8例。46例患者中,40例存在颜面擦皮伤。术前进行ASIA分级,所有患者术前行X线、CT、MRI检查,其中MRI检查必须有脂肪抑制序列。根据术前MRI影像结果判断椎间盘存在撕裂的可能,并记录能判断椎间盘撕裂的MRI影像信号特征,术式采用前路损伤节段的ACDF手术。所有前路手术患者全麻后,颈部摆过伸位,透视,部分椎间盘撕裂的节段,会呈现上位椎体向后方移位。如术前高度怀疑椎间盘撕裂,术中未见撕裂,则术中给予次椎间盘造影。将术前MRI特征的影像学表现与术中探查的结果进行对比,总结MRI特征性影像学表现。比较术前、术后1周、术后1个月和末次随访时颈痛的VAS评分及Oswestry功能障碍指数(ODI)。结果:46例患者B级2例,C级7例,D级26例,E级11例,术后末次随访D级1例,E级45例,病例特点为神经损伤轻,而且术后恢复效果好。根据术前MRI影像特征及术中实际探查椎间盘损伤结果分析,将椎间盘撕裂的MRI特征表现分为典型表现和不典型表现两种类型。全麻下后颈部后伸位透视及术中椎间盘造影及对判断椎间盘损伤有一定辅助意义。术中发现46例患者并不都是一个节段椎间盘撕裂,2个节段椎间盘撕裂的有12例,3个节段椎间盘撕裂的有3例,共有74个椎间盘撕裂。前路ACDF手术治疗椎间盘撕裂疗效满意。46例患者完成随访时间为6.0±1.3个月(4～8个月)。所有患者在随访过程中均逐渐改善,术后1周、1个月及末次随访时的VAS评分及ODI与术前比较均显著性改善(P0.05)。结论:外伤性颈椎间盘撕裂患者脊髓损伤轻,术后神经恢复较好,MRI检查有特征性影像表现能明确诊断外伤性颈椎间盘撕裂,颈椎前路ACDF手术是针对病因治疗,效果满意。     

颈椎间盘自发性融合1例

正患者,男,81岁,颈肩部不适伴双手发胀2个月,行走时下肢发僵伴足底踩棉花感1个月就诊。查体:蹒跚步态,项部肌肉发紧,双侧C_(5~7)神经根支配区痛觉减退,双侧肱二头肌、肱三头肌肌腱反射减弱,双上肢运动缓慢,左手握拳时各指不能触及掌心。双侧Hoffman征可疑,腹壁反射消失,双膝腱反射,双侧Babinski征+。初步诊断为混合型颈椎病(脊髓型+神经根型)。颈椎6位片显示颈椎退变,多个     

猪-人异种椎间盘移植在生化和解剖中的可行性初步研究

目的通过对猪-人椎间盘生物化学及解剖结构进行对比研究,探讨椎间盘异种移植的可能性。方法采用常规方法测定髓核和纤维环的水分、糖醛酸及羟脯氨酸含量。以卡尺测量椎间盘矢状、冠状径线以及髓核前缘、后缘距椎间盘前缘、后缘的距离、椎间盘前后部的高度。结果猪-人椎间盘组织含水量无显著差异,P>0.05。纤维环糖醛酸含量无差异,P>0.05。髓核中糖醛酸含量有显著差异,P<0.05;纤维环中糖醛酸的含量与髓核的比较,有显著差异,P<0.05。纤维环和髓核所含羟脯氨酸的量人较猪的为多,有显著差异,P<0.05。猪腰椎与人体颈椎的某些椎间盘在大小上无显著差异,P>0.05。结论为近交系猪腰椎椎间盘实施异种移植的进一步研究提供了试验数据。     

The presence and distribution of lubricin in the caprine intervertebral disc

Lubricin is a large, multifunctional glycoprotein that is known to play a role as a boundary lubricant in diarthrodial joint articulation. The hypothesis of this study was that lubricin is present in the intervertebral disc in a distribution consistent with serving to facilitate interlamellar tribology. The objectives were to: (1) determine the distribution of lubricin in the normal caprine disc; and (2) investigate the synthesis of lubricin by caprine annulus fibrosus (AF) and nucleus pulposus (NP) cells in vitro, using immunohistochemical methods. Caprine lumbar intervertebral discs from five levels and four animals were studied. Positive staining revealed the presence of the lubricin in the outer AF of nearly all samples. No staining was present in the inner AF or the NP. Within the outer AF, lubricin was prominent in the layers separating lamellae and in the extracellular matrix of the lamellae. Some of the AF cells within the lubricin‐positive regions demonstrated intracellular lubricin staining, suggesting that these cells may be synthesizing the lubricin protein observed. Immunohistochemistry performed on monolayer cultures of primary AF and NP cells demonstrated intracellular lubricin staining in both cell types. Thus, lubricin is selectively present in the outer caprine intervertebral disc AF, and its distribution suggests that it may play a role in interlamellar tribology. Cells from both the annulus and nucleus were found capable of synthesizing lubricin in vitro, suggesting that these cells may be a potential source of the glycoprotein under some conditions. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1398–1406, 2008     

Calcification in human intervertebral disc degeneration and scoliosis

Calcification is a pathological process that may lead to impairment of nutrient supply and disc metabolism in degenerative and scoliotic intervertebral discs (IVDs). The purpose of this study was to assess the calcification potential of IVDs in degenerative disc disease (DDD) and adolescent idiopathic scoliosis (AIS). For this purpose, 34 IVDs from 16 adult patients with DDD and 25 IVDs from 9 adolescent patients with AIS were obtained at surgery. The concave and convex parts of the scoliotic discs were analyzed separately. Von Kossa staining was performed to visualize calcium deposits, while type X collagen (COL X) expression associated with endochondral ossification was measured by immunohistochemistry. Alkaline phosphatase activity and calcium and inorganic phosphate concentrations were used as indicators of calcification potential. Results showed the presence of calcium deposits and COL X in degenerative and scoliotic IVDs, but not in control discs, and the level of the indicators of calcification potential was consistently higher in degenerative and scoliotic discs than in control discs. The results suggest that disc degeneration in adults is associated with ongoing mineral deposition and that mineralization in AIS discs might reflect a premature degenerative process. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1888–1895, 2011     

Organ culture stability of the intervertebral disc: Rat versus rabbit

There is a need to develop mechanically active culture systems to better understand the role of mechanical stresses in intervertebral disc (IVD) degeneration. Motion segment cultures that preserve the native IVD structure and adjacent vertebral bodies are preferred as model systems, but rapid ex vivo tissue degeneration limits their usefulness. The stability of rat and rabbit IVDs is of particular interest, as their small size makes them otherwise suitable for motion segment culture. The goal of this study was to determine if there are substantial differences in the susceptibility of rat and rabbit IVDs to culture‐induced degeneration. Lumbar IVD motion segments were harvested from young adult male Sprague–Dawley rats and New Zealand White rabbits and cultured under standard conditions for 14 days. Biochemical assays and safranin‐O histology showed that while glycosaminoglycan (GAG) loss was minimal in rabbit IVDs, it was progressive and severe in rat IVDs. In the rat IVD, GAG loss was concomitant with the loss of notochordal cells and the migration of endplate (EP) cells into the nucleus pulposus (NP). None of these changes were evident in the rabbit IVDs. Compared to rabbit IVDs, rat IVDs also showed increased matrix metalloproteinase‐3 (MMP‐3) and sharply decreased collagen type I and II collagen expression. Together these data indicated that the rabbit IVD was dramatically more stable than the rat IVD, which showed culture‐related degenerative changes. Based on these findings we conclude that the rabbit motion segments are a superior model for mechanobiologic studies. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 838–846, 2013     

儿童椎间盘钙化症的诊治

目的：提高儿童椎间盘钙化症的诊断及治疗水平。方法：对32例椎间盘钙化症患儿的临床症状,影像学特征进行分析。32例均住院枕颌带牵引治疗。结果：24例牵引治疗7－10例后症状完全消失,6例合并环枢关节半脱位者牵引治疗10－14天后症状完全消失。X线片显示环枢关节已复位;2例有神经受压症状者牵引治疗后症状完全消失。结论：儿童椎间盘钙化症属自限性疾病,预后良好,根据其临床表现和影像学特征,诊断并不困难,枕颌带牵引治疗效果好,即使存在神经压迫症状,仍可获得满意疗效。     

Intradisc injection of trasylol in lumbar intervertebral disc syndrome

Summary Eighty-three patients who presented clinically and myelographically with a lumbar intervertebral disc protrusion or a lateral prolapse were treated by an intradisc injection of Trasylol. A quarter of the cases showed a recovery and from a written questionnaire, it became clear that nine of these were able to report a continuance lasting for over two years.Older patients (over 50) and those with a recognizable protrusion solely in the lateral view myelogram can apparently rather more expect to be able to make a good recovery with this treatment.

---

Zusammenfassung Bei 83 Patienten, die klinisch und myelographisch eine lumbale Bandscheibenprotrusion oder einen lateralen Vorfall aufwiesen, wurde eine intradiskale Trasylol-Injektion vorgenommen. In einem Viertel der Fälle ergab sich ein Erfolg, der nach der schriftlichen Befragung in 9 Fällen eine über 2 Jahre anhaltende Beschwerdefreiheit bedeutete.Ältere Patienten über 50 Jahre und Patienten mit einer lediglich im Seitenbild des Myelogramms erkennbaren Protrusion können offenbar eher ein gutes Resultat erwarten.

     

组织蛋白酶L与人腰椎间盘退变关系的研究

[目的]探讨Cathepsin L与人腰椎间盘退变的关系.[方法]实验组标本来源于腰间盘突出症的患者,在外科手术过程中取得的退变间盘组织,并根据术中所见将腰间盘突出分为非包含型组和包含型组;对照组间盘来源于胸腰段骨折行前路手术患者手术中切除的间盘组织,以上标本采用.HE染色组织学观察椎间盘的退变特征,免疫组织化学S-P法和逆转录-聚合酶链式反应(RT-PCR)法检测人腰椎间盘细胞Cathepsin L蛋白表达.[结果]HE染色组织学观察在退变组间盘中,各标本均表现出一定的退变特征纤维环板层结构紊乱,软骨细胞巢状增生,纤维环粘液瘤样变,髓核软骨细胞减少,纤维细胞增生,玻璃样变及纤维化,髓核毛细血管的侵入,炎性细胞的浸润等.在未包含型组与包含型组比较显示了更多的髓核毛细血管侵入和炎性细胞浸润,髓核及纤维环退变更严重,纤维细胞增生及瘢痕形成.免疫组织化学染色显示组织蛋白酶L阳性率在退变组(90.68±7.61)%明显高于对照组(10.00±8.69)%,并且在非包含型组(95.45±4.63)%明显高于包含型组(86.93±7.49)%.RT-PCR结果显示组织蛋白酶L的mRNA表达水平在退变组(1.445±0.206)%较对照组(0.526±0.378)%明显上调,并且在非包含型组(1.608±0.044)%明显高于包含型组(1.282±0.166)%.以上结果均经统计分析证实组间差异有统计学意义.[结论]Cathepsin L与人腰椎间盘退变有关.     

Drug‐induced changes to the vertebral endplate vasculature affect transport into the intervertebral disc in vivo

Intervertebral disc health is mediated in part by nutrient diffusion from the microvasculature in the adjacent subchondral bone. Evidence suggests that a reduction in nutrient diffusion contributes to disc degeneration, but the role of the microvasculature is unclear. The purpose of this study was to induce changes in the endplate microvasculature in vivo via pharmaceutical intervention and then correlate microvasculature characteristics to diffusion and disc health. New Zealand white rabbits were administered either nimodipine (to enhance microvessel density) or nicotine (to diminish microvessel density) daily for 8 weeks compared to controls. Trans‐endplate diffusion and disc health were quantified using post‐contrast enhanced magnetic resonance imaging (MRI). Histology was utilized to assess changes to the subchondral vasculature. Results indicate that nimodipine increased vessel area and vessel‐endplate contact length, causing a significant increase in disc diffusion. Surprisingly, nicotine caused increases in vessel number and area but did not alter diffusion into the disc. The drug treatments did affect the microvasculature and diffusion, but the relationship between the two is complex and dependent on multiple factors which include vessel‐endplate distance, and vessel‐endplate contact length in addition to vessel density. Our data suggest that drugs can modulate these factors to augment or diminish small molecule transport. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1694–1700, 2014.     

Multidirectional flexibility analysis of anterior and posterior lumbar artificial disc reconstruction: in vitro human cadaveric spine model

The in vitro multidirectional flexibility analysis was conducted to investigate the initial biomechanical effect of biomimetic artificial intervertebral disc replacement from either anterior or posterior approach in a cadaveric lumbosacral spine model. Two designs of anterior total and posterior subtotal artificial discs were developed using bioactive three-dimensional fabric and bioresorbable hydroxyapatite/poly-l-lactide material (3DF disc). Both models were designed to obtain the stable interface bonding to vertebral endplates with maximum surface area occupation. Using seven cadaveric lumbosacral spines, the following three anterior reconstruction methods were sequentially performed at L4–5 level: anterior 3DF disc replacement; anterior BAK cages (BAK); and posterior pedicle screw fixation and anterior BAK cages combined (BAK + PS). The L2–3 level received two methods of posterior reconstructions: subtotal 3DF disc replacement (two implants), and posterior interbody cages and pedicle screw fixation (PLIF). Six unconstrained pure moments were applied and three-dimensional segmental motions were measured with an optoelectronic motion measurement system. The center of rotation (COR) calculation was conducted radiographically using flexion-extension films. Both anterior and posterior 3DF replacements statistically demonstrated equivalent range of motions (ROMs) in all loading modes compared to intact segment. Anterior BAK, BAK + PS, and PLIF demonstrated significantly lower ROMs when compared to intact and 3DF groups (P<0.05). The 3DF reconstruction tended to realign the COR to the posterior third or surrounding position at the operative disc level. The stand-alone lumbar 3DF disc replacement demonstrated biomechanical characteristics nearly equivalent to the intact spinal segments even through anterior or posterior approach in vitro, suggesting an excellent clinical potential.     

腰椎间盘突出症骨性椎间孔的测量分析

目的研究腰椎间盘突出症骨性椎间孔的病理变化规律,探讨腰椎间孔狭窄的发病机制。方法对100例无下腰痛病史及腰椎畸形的人群(正常组)和59例L4～5椎间盘突出症患者(L4～5突出组)拍摄标准腰椎X线侧位片。在侧位片上分别测量L3～4及L4～5椎间隙高度、椎间孔高度、椎间孔上部宽度;采用"同身法"处理后进行统计分析。结果 L4～5突出组病变椎间隙高度、椎间孔高度和椎间孔上部宽度均较正常组明显变小(P<0.001);椎间孔高度与椎间隙高度变化正相关;椎间孔上部宽度与椎间孔高度变化正相关。结论 L4～5椎间盘突出症患者的病变节段骨性椎间孔高度和上部宽度明显变小,腰椎间孔有效空间明显减少;椎间孔的高度随腰椎间盘退变的加重而减小;腰椎间盘退变对腰椎间孔上部宽度无直接影响;腰椎间孔高度和上部宽度的变化有关联性。