椎间盘移植的实验研究

本实验研究目的在于：（１）建立间盘移植动物模型，（２）观察椎间盘移植术后不同时期Ｘ线、组织病理学、生物化学和生物力学变化。于１５只猴体上制备自体腰椎间盘移植模型，另有３只猴作为正常生物力学对照。结果表明移植间盘高度术后１～３个月呈下降趋势，４～１２个月呈恢复上升趋势。光镜下纤维环和终板软骨结构无明显改变，髓核中有部分细胞退变，同时亦有成软骨样纤维细胞的再生。术后２～４个月蛋白多糖和含水量呈下降趋势，６～１２个月有恢复；胶原含量２～６个月增加幅度较大，６～１２个月较平缓，其中髓核较纤维环明显。生物力学结果表明术后２个月时移植间盘活动度增大，术后４～１２个月恢复至正常水平。实验结果表明移植间盘在组织病理及生物化学方面有轻度退变倾向，同时又有一定的自我修复能力，生物力学上可满足生理活动功能需要。     

脱钙异体骨关节移植诱导成骨和成软骨作用的研究

评价脱钙异体骨关移植诱导成骨和成软骨的作用。方法：将２４只成年雄性新西兰兔随机分成两组。．除Ｉ组左侧桡骨作为正常对照外，余均截去桡骨近段２０ｍｍ，包括骨膜和关节软骨，分别移植脱钙异体骨关节和不移植。术后２－２４周做Ｘ线检查，组织学和检查和生物力学试验。     

吻合血管异体骨膜移植修复骨缺损能力的实验研究

实验选用２６只成年兔子对吻合血管异体骨膜移植修复骨缺损的能力进行研究。为保证供受体组织抗原不相容性，供体选用大耳白兔（６只），受体和对照组选用青紫蓝免（２０只）。实验组：切取供体兔股骨骨膜，移植于受体兔１．２ｃｍ骨缺损区，通过吻合血管保证骨膜血供。术日起给予免疫抑制剂。对照组：兔桡骨１．２ｃｍ骨缺损不作骨膜移植。术后通过系列Ｘ线平片、骨组织形态测量学检查、四环素荧光标记检查及电镜检查观察骨膜成骨情况，观察１～４个月。结果：实验组１２例中９例骨缺损愈合，对照组８例中无１例骨缺损愈合。两组骨缺损愈合率统计学上差异有高度显著性。结果表明，只要血管蒂保持通畅，移植的异体骨膜就能不断形成新生骨使骨缺损愈合。     

椎间盘移植实验──生物力学研究

本实验在６只猴体上制备自体椎间盘移植模型，观察术后不同时期生理载荷下屈伸活动时移植椎间盘的刚度（ｓｔｉｆｆｎｅｓｓ）变化。结果表明：术后２月，移植的Ｌ３～４椎间盘在整个屈伸活动中较上、下正常对照椎间盘的变形增大；术后４月，移植椎间盘变形接近正常对照椎间盘；术后６月，移植椎间盘刚度明显恢复。实验结果提示术后早期有腰椎节段性不稳倾向，中晚期稳定性恢复，移植椎间盘可满足生理活动功能需要。     

跟外侧血管蒂骨膜瓣移植治疗儿童距骨坏死随访

应用跟外侧血管蒂骨膜瓣植入治疗儿童距骨坏死５例，结果显示：术后３－４个月Ｘ线片距骨密度及形态明显改善，８个月距骨形态恢复正常。并经３－１０年的随访，疗效肯定。其中有以下优点；１．清除死骨彻底减压；２重建距骨血液循环系统；３．带血管的骨膜植入可为距骨带入成骨效应成分，加速骨重建。     

经皮囊内注射移植自体骨髓治疗单房性骨囊肿的初步报告

目的报道经皮囊内注射移植自体骨髓治疗８例单房性骨囊肿的疗效。方法保守治疗８例单房性骨囊肿,男５例,女３例,平均年龄１０岁５个月（７～１８岁）。５例位于肱骨近端,２例位于股骨颈,１例位于股骨干。抽去囊液后注入从髂骨吸取的骨髓。结果平均用骨髓３５ｍｌ（３０～６５ｍｌ）。５ｍｌ组每个穿刺点骨髓有核细胞为（５８５±２９９）×１０９／Ｌ。计算机测量平均囊腔面积为１０９００４ｍｍ２。未见手术并发症发生。下肢治疗６周后去石膏逐渐负重。治疗后６个月内Ｘ线片示所有囊腔骨化,随访６～１７个月,平均１１个月,骨愈合满意,未见并发症发生。结论经皮囊腔内注射移植自体骨髓治疗单房性骨囊肿有效。     

腓骨游离瓣重建口腔下颌骨缺损

目的　探讨腓骨游离瓣在口腔下颌骨缺损修复中的应用价值。　方法　对１９９６ 年４月以来以腓骨游离（ 皮） 瓣一期修复口腔下颌骨缺损的２６ 例进行回顾分析,记录供、受区创口愈合及骨瓣存活情况,分析术后３ 个月颜面外形、张口度及供区并发症,并摄 Ｘ 线片了解移植骨愈合、固位以及剩余腓骨段及踝关节变化情况。　结果　１７ 例移植骨瓣及９ 例骨皮瓣全部成活。２５ 例受区创口一期愈合。术后３ 个月颜面外形１５ 例为优,７ 例中等,４ 例差;２３ 例张口度大于２５ ｃｍ 。所有吞咽功能均正常。２ 例供区有肿痛,１ 例小腿外侧皮肤麻木,２ 例跑步受限,１ 例轻度跛行。 Ｘ 线片显示２４ 例端对位良好,骨痂形成正常,除１ 例远端残余腓骨段外移外,其余未见腓骨及踝关节位置变化。　结论　腓骨游离瓣是一种比较理想的下颌骨缺损修复材料。可用于修复各类下颌骨缺损,尤其适应于涉及双侧下颌体直线缺损的修复;可同期植入种植体,恢复咀嚼功能     

椎间盘移植实验—组织形态学研究

观察了６只猴自体腰椎间盘移植术后不同时期间盘组织形态学变化。结果表明：移植椎间盘高度术后１～３月呈下降趋势，４～６月呈恢复上升趋势。大体形态观察，移植间盘髓核的反光性减弱，呈较粘稠状。光镜下纤维环和终板软骨结构无明显改变，髓核中有部分细胞退变，同时亦有软骨样纤维细胞再生，表明间盘组织对损伤有一定的自体修复能力。组织形态学研究结果表明，猴自体椎间盘移植是可以接受的。     

同种异体血管移植的实验研究与临床应用

选５０只Ｗｉｓｔａｒ鼠分成Ａ、Ｂ两组，每组２５只，Ａ组移植低温贮存的同种异体颈动脉３０条（其中５只行双侧颈动脉移植），Ｂ组移植自体颈动脉２５条．Ａ、Ｂ两组通畅率分别为９０％和９２％，两组组织学变化类似，无明显排异反应．作者用低温贮存的同种异体血管修复了６例７条血管，缺损血管平均长４．７５ｃｍ（１．０～１５．０ｃｍ），缺损血管平均外径２．０３ｍｍ，平均随访１９．６个月（１３～３６个月），５例良好，１例失败．     

巩膜腔内异种异体骨移植的临床应用研究

作者为探索一种理想的生物材料植入巩膜腔内，用以防治眼内容物剜除术后的继发畸形。在动物实验的基础上，于临床行眼内容物剜除术后将部分脱蛋白猪骨和脱钙同种异体骨碎块各１．５克混合移植于巩膜腔内，４周后安装义眼。２４例均无排斥反应及交感性眼炎发生，双眼外观对称，义眼活动满意。１个月后Ｘ线片显示有新骨生成现象，半年后复合骨由新骨替代，２年后随访，疗效稳定。认为本复合骨移植作为眼内充填物具有对人体无害，质轻，机械强度高，骨诱导能力和组织相容性良好等优点     

Vertebral column allografts for the treatment of segmental spine defects. An experimental investigation in dogs

Vertebral column allografts, with their intervertebral discs, were implanted into thoracic spine defects (T7-T9) in 11 dogs in an attempt to re-establish spinal stability and preserve spinal biomechanics. Before implantation, the allografts were harvested under sterile conditions from similar-sized dogs and deep frozen at -80 C. The animals were followed for 18 months postoperatively. Radiographs demonstrated gradual loss of intervertebral disc height. Biomechanical analysis showed that the dogs with allografts had no significant difference in spine stiffness compared with normal spines in compression, flexion, and extension testing. Control spines that had been fused were significantly stiffer than the allograft spines in all modes tested (P less than 0.05). Histologic analysis showed incorporation of the allograft but with incomplete revascularization of the allograft's eighth thoracic body. This investigation found that vertebral body allografts with intervertebral discs can function successfully for 18 months in a canine model. This research may assist in the development of physiologic treatment for spinal deficiencies in humans.     

椎间盘移植实验—生物化学研究

恒河猴１２只，于Ｌ＿（３￣４）行自体间盘移植手术。对术后不同时间移植间盘进行生化分析，测定了间盘组织的水、胶原和蛋白多糖含量变化，结果显示：术后２月蛋白多糖及水含量降低，胶原含量升高，髓核较纤维环变化明显。术后４月蛋白多糖及水含量进一步降低，胶原含量回升，与对照组已无统计学差异，水份和胶原含量较，４月无明显变化。提示：椎间盘移植后虽然在早朝有退变倾向，但在后期这种退变部分恢复。     

Effects of collagenase upon the intervertebral disc in monkeys.

The authors studied 5 rhesus monkeys for the effects of annulotomy, with or without the addition of a bacterially-derived collagenase into the nuclear-evacuated centrum of lumbar intervertebral discs. The animals were sacrificed from 3 weeks to 21 months after the single or staged double procedures. The earliest radiographic changes were loss of height of the interspace at 7 days, erosion of the vertebral body margins at 3 weeks, malalignment at 6 weeks, osteophytic formation at 3 1/2 months, sclerosis of vertebral body surfaces at 9 1/2 months, and fusion of adjacent vertebral bodies at 13 1/2 months. Pathological changes included early loss of disc convexity, focal new home formation, osteophytic new growth, through-and-through bone formation, irregular cystification, and disc replacement by hyaline fibrous tissue. Changes were reminiscent of those seen in humans with naturally acquired disc disease or aging of the disc. Injuries were produced in a tissue that probably has a limited scope of variation in reaction to insult.     

Morphologic comparison of cervical, thoracic, lumbar intervertebral discs of cynomolgus monkey (Macaca fascicularis)

The aim was to analyze the morphological differences of the intervertebral disc and endplates at different levels. Forty-five vertebral motion segments were obtained from the spine of nine 3 to 4-year-old cynomolgus monkeys (Macaca fascicularis). From every spine, five discs were sectioned (C5–C6, T3–T4, T9–T10, L2–L3, L4–L5). In all the groups, tissue samples were collected and sections were stained with Masson’s trichrome, Safranine-O and van Gieson’s connective tissue stain to analyze the intervertebral discs. Immunohistochemistry was performed, using specific antibodies to detect collagens I and II. The intervertebral disc height, the maximum nucleus pulposus height, the superior and inferior endplate heights were histomorphometrically measured and different indexes were calculated to compare the differences between specimens of the same animal and between discs of the same level, and finally the differences between groups of discs of different levels. There were no differences existing in annular fibers anchoring on the endplate between discs of different levels. A positive immune reaction for type I collagen was observed in the longitudinal ligaments and in the annular region adjacent to them. Collagen II immune reactivity was found in the annulus close to the nucleus pulposus, in the endplates and in the nucleus. There were no differences between discs of different levels in the collagen I and II localization. The height of the discs varied along the spine. The smallest value was measured in T3–T4, with a larger increase caudally than cranially. The highest value was measured in L2–L3. A cervical disc was 55% the height of a lumbar one. The endplate height increased along the length of the spine. The inferior EP was always higher than the superior. The study provides a detailed structural characterization of the intervertebral disc and may be useful for further investigations on the disc degeneration process. An erratum to this article can be found at     

阻断双侧终板营养途径构建山羊椎间盘退变模型

目的通过建立山羊腰椎双侧终板营养途径阻断的动物模型,观察椎间盘退变(IDD)的情况,研究椎间盘营养途径与IDD的相关性。方法选取8只24月龄雌性关中山羊,每只山羊L2~3、L3~4作为实验椎间盘,麻醉后在平行于终板2 mm的椎体骨质处造成骨缺损,并使用骨水泥填塞,阻断椎体和终板之间的营养通路,L1~2、L4~5作为对照椎间盘。分别于术后4、12、24、48周行X线、MRI检查,各时间点随机处死2只山羊,采集椎间盘标本,计算骨水泥有效阻断面积、椎间高度指数(DHI)和Pfirrmann分级,并行HE、Masson三色、蛋白多糖、番红O染色组织学检查。结果术后骨水泥有效阻断面积达49.6%~69.6%(60.7%±5.3%)。术后48周时实验椎间盘DHI百分比为60.5%~81.7%(72.7%±5.6%),椎间高度丢失较对照差异有统计学意义(P<0.01);术后48周时实验椎间盘Pfirrmann分级为3~5(4.0±0.7)分,较对照差异有统计学意义(P<0.01)。组织学检查证实,实验椎间盘术后12周即发生退变,并随时间(24、48周)逐步加重。结论骨水泥填塞阻断双侧终板营养途径可以构建山羊IDD的动物模型,阻断终板营养途径可以导致IDD发生。     

双节段人工椎间盘置换加融合在多节段颈椎间盘突出症的应用

目的 总结1例多节段颈椎间盘突出症患者相邻颈椎节段实施人工椎间盘置换和植骨融合的效果，以及二者间的相互影响，为多节段椎间盘突出症寻找新的外科治疗方法。方法2004年12月对确诊为C3～7椎间盘突出症的患者，实施C4～6椎间盘置换术，C3,4及C6、7椎间盘切除，椎体间行钛网植骨、Zephir钢板内固定术。术后2d下床行颈椎功能锻炼，术后3周～3个月颈椎支具制动。以术后动力位X线片衡量其颈椎活动范围。结果术后患者颈椎活动时无疼痛，脊髓神经症状有所缓解。获随访1年2个月，颈椎活动无明显受限，四肢感觉、肌力正常。动力位X线片可见颈椎前屈、后伸和左右侧弯活动范围均接近正常水平。结论人工椎间盘置换结合植骨融合治疗多节段颈椎间盘突出症，近期临床效果较好；术后早期加强颈椎功能锻炼，再限制颈椎活动，可较好地处理术后活动和制动的矛盾，达到手术目的。     

Cryopreserved intervertebral disc allografts in dogs: Chronological changes in 3-year period after transplantation

To explore the potential clinical applications of allografting cryopreserved intervertebral discs, we employed the technique in 10 donor and 20 recipient mongrel adult dogs. The intervertebral disc was excised en bloc, along with portions of the adjoining vertebral bodies, from the donor dogs. These “units” were soaked with 10% dimethyl sulfoxide and cryopreserved at −80°C for 8 weeks or at −196°C for 3 weeks. The unit was implanted at the L4/L5 or L5/L6 level in the recipient animal. Synostosis between the donor and recipient vertebral bodies was completed within 6 months of surgery. Radiologically, the intervertebral spaces within the transplanted unit were well preserved. The spaces were still maintained at 12 months, despite radiological manifestations of slight degeneration, with no marked changes being observed from the condition at 6 months. At 36 months, the unit showed marked morphological changes, including narrowing of the intervertebral spaces, but the upper and lower bodies had not yet fused. Cell incubation indicated a profound decrease in the cellular activity of the transplanted disc. Our findings suggested that the cryopreserved and transplanted intervertebral disc maintained mobility for at least 36 months. The techniques employed and results of the present study may contribute to further exploration of the clinical applicability of cryopreserved allografts.     

Lumbar intervertebral disc heights in normal subjects and patients with disc herniation

A method for the measurement of intervertebral disc heights from lateral radiographs obtained in controlled conditions was examined for intra- and interobserver errors. The use of a strict criterion for the positioning of marks on the images of the vertebrae was shown to enable reproducible measurements to be made with a maximum error of 0.7 mm. Measurements of anterior and posterior disc heights and disc depths were made for 11 normal subjects and ten male patients with prolapsed intervertebral discs, while standing upright. The level of the prolapsed discs were shown to have reduced height compared with normal before surgery, and further narrowing 3 months after surgery. The unaffected discs of the patients were the same height as those of the controls. The technique is proposed as suitable for the investigation of the effect on intervertebral discs of procedures such as the injection of chymopapain.     

Intervertebral mobility in the progressive degenerative process. A radiostereometric analysis

Three separate stages have previously been defined in the progressive degenerative process. The first stage, characterized as temporary dysfunction with early degenerative findings, transforms into a second period of segmental instability evidenced by a resulting deformity. With the deformity the process has reached a late stage of definitive stabilization induced by osteoligamentary repair mechanisms. To test the validity of this three-stage hypothesis, we assessed the intervertebral mobility for the two most-distal lumbar disc levels in 18 adult patients with low back pain, disc degenerative findings and no prior spinal surgery. Each spinal segment was categorized according to grade of disc degeneration: (IA) normal disc height without dehydration; (IB) normal disc height with dehydration; (II) disc height decreased by less than 50%; (III) disc height decreased by at least 50%; and (IV) disc height obliterated. The intervertebral mobility was measured by radiostereometric analysis (RSA) and compared between the categories. With the patient changing position from supine to sitting, the mean vertical translation across the 11 discs categorized as IA was 2.0 mm. A small increase in mean vertical mobility with progressive loss of disc height through the degenerative stages IB (2.2 mm, seven discs) and II (2.6 mm, ten discs) was not significant. Further degeneration to grade III meant a significant mean reduction in vertical mobility to 0.8 mm for the eight discs in that category. No discs were classified as obliterated, category IV. The corresponding values for sagittal translations were 3.0 mm, 3.1 mm, 3.6 mm and 1.7 mm for the four disc categories found. These alterations were not statistically significant. We conclude that intervertebral mobility changes throughout the degenerative process, and a stage of stabilization begins when disc height is reduced by 50%. The segmental mobility status cannot be deduced from the radiographic, degenerative disc stage, since the inter-individual differences in mobility are pronounced for the same disc status. A fully stable situation cannot be taken for granted, even when the disc is reduced by more than 50%, considering the fact that some persisting mobility was seen for most patients in category III. A preceding stage of instability, in the clinical situation proven by a resulting deformity, was not verified in this study.     

Coflex棘突间动态固定系统治疗腰椎间盘突出症的短期疗效评价

目的 对Coflex棘突间动态固定系统在治疗腰椎间盘突出症中的应用进行短期疗效评价.方法 回顾性分析2007年11月至2008年6月采用Coflex动态固定系统治疗腰椎间盘脱出的病例31例,男性16例,女性15例;年龄33～70岁,平均年龄51.4岁.病史6～48个月,平均15.6个月.随访6个月～1年,通过VAS评分、腰椎JOA评分、Oswestry功能障碍指数(ODI)和影像学分析来评价其疗效.结果 腰椎JOA评分从术前9.1±1.1增加到了26.4±1.7(术后6个月).ODI从术前24.7±4.8降低到了4.5±1.1(术后6个月).VAS评分从术前7.9±0.8减少到3.0±0.9(术后6个月),患者术后症状改善明显.相关影像学分析显示手术前后手术节段椎间盘背侧高度(HD)、椎间孔间最大距离(DI)、棘突顶距(DA)差异均有统计学意义(P<0.05).出现并发症3例,其中腰痛1例,对侧下肢痛1例,Coflex松动1例.结论 Coflex在治疗腰椎间盘突出症中,确实增加了椎间盘背侧高度和椎间孔间最大距离,对维持椎间隙高度、缓解腰椎间盘突出症的根性症状具有积极的作用.