腰椎间盘蛋白多糖核心蛋白的基因表达

目的　探讨在椎间盘中核心蛋白ｍＲＮＡ 表达的增龄性变化。方法　通过ＲＴ－ ＰＣＲ制备核心蛋白特异性的ｃＤＮＡ 探针,应用原位杂交的方法,分别对胎儿和成人椎间盘标本进行核心蛋白ｍ ＲＮＡ表达的定位观察。结果　在胎儿椎间盘标本中,髓核内呈现高表达,纤维环和髓核交界处表达减弱,纤维环处未见阳性表达信号。在成人标本中,髓核和纤维环均未见明显的阳性表达。结论　在胎儿椎间盘核心蛋白主要在髓核高表达,从髓核到纤维环其表达依次降低。     

实验性脊柱内固定后相应区域椎间盘超微结构观察

目的　观察脊柱内固定后相应区域椎间盘的超微结构变化。　方法　日本大耳白兔2 4只,随机分成实验组和对照组,每组12只。实验组骨膜下游离T1 0 ～L3棘突和关节突,克氏针制成“L”形,将钢丝横行穿过T1 1、1 2 ,L1、2 的关节突关节,并与置于T1 1 ～L3棘突两旁的克氏针系紧,对相应区域的脊柱行内固定术。对照组未行手术,仅喂养至实验完成。术后6个月,对两组动物摄X线片观察1次,随后处死动物。取两组动物的L1 椎间盘组织(髓核、纤维环内侧及纤维环外侧)行透射电镜观察,对两组T1 2 、L2 椎间盘组织分别行水平面和矢状面透射电镜及扫描电镜观察。　结果　X线片显示,实验组与对照组椎体及椎间隙差别不明显;透射电镜与扫描电镜观察,实验组椎间盘的髓核、纤维环内层细胞的结构改变较纤维环外层早;对照组的髓核、纤维环内层细胞的结构改变与纤维环外层差别不明显。在退变的椎间盘基质中,蛋白多糖颗粒和特殊结构明显减少。髓核与纤维环基质内有蛋白多糖颗粒和一种特殊结构,而特殊结构在髓核与纤维环内层的形态不一致。　结论　脊柱内固定术后6个月,实验组在异常应力环境下发生椎间盘退变。髓核、纤维环内层基质内的特殊结构分布有特殊规律,与蛋白多糖颗粒在椎间盘退变中的生物学行为密切相关。     

腰椎间盘蛋白多糖核心蛋白的基本表达

目的 探讨在椎间盘中核心蛋白ｍＲＮＡ表达的增龄性变化。方法 通过ＲＴ－ＰＣＲ制备核心蛋白特异性的ｃＤＮＡ探针,应用原位杂交的方法,分别对胎儿和成人椎间盘标本进行核心蛋白ｍＲＮＡ表达的定位观察。结果 在胎儿椎间盘标本中,髓核内呈现高表达,纤维环和髓核交界处表达减弱,纤维环处未见阳性表达信号。在成人标本中,髓核和纤维环均未见明显的阳性表达。结论 在胎儿椎间盘核心蛋白主要在髓核高表达,从髓核到纤维环其表     

腰椎间盘切除术后纤维环修复的研究进展

腰椎间盘切除术后髓核再突出（postoperative relapse of lumbar disc herniation, rLDH）压迫神经易引发腰椎术后综合征（failed back surgery syndrome, FBSS）。由于纤维环的供血主要来自周围节段性动脉分支的小血管，纤维环裂口瘢痕形成多需3～6个月。破口处形成的新瘢痕强度较低，当椎间盘内压力极速增加时，残余髓核多会从瘢痕处再次突出。同时由于椎管内的炎性因子通过纤维环破口进入椎间盘，进一步加重了椎间盘的退变。纤维环修复能够促进破口瘢痕的愈合，明显增强瘢痕的硬度，降低髓核再突出率，减少术后翻修的可能。随着脊柱外科微创化理念的流行，纤维环修复的方式逐渐从开放式椎板开窗手术转变为内镜微创手术。因此，本文就不同术式下行纤维环修复作一综述。     

成骨蛋白-1对髓核抽吸术后兔腰椎间盘组织病理变化的影响

目的:观察成骨蛋白-1(osteogenic protein-1,OP-1)对髓核抽吸术后兔椎间盘组织病理变化的影响.方法:32只日本大耳白兔,用21号针头行L1/2、L3/4椎间盘后外侧穿刺,抽吸出部分髓核组织,L3/4用微量注射器注射OP-1 25μl作为实验椎间盘(OP-1组),L1/2注射25μl生理盐水作为对照椎间盘(Saline组),L2/3作为正常对照椎间盘(正常组),术后2周、4周、8周、12周分别随机处死8只兔,每只取L1/2、L2/3和L3/4椎间盘,切片,行Masson染色,观察椎间盘组织病理学变化情况.结果:正常对照组椎间盘髓核组织胶原稀疏、排列有序,细胞可呈岛状分布,纤维环胶原纤维排列整齐,无扭曲及无分层现象,术后2周、4周、8周、12周椎间盘组织病理变化不明显.Saline组椎间盘术后2周时髓核部分缺失,胶原排列紊乱,出现大量分布不均匀的无定型颗粒;术后4周髓核组织裂隙形成,出现较多的类软骨细胞,胶原纤维扭曲严重;术后8周髓核组织广泛裂隙,胶原排列极其紊乱,出现介于类软骨细胞及纤维细胞之间的细胞,较明显的分层裂隙,胶原纤维极度扭曲,部分断裂;术后12周凝胶状髓核组织呈现明显纤维化,髓核内出现较多纤维样细胞,类软骨细胞数量明显减少,纤维环出现巨大分层裂隙,伴有部分纤维环断裂.OP-1组椎间盘术后2周髓核胶原排列尚有序,髓核细胞仍较多,纤维环形态接近正常;术后4周髓核组织轻微裂隙,胶原排列紊乱,髓核细胞减少,出现类软骨细胞,内层纤维环胶原纤维轻度扭曲;术后8周髓核组织较多裂隙,胶原扭曲,类软骨细胞增多,内层纤维环胶原纤维明显扭曲,排列紊乱;术后12周时类软骨细胞仍较多,出现少量介于类软骨细胞与纤维细胞之间的细胞,全层纤维环胶原纤维扭曲,排列紊乱,但外层纤维环仍完整,纤维环无巨大裂隙出现.结论;OP-1能延缓后外侧纤维环穿刺髓核抽吸术后兔腰椎间盘髓核细胞及纤维环的退变.     

有限髓核摘除结合纤维环缝合治疗腰椎椎间盘突出症的早期疗效

目的观察有限髓核摘除结合纤维环缝合治疗腰椎椎间盘突出症的早期临床疗效。方法对2015年1月—2016年3月在本院行有限髓核摘除术的59例腰椎椎间盘突出症患者临床资料进行回顾性对照研究。缝合组28例行小切口腰椎椎板开窗有限髓核摘除结合纤维环缝合术;对照组31例行小切口腰椎椎板开窗有限髓核摘除,未行纤维环缝合。采用MacNab标准对术后1、3、6个月的治疗效果进行评价,同时采用椎间盘高度及椎间盘夹角对术后6个月时的脊柱稳定性进行评价。结果术后1、3个月2组Mac Nab评分优良率比较差异无统计学意义;术后6个月时缝合组患者优良率高于对照组,差异有统计学意义(P0.05)。术后6个月时缝合组患者椎间盘高度高于对照组,差异有统计学意义(P0.05),椎间盘夹角小于对照组,差异有统计学意义(P0.05)。随访6个月无复发及再手术患者。结论有限髓核摘除结合纤维环缝合术治疗腰椎椎间盘突出症安全、可靠,能获得满意的早期临床疗效且不影响脊柱稳定性,是降低复发率和再手术风险的一种行之有效的方法,值得临床推广应用。     

颈椎间盘突出类型的术中显微镜下观察

目的 报告并探讨颈椎椎间盘内容物突破纤维环、后纵韧带甚至硬膜囊的特征.方法 自2000年6月至2005年12月实施显微镜下经椎间隙颈前路减压融合术治疗颈椎间盘突出症272例,共378个椎间隙.观察项目包括:纤维环、后纵韧带以及硬膜囊的完整性,后纵韧带前方和后方的突出物.结果 MRI术前判断:纤维环完整者81个椎间隙,纤维环破裂后纵韧带完整者123个椎间隙,后纵韧带破裂者70个椎间隙,髓核后纵韧带后方游离者48个椎间隙,髓核突入硬膜囊2个椎间隙以及椎闻盘形态正常54个椎间隙.手术发现纤维环破裂及后纵韧带后方游离髓核组织的椎间隙数量明显高于MRI的提示:纤维环完整者38个椎间隙,纤维环破裂后纵韧带完整者163个椎间隙,后纵韧带破裂髓核疝62个椎间隙,后纵韧带后方游离髓核63个椎间隙,硬膜囊下疝2个椎间隙以及椎间盘形态正常者50个椎间隙.结论 术前MRI基本能够准确判断髓核突出的位置、方向、大小以及与周围组织的关系,但术中发现大量纤维环全层破裂、后纵韧带破裂以及"较完整"后纵韧带的背侧游离髓核组织的病例,术前MRI无法进行正确判断,说明MRI对于判断纤维环和后纵韧带的完整性有一定局限性;术中有必要切开后纵韧带进行探查.以上解剖认识以及病理分型,有助于实施前路手术的彻底减压.     

经皮穿刺技术治疗椎间盘病变的适应证和并发症

椎间盘病变是脊柱外科领域的重要内容。近年来，随着脊柱微创外科技术日益受到临床医师的重视，经皮穿刺技术治疗椎间盘病变为腰腿痛患者提供了一种较为简便、安全的选择。等离子消融髓核成形术（coblation nucleoplasty）、经皮激光椎间盘减压术（percutaneous laser disc decompression，PLDD）、椎间盘内电热疗法（intradiscal electrical thermotherapy，IDET）是诸多技术中的代表。这些方法通过不同的机制，在椎间盘内产生适当的高温状态，达到髓核或纤维环的细胞重新排列，降低椎间盘内压,并使一定范围内的窦椎神经纤维的痛觉末梢灭活,从而达到缓解疼痛的目的。     

热疗技术治疗椎间盘源性疾病的研究进展

椎间盘源性疾病是椎间盘在各种内外因素的作用下发生退变、纤维环破裂、髓核突出,刺激或压迫脊髓、神经根、马尾神经所出现的一系列综合征。椎间盘为一特殊的纤维结缔组织结构,由纤维环、髓核、软骨板三部分构成,其主要成分有胶原、蛋白多糖、水、非胶原蛋白和少量弹性纤维。椎间盘是人体脊柱活动的主要承载结构,具有弹簧垫样缓冲作用,协调脊柱的活动。     

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,     

Enhanced prolylhydroxylase activity in the posterior annulus fibrosus of canine intervertebral discs following long-term running exercise

Summary The effect of long-term exercise on the intervertebral disc collagen concentration (hydroxyproline), collagen-synthesizing enzymes (prolyl-4-hydroxylase, PH, and galactosyl-hydroxylysyl glucosyltransferase, GGT) and hydroxypyridinium crosslinks was studied in ten female beagle dogs. The dogs were run on a treadmill for 1 year starting at the age of 15 weeks. The daily running distance was gradually increased to 40 km, which distance the dogs ran for the final 15 weeks. Ten untrained dogs from the same breeding colony served as controls. The nucleus pulposus and anterior and posterior halves of the annulus fibrosus of C2–3, T10–12, L4–5 disc segments were analysed. Crosslinks were measured from the anterior annulus fibrosus of the T10–11 disc. Hydroxyproline and hydroxypyridinium concentrations remained similar in both groups. PH and GGT were significantly elevated by running in the posterior annulus fibrosus of the thoracic and lumbar discs and in the lumbar nucleus pulposus. In the thoracic nucleus pulposus GGT was reduced significantly. The results suggest activated collagen metabolism in the posterior annulus fibrosus of the thoracic and lumbar discs as a result of locally increased strains on the spine.The research was carried out at the Department of Anatomy, University of Kuopio     

T2* mapping of ovine intervertebral discs: Normative data for cervical and lumbar spine

To obtain T2* values in histologically evaluated healthy ovine intervertebral discs of the cervical and lumbar spine. Intervertebral discs of nine sheep and nine lambs underwent histological assessment with the modified Boos score for grading of disc degeneration. Discs with a score <10 points (maximum = 40 points) underwent T2* mapping (n = 64). Mid‐sagittal T2* values were obtained in five regions: Anterior annulus fibrosus, anterior nucleus pulposus, central nucleus pulposus, posterior nucleus pulposus, and posterior annulus fibrosus. We noted a zonal T2* distribution with high values in the central nucleus and low T2* values in the anterior and posterior annulus fibrosus. The T2* values were higher in lamb than in sheep IVDs for both cervical and lumbar spine (p < 0.001). The T2* values were also higher in the cervical than in the lumbar spine (p = 0.029 for sheep and p < 0.001 for lamb IVDs). The T2* values obtained in these ovine intervertebral discs can serve as baseline values for future T2* measurements both in health and disease. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:717–724, 2016.     

Histological development of intervertebral disc herniation

Sagittal and horizontal sections of 257 intervertebral discs obtained at autopsy and material obtained from 441 operations for herniation of a disc were examined histologically. In the material that was taken at autopsy, myxomatous degeneration of the annulus fibrosus increased in proportion to the age of the subject. The bundles in the internal layer of the annulus fibrosus reversed their usual direction and showed myxomatous degeneration, sometimes resulting in posterior and anterior convex bulging in the internal layer of the anterior and posterior parts of the annulus fibrosus, respectively. When material from a disc was surgically removed as a single free fragment (as in a complete extrusion or a sequestration type of herniation), annulus fibrosus with myxomatous degeneration was found in most material, while the nucleus pulposus rarely was. These results suggest that, from the standpoint of pathomechanism, a protrusion type of herniation of the annulus fibrosus exists in which only the annulus fibrosus is protruded due to reversal of the bundles of the annulus fibrosus, without involvement of the nucleus pulposus. This type of herniation would be a separate entity from the protrusion type of herniation of the nucleus pulposus that occurs when the nucleus pulposus is protruded through a fissure in the annulus fibrosus.     

腰椎间盘MRI高信号区的组织病理学特点和临床意义

目的研究椎间盘源性下腰痛患者腰椎间盘纤维环后方MRI高信号区的组织病理学特征及其临床意义。方法对52例经保守治疗无效、CT片显示无腰椎间盘突出的下腰痛患者行腰椎MR检查及腰椎间盘造影术。男39例,女13例;平均年龄38.8岁。选择纤维环后方出现高信号区的部分病例行腰椎后路椎间盘切除、椎体间融合、椎弓根螺钉内固定术,术中收集包括高信号区部位的椎间盘。对标本行矢状面连续组织学切片,光镜下观察高信号区椎间盘组织的组织病理学结构,并分析其临床意义。结果在行腰椎间盘造影的52例142个椎间盘中,17例17个椎间盘显示高信号区,且在椎间盘造影过程中全部呈现2或3级的纤维环破裂和疼痛复制反应。敏感性和特异性均为100%。高信号区与纤维环破裂程度分级呈正相关,说明纤维环破裂程度分级越高,越易出现高信号区(R=0.462,P<0.01)。共收集11例患者11个椎间盘,组织学研究发现对应高信号区的椎间盘组织表现为沿纤维环裂隙形成的不同程度的血管化肉芽组织,有成熟的瘢痕化胶原组织。结论症状性下腰痛患者的腰椎MRI上有椎间盘高信号区,可以作为椎间盘源性下腰痛诊断的重要征象。     

Histological study on chemonucleolysis with special reference to the relationship between the dose of chymopapain and disc regeneration

The present study on chemonucleolysis was conducted to determine the influence of chymopapain dose level and patient age on the degree and mode of the response and regeneration of the intervertebral disc. Chymopapain at various doses was injected into the intervertebral discs of young (8-week-old) and mature (20-week-old) rabbits respectively for a histological study. In rabbits undergoing high dose injection, not only the nucleus pulposus but also the inner layer of the annulus fibrosus was digested. Regeneration hardly occurred, and only a slight amount of scar tissue appeared in many animals. At lower dose, the annulus fibrosus remained intact and the posterior inner layer of the annulus fibrosus mainly proliferated toward the anterior portion of the disc, filled the space of digested nucleus pulposus, and restored disc height. This regeneration process was not thought to be specific to the damages caused by chymopapain but rather a common response of injured intervertebral discs.     

The pathogenesis of discogenic low back pain

Discogenic low back pain is a common cause of disability, but its pathogenesis is poorly understood. We collected 19 specimens of lumbar intervertebral discs from 17 patients with discogenic low back pain during posterior lumbar interbody fusion, 12 from physiologically ageing discs and ten from normal control discs. We investigated the histological features and assessed the immunoreactive activity of neurofilament (NF200) and neuropeptides such as substance P (SP) and vasoactive-intestinal peptide (VIP) in the nerve fibres. The distinct histological characteristic of the painful disc was the formation of a zone of vascularised granulation tissue from the nucleus pulposus to the outer part of the annulus fibrosus along the edges of the fissures. SP-, NF- and VIP-immunoreactive nerve fibres in the painful discs were more extensive than in the control discs. Growth of nerves deep into the annulus fibrosus and nucleus pulposus was observed mainly along the zone of granulation tissue in the painful discs. This suggests that the zone of granulation tissue with extensive innervation along the tears in the posterior part of the painful disc may be responsible for causing the pain of discography and of discogenic low back pain.     

Analysis of rabbit intervertebral disc physiology based on water metabolism. I. Factors influencing metabolism of the normal intervertebral discs

Basic factors influencing the metabolism of intervertebral discs of rabbits were quantitatively analyzed based on the water metabolism. The blood flow surrounding the intervertebral disc was calculated using pharmacokinetic concepts from the data obtained by time-related tritiated water distribution analyses. The blood flow was estimated as 0.056 (mg/min/mg tissue) in the anterior annulus, 0.106 in the posterior annulus, 0.120 in the lateral annulus, and 0.084 in the nucleus pulposus, respectively (Experiment 1). Water content and fixed charge density in the intervertebral disc fractions also were measured (Experiment 2). The cations and uncharged small solutes transported into the disc tissue ranged in descending order from nucleus pulposus, lateral annulus, posterior annulus, to anterior annulus. The authors also calculated theoretically the swelling pressure of the proteoglycan in the intervertebral disc fractions from the results of Experiment 2. It was concluded that swelling pressure was highest in the nucleus pulposus, and lowest in the anterior annulus. The water in the posterior annulus is less exchangeable than in the other disc tissue fractions.     

椎间盘源性下腰痛的发病机制

目的探讨椎间盘源性下腰痛的发病机制。方法收集腰椎后路切除的17例椎间盘源性下腰痛患者的19个经腰椎间盘造影术证实的疼痛腰椎间盘;同时收集12个在MRI T2加权像上信号强度明显减弱、无腰痛症状的生理老化椎间盘和10个正常对照椎间盘,行组织学检查和P物质、神经丝蛋白和血管活性肠肽的免疫组织化学染色检查。结果椎间盘源性下腰痛患者的疼痛椎间盘在组织学上的显著特征表现为,一条从髓核至纤维环外层的血管化肉芽组织条带区,其间伴有1个或多个裂隙;肉芽组织条带区与椎间盘造影术后CT上显示的纤维环裂隙一致,肉芽组织之外的纤维环结构基本正常。生理老化椎间盘和正常对照椎间盘表现为与年龄相关的改变。免疫组织化学染色显示,疼痛椎间盘中P物质、神经丝蛋白和血管活性肠肽3种神经肽阳性神经纤维分布数量和比例,较正常对照椎间盘和生理老化椎间盘明显增多;神经纤维主要沿伴有裂隙的肉芽组织条带区分布;疼痛椎间盘髓核中可见P物质和神经丝蛋白的阳性神经纤维分布。结论椎间盘后方神经分布广泛的肉芽组织条带区是椎间盘造影术疼痛和椎间盘源性下腰痛的起源部位。肉芽组织条带可能起源于椎间盘的创伤修复过程。生理老化椎间盘和疼痛椎间盘的差异是后者形成组织学上的肉芽组织条带区。     

成人腰椎软骨终板的组织学特征

目的探讨健康成人腰椎软骨终板组织学特征。方法选取18具新鲜成人尸体腰椎标本,死亡原因为车祸伤或意外,无腰椎外伤和糖尿病。从8个不同区域取材,制备软骨终板样本,利用高敏感测高仪测量软骨终板厚度,通过显微镜观察经HE染色后终板的组织学特征。结果不同区域软骨终板厚度差异有统计学意义(P 0.05),终板厚度为0.696～1.045 mm,后区下部终板最厚,中央区上部最薄。HE染色结果显示,软骨终板的细胞密度比髓核和纤维环的细胞密度高,软骨终板中央区和侧区的胶原纤维分别比髓核和纤维环组织中的胶原纤维更加紧密。结论腰椎不同区域软骨终板厚度不同,其组织学特征与椎间盘的营养供应相关。