环氧合酶-2、前列腺素E2在突出腰椎间盘中的表达及其意义

目的探讨环氧合酶-2(COX-2)、前列腺素E2(PGE2)在突出腰椎间盘组织中的表达及其在坐骨神经痛发病机制中的作用。方法病变组42个突出椎间盘标本取自42例因腰椎间盘突出并具有坐骨神经放射性疼痛症状行手术治疗的患者,包括突起型12例,破裂型15例,游离型15例,取材部位为紧贴神经根突入椎管的椎间盘组织(A部位)和椎间隙内残存的椎间盘组织(B部位)。对照组5个标本取自1例新鲜年轻尸体的L1~S1椎间盘组织,取材部位为椎间盘边缘(A部位)和中央髓核(B部位)。术前对所有患者的坐骨神经痛严重程度进行视觉模拟疼痛评分(VAS)。应用ELISA方法检测各组标本中COX-2和PGE2的含量。结果 COX-2和PGE2在腰椎间盘突出组中的含量明显高于对照组(P0.01);突出组A部位COX-2和PGE2的含量从突起型到→破裂型→游离型均逐渐升高,差异有统计学意义(P0.01)。突出组A部位COX-2和PGE2的含量要高于B部位(P0.01);突出腰椎间盘组织中COX-2和PGE2的含量之间存在明显相关性(r=0.863,P0.01);PGE2的含量与患者坐骨神经痛的VAS评分存在明显相关性(r=0.848,P0.01)。结论 COX-2与PGE2的含量密切相关,并参与对PGE2表达的调控;PGE2的含量与坐骨神经痛的严重程度密切相关。     

基质金属蛋白酶3和白细胞介素1在突出的腰椎间盘组织中的含量及其相关性研究

目的检测正常和突出的腰椎间盘组织中的基质金属蛋白酶3(m atrix m eta lloprote inase 3,MM P-3)、白细胞介素1(in terleuk in 1,IL-1)含量,探讨MM P-3及IL-1间的关系,以及在椎间盘突出症中的作用。方法检测标本分为实验组和对照组,为2003年6月~2004年12月突出的腰椎间盘标本,实验组30例为膨隆型11例,突出型9例,脱垂游离型10例。其中男14例,女16例。年龄33~64岁。对照组9例,为非突出的腰椎间盘标本。其中男4例,女5例。年龄21~58岁。用酶联免疫吸附实验方法测定两组椎间盘标本中MM P-3、IL-1的含量。结果实验组MM P-3膨隆型、突出型和脱垂游离型分别为14.25±1.32、19.89±2.97和20.69±2.18 ng/m l,IL-1膨隆型、突出型和脱垂游离型分别为8.52±0.22、11.88±0.52和11.90±0.73 pg/m l,含量明显高于对照组(P<0.01);实验组中突出型和脱垂游离型MM P-3、IL-1的含量差异无统计学意义(P>0.05),明显高于膨隆型(P<0.01);对照组和各型突出的腰椎间盘标本中MM P-3、IL-1含量差异有统计学意义(P<0.01)。结论退行性变的腰椎间盘能产生MM P-3及IL-1,且二者在椎间盘退行性变中起着重要作用。     

环氧化酶2与血管内皮生长因子在突出腰椎间盘中的表达及意义

目的：探讨环氧化酶2（COX-2）、血管内皮生长因子（VEGF）在突出腰椎间盘中的表达及其意义。方法：62个突出椎间盘标本取自58例腰椎间盘突出症手术患者,包括突起型22个,破裂型20个,游离型20个。取材部位分别为突出组织或游离组织（A部位）和椎间隙残余髓核组织（B部位）。对照组取自4例新鲜年轻尸体的L3/4、L4/5及L5/S1椎间盘组织共12个标本,取材部位为椎间盘边缘（A部位）和中央髓核（B部位）;应用免疫组化法对各组标本中COX-2和VEGF的表达进行检测;应用图像分析系统测量标本中COX-2和VEGF表达量的平均光密度值。结果：在腰椎间盘突出组,特别是破裂型和游离型组的突出组织中存在富含新生血管的肉芽组织,COX-2和VEGF染色阳性细胞主要表达于肉芽组织中及突出组织的椎间盘细胞中,对照组未见阳性染色细胞。在突出组的A部位从突起型、破裂型到游离型COX-2和VEGF的表达均逐渐增高,差异有显著性（P〈0.01）。突出组的A部位COX-2和VEGF的表达明显高于B部位（P〈0.01）。腰椎间盘组织中COX-2和VEGF的表达存在明显相关性（r=0.855,P〈0.01）。结论：COX-2、VEGF参与腰椎间盘退变、突出的发病过程;随着腰椎间盘退变突出的进展,COX-2、VEGF的表达均逐渐增高;COX-2与VEGF表达密切相关。     

经皮内镜椎板间入路椎间盘切除术治疗L5～S1游离型腰椎间盘突出症

目的 探讨经皮内镜椎板间入路椎间盘切除术(PEID)治疗L5～S1游离型腰椎间盘突出症的临床疗效.方法 采用PEID治疗41例L5～S1游离型腰椎间盘突出症患者.记录疼痛VAS评分、JOA评分、ODI.术后12个月采用改良MacNab标准评价临床疗效.结果 手术时间55～98(76.50±20.16)min,住院时间2...     

腰椎间盘中血管内皮生长因子的表达及其意义

目的 :观察并探讨腰椎间盘中内源性血管内皮生长因子 (vascularendothelialgrowthfactor,VEGF)的表达分布规律及其意义。方法 :采用免疫组织化学技术检测 1 6例胎儿期、8例生长期、1 2例成熟退变期和 42例突出椎间盘中VEGF的表达。结果 :胎儿椎间盘脊索细胞和纤维环外层血管内皮细胞出现阳性免疫染色 ,阳性率为 87 5 % ;生长期和成人期椎间盘未见阳性表达 ;退变突出组总阳性率为 83 3 %。VEGF表达主要出现于破裂型和游离型椎间盘突出 (P <0 0 1 ) ,其细胞来源主要是突出椎间盘组织中毛细血管内皮细胞、髓核内的类软骨细胞及单核巨噬细胞。年龄与VEGF表达阳性率关系不大 (P >0 0 5)。病程超过 1年者VEGF阳性率明显低于 1年以内者 (P <0 0 5)。结论 :胎儿期和破裂型 (包括游离型 )突出椎间盘组织可产生内源性VEGF ,突出椎间盘中VEGF的阳性表达与病程、突出类型密切相关     

突出腰椎间盘组织中巨噬细胞的表达及意义

目的　通过对突出腰椎间盘组织中巨噬细胞浸润的检测 ,进一步探讨腰椎间盘突出症的致痛机制。方法　 38例标本取自不同类型的腰椎间盘突出症患者 ,患者术前术后记录疼痛等级。采用免疫组化SABC法对标本进行CD6 8(为单核 /巨噬细胞的表面标记 )染色。将组织学观察结果与患者术前及术后的疼痛量化结果进行比较。结果　① 38例标本中CD6 8的阳性表达为2 2例 (5 7% ) ,其中 18例脱出及游离型椎间盘标本中阳性为 14例 (78% ) ,2 0例膨出及突出型中为 8例 (40 % )。②椎间盘组织中的巨噬细胞浸润与患者疼痛有相关性。结论　突出的椎间盘组织中存在着巨噬细胞 ,巨噬细胞在盘源性腰腿痛的发病机制中起重要作用     

水通道蛋白1在不同程度退变腰椎间盘中的表达及意义

目的 观察水通道蛋白1在退变腰椎间盘组织中的表达变化,研究其与椎间盘退变的关系。方法 实验组取材于经手术治疗腰椎间盘突出症患者椎间盘标本30例,突出型、脱出型、游离型各10例;对照组取材于腰椎损伤致椎体骨折患者切除椎间盘10例。应用免疫组织化学法检测水通道蛋白1在椎间盘组织中的表达。结果 （1）苏木精-伊红染色显示,对照组椎间盘组织仍保持着致密的板层结构,实验组椎间盘组织多呈纤维化样改变。（2）各组髓核细胞中水通道蛋白1表达均明显高于同组纤维环细胞中的表达(P≤0.01)。（3）实验组突出型椎间盘标本髓核及纤维环细胞中水通道蛋白1表达明显低于对照组(P＜0.01),脱出型和游离型椎间盘标本中水通道蛋白1表达明显低于突出型 (P＜0.01)。结论 水通道蛋白1随着椎间盘突出、脱出、游离不同程度退变,表达呈逐渐下降趋势。     

腰椎间盘突出所致坐骨神经痛发病机制

目前研究认为腰椎间盘突出导致坐骨神经痛发病机制为突出椎间盘组织对邻近神经根造成机械性压迫损害,主要包括牵张和压迫两种机制;退变、突出的椎间盘组织是一种发生炎性改变的组织,表达多种炎症细胞因子,这些细胞因子刺激邻近神经根,诱发坐骨神经疼痛性改变;突出椎间盘组织还可诱发自身免疫反应,临床疼痛程度与自身免疫反应程度密切相关;退变椎间盘组织中出现多种神经生长因子表达和神经纤维长入,神经生长因子促进神经纤维生长,神经纤维在诱发坐骨神经疼痛传导中具有重要作用;患者心理和社会因素与坐骨神经痛之间也存在相关性。腰椎间盘突出所致坐骨神经痛发病机制的研究,有助于指导临床合理治疗。     

两种术式治疗腰椎间盘突出症的疗效比较

目的比较显微椎间盘切除术与传统椎板开窗椎间盘切除术治疗单节段腰椎间盘突出症的临床效果。方法 2002年11月-2005年10月,对241例单节段腰椎间盘突出症患者采用显微椎间盘切除术(A组,93例)和传统椎板开窗椎间盘切除术(B组,148例)治疗。A组:男51例,女42例;年龄18～47岁,平均32.3岁。病程1～18个月,平均8.5个月。突出型23例,脱出型52例,游离型18例。椎间盘突出位于L2、38例,L3、411例,L4、535例,L5、S139例。B组:男81例,女67例;年龄16～50岁,平均31.8岁。病程1～20个月,平均9.3个月。突出型37例,脱出型85例,游离型26例。椎间盘突出位于L2、39例,L3、415例,L4、563例,L5、S161例。两组患者年龄、性别、突出节段、突出类型和病程比较,差异均无统计学意义(P0.05),具有可比性。结果术后225例(93.4%)患者腰腿痛得到即刻缓解。术后1周A组患者满意度为91.4%,B组为87.8%,差异无统计学意义(P0.05)。A组切口长度、术中出血量、术后引流量和住院时间明显少于B组(P0.05),手术时间长于B组,但差异无统计学意义(P0.05)。术中A组4例、B组5例发生硬膜撕裂;B组5例发生切口浅表感染,4例椎间隙感染;A组1例发生硬膜外血肿。A、B组围手术期并发症发生率分别为5.4%(5/93)和9.5%(14/148),A组明显低于B组(P0.05)。术后A组4例(4.3%)、B组9例(6.1%)腰椎间盘突出症复发,差异无统计学意义(P0.05);其中11例接受再手术治疗,2例保守治疗。241例均获随访,随访时间36～77个月,平均51.4个月。两组术前及末次随访时视觉模拟疼痛评分(VAS)和Oswestry功能障碍指数(ODI)评分比较差异均无统计学意义(P0.05),术后1周VAS评分组间差异有统计学意义(P0.05);组内术后1周及末次随访时VAS和ODI评分与术前比较均有明显改善(P0.05)。两组末次随访时VAS和ODI评分改善率比较差异均无统计学意义(P0.05)。末次随访时根据改良Macnab标准评价临床疗效,A组优良率为90.3%,B组为86.5%,组间比较差异无统计学意义(P0.05)。结论两种手术方式均能有效治疗腰椎间盘突出症,但与传统椎板开窗椎间盘切除术比较,显微椎间盘切除术创伤更小,住院时间更短,是手术治疗单节段椎间盘突出症的有效方法之一。     

破裂型腰椎间盘突出症16例分析

破裂型腰椎间盘突出症１６例分析季祝永，夏武庆我院于１９８７年至１９９２年在对腰椎间盘突出症患者施行手术治疗的过程中，发现有１６例椎间盘破裂，椎间性组织突入或游离入椎管内形成不同部位的压迫，现报告如下：临床资料本组１６例中，男性１１，女性５例。年龄４０...     

突出腰椎间盘组织中免疫复合物的表达及意义

目的：检测突出腰椎间盘组织中是否有免疫复合物（Immune Complexes IC)的表达，以便进一步探讨突出腰椎间盘组织的致痛机制。方法：取76例不同类型突出腰椎间盘组织标本用生物素化羊抗人IgG抗体进行免疫组化染色。结果：48例脱出和游离型腰椎间盘组织标本中40例IC表达阳性（占83％），28例膨出和突出型中仅8例（占28％）表达阳性。结论：突出腰椎间盘组织中存在着IC的表达，且IC很可能是盘源性下腰痛及坐骨神经痛的重要病生基础之一。     

Expression of Fas receptor on disc cells in herniated lumbar disc tissue

STUDY DESIGN: The expression of Fas receptor, an apoptosis-related protein, on disc cells was examined in surgically obtained disc specimens. OBJECTIVE: To assess the fate of disc cells in herniated disc tissue and the difference in the degree of expression of the Fas receptor between contained and noncontained discs. SUMMARY OF BACKGROUND DATA: Little is known about the fate of disc cells after herniation. METHODS: Twenty-three herniated lumbar disc specimens were classified into contained discs (protrusion or subligamentous extrusion; n = 9) and noncontained discs (transligamentous extrusion or sequestration; n = 14). All specimens were stained using the avidin-biotin-peroxidase complex method. The percentage of disc cells positive for Fas receptor was calculated and compared with clinical and radiologic data. RESULTS: There was a significant difference in the percentage of Fas-positive disc cells between the contained and noncontained discs (8.44 vs.- 14.29;P = 0.044). The percentage of Fas-positive disc cells correlated significantly with the patient's age (r = 0.455, P = 0.029), but not with the degree of disc degeneration on magnetic resonance imaging (r = 0.252, P = 0.214). CONCLUSION: This is the first study to identify the expression of Fas receptor on disc cells in herniated disc tissue. The results show that the disc cells after herniation may undergo Fas-mediated apoptosis and that the degree of expression of Fas receptor differs depending on the type of herniation.     

Proinflammatory cytokines in cerebrospinal fluid and serum in patients with disc herniation and sciatica

Proinflammatory cytokines have been identified in herniated intervertebral discs in humans, and such cytokines have experimentally been demonstrated to be important in the pathophysiological mechanisms of disc herniation. Cerebrospinal fluid (CSF) and serum concentrations of interleukin (IL)-1beta IL-6, IL-8, interferon (IFN)-gamma and tumour necrosis factor (TNF)-alpha were investigated using the enzyme-linked immunosorbent assay (ELISA) technique in 39 patients with lumbar disc herniation and sciatica. Pain duration and pain intensity (visual analogue scale, VAS) were recorded at inclusion, and a clinical examination was performed evaluating neurological findings. The extent of disc herniation (protrusion or extrusion/sequestration) was evaluated perioperatively. Normal concentrations of IL-1beta, IL-6, IFN-gamma and TNF-alpha were present in CSF and serum in almost all patients with lumbar disc herniation. The concentrations of IL-8 in CSF were increased in 12 out of 39 patients, and these increased levels of IL-8 correlated to a short duration of pain and to more pronounced herniation (extrusion or sequestration). No relationship between IL-8 concentrations in CSF and pain intensity, positive neurological findings or a positive straight leg-raising (SLR) test was found. The observation of increased concentrations of IL-8 in CSF in patients with a short duration of symptoms supports the concept of the initial involvement of inflammatory mechanisms after a disc herniation. The finding that most of the patients with increased concentrations of IL-8 in CSF had an extrusion or a sequestration may suggest that the increase in IL-8 is related to mechanical nerve root compression, but may also indicate a biochemical effect exerted by the herniated disc on the surrounding tissue. Further studies on the potential role of IL-8 as a biomarker for disc herniation are warranted.     

Expression of Fas ligand and apoptosis of disc cells in herniated lumbar disc tissue

STUDY DESIGN: An examination of surgically obtained herniated lumbar disc tissues performed by using immunohistochemical staining and the DNA nick end labeling method. OBJECTIVE: To investigate the cell type that expresses Fas ligand (FasL) and any evidence of apoptosis of the disc cells in herniated lumbar disc tissues. SUMMARY OF BACKGROUND DATA: The Fas/FasL system is involved in delivering a death signal that rapidly commits the cells to apoptosis. In the authors' previous study, the expression of Fas on disc cells was identified in herniated lumbar disc tissue. METHODS: Twenty-three herniated lumbar disc tissues (contained disc, n = 9; noncontained disc, n = 14) were examined to investigate the cell type that expresses FasL and any evidence of apoptosis of the disc cells by using immunohistochemical staining and the DNA nick end labeling method, respectively. The percentage of FasL-positive disc cells was calculated and compared with clinical and radiologic data. RESULTS: FasL was expressed in the cytoplasm of the disc cells, and nuclear DNA fragmentation in a few disc cells was identified. A higher degree of FasL expression in disc cells was found in noncontained discs than in contained discs (P < 0.05). The percentage of FasL-positive disc cells significantly increased with the patient's age (P < 0.05), but not with the degree of disc degeneration (P > 0.05). CONCLUSION: The current results indicate that disc cells, after herniation, undergo apoptotic cell death via autocrine or paracrine FasL mechanisms by the disc cells themselves.     

突出椎间盘自然吸收现象的回顾性研究

目的研究突出椎间盘自然吸收的现象,为腰椎间盘突出症的非手术或手术治疗选择提供依据。方法对18例发生突出椎间盘自然吸收现象患者的病程、症状、体征及影像学资料进行回顾性分析。结果所有患者均为破碎型突出。18例均获随访,时间6~72(17±15)个月。突出物吸收率:完全消失12例,显著缩小6例。其中1例后纵韧带破裂者遗留少许腰痛,跟腱反射未恢复,但能正常工作及生活;另有1例腰腿痛复发,影像学显示突出间盘缩小后再次大块脱出,后纵韧带破裂;其余患者症状体征完全恢复,腰椎主动活动自如。结论腰椎间盘突出症如果后纵韧带完整,即使突出物巨大,症状重,只要没有马尾综合征或进行性单根神经根麻痹,都可以进行非手术治疗,且预后良好;但椎间盘吸收后在合适的条件下可再次突出。     

Percutaneous removal of herniated lumbar discs. 50 cases with ten-year follow-up periods

L4-L5 herniated discs documented by myelogram were removed percutaneously from 50 patients, under local anesthesia and X-ray control, and the patients were followed for ten years. Forty-three patients (86%) had relief of sciatica and sensory deficit. However, only one out of eight patients who had had motor neurological deficit had return of normal power and relief of sciatica from this procedure. The best clinical results were in those patients who felt improvement and relief of pain in the leg at the time of the removal of the disc material. The best clinical results were in patients with a major bulge of the disc and decompression of the nerve root. Patients with sequestration of the disc do not uniformly respond well to this procedure. There were no significant complications. Percutaneous excision of herniated L4-L5 lumbar discs, under local anesthesia, is a safe and valid procedure to reduce patient morbidity and hospital stay, and it does not prejudice the outcome of a formal laminectomy if it should fail.     

一氧化氮在突出腰椎间盘中的表达及其意义

目的 :研究一氧化氮 (NO)在突出腰椎间盘组织中的含量及组织学定位 ,并对其意义进行探讨。方法 :对 32例腰椎间盘突出患者的突出间盘组织采取两种方法进行研究 :(1) 12例做体外培养 ,用分光光度法测定培养液上清中NO含量 ;(2 ) 2 0例用免疫组化方法对产生NO的细胞类型及组织学定位进行研究。同时对取自 4具新鲜尸体的 12个正常椎间盘采用相同方法做为对照。结果 :突出腰椎间盘组织产生NO的量为 2 0 0 70± 6 5 5 5nmol/g ,正常对照组的NO量为 76 31± 19 49nmol/ g ,两者统计学有显著性差异 (P <0 0 0 1)。免疫组化结果发现 ,2 0例患者椎间盘组织中一氧化氮合成酶表达阳性 16例 ,12个正常椎间盘组织中无表达阳性细胞。结论 :诱导型一氧化氮合成酶主要由突出椎间盘周围的肉芽组织产生 ,阳性细胞主要以成纤维细胞、软骨细胞及淋巴细胞为主。腰椎间盘可自身合成NO ,NO可能在椎间盘退变中起重要作用 ,突出腰椎间盘中的NO主要由突出腰椎间盘周围的肉芽组织产生。