骨质疏松大鼠膝关节组织总胶原、Ⅰ型及Ⅱ型胶原蛋白的含量变化

背景：目前研究认为胶原蛋白在骨细胞的增殖与分化、骨质的形成和吸收、骨基质矿化等过程中起着非常重要的作用。 目的：观察骨质疏松模型大鼠膝关节组织总胶原、Ⅰ型及Ⅱ型胶原蛋白含量变化。 方法：SD雌性大鼠40只随机分为实验组和对照组,实验组大鼠行双侧卵巢切除16周后,取膝关节软骨和交叉韧带,采用微量羟脯氨酸测定法及酶联免疫吸附法测定大鼠膝关节软骨及前交叉韧带组织总胶原、Ⅰ型及Ⅱ型胶原蛋白含量。 结果与结论：骨质疏松膝关节模型大鼠膝关节软骨、前交叉韧带总胶原、Ⅰ型及Ⅱ型胶原蛋白含量明显下降(P < 0.05),Ⅰ型/Ⅱ型胶原比值也显著降低(P < 0.05),提示骨质疏松可引起膝关节内组织总胶原、Ⅰ型及Ⅱ型胶原含量及其比值改变,与膝关节骨性关节炎的发生密切相关。     

肥厚腰椎黄韧带中成纤维细胞生长因子、转化生长因子及结缔组织生长因子的表达

背景:腰椎黄韧带肥厚是临床上引起腰椎管狭窄的主要因素之一,但其分子机制仍不是非常清楚。目的:分析纤维化相关细胞因子碱性成纤维细胞生长因子、转化生长因子β1和结缔组织生长因子在腰椎黄韧带肥厚过程中的作用。方法:取临床手术所取黄韧带,对照组6例(椎管内占位且无腰椎不稳患者黄韧带)、突出组(单纯腰椎间盘突出症患者黄韧带)6例、腰椎管狭窄症组6例。采用实时定量RT-PCR的方法检测各组黄韧带中碱性成纤维细胞生长因子、转化生长因子β1、结缔组织生长因子及Ⅰ、Ⅲ、Ⅴ型胶原蛋白的mR NA含量,分析3个细胞因子在黄韧带肥厚过程中的作用。结果与结论:腰椎管狭窄症组碱性成纤维细胞生长因子mR NA表达均明显高于突出组和对照组(均P0.05);腰椎管狭窄症组转化生长因子β1 m RNA在3组中的表达明显高于对照组和突出组(均P0.01);结缔组织生长因子mR NA 3组间差异无显著性意义(P0.05)。腰椎管狭窄症组Ⅰ型胶原蛋白mR NA表达明显高于突出组和对照组(均P0.05);Ⅲ型胶原蛋白、Ⅴ型胶原蛋白mR NA表达3组之间差异无显著性意义(P0.05)。结果说明碱性成纤维细胞生长因子、转化生长因子β1在腰椎黄韧带肥厚形成过程中有重要作用,引起黄韧带肥厚的主要胶原产物为Ⅰ型胶原蛋白。     

MRI显示神经根沉降征在腰椎管狭窄症中的应用价值北大核心

背景:神经根沉降征在腰椎管狭窄症患者中的应用价值目前仍未有专家共识。目的:探讨神经根沉降征在腰椎管狭窄症患者中的阳性率及其关系。方法:收集281例由于腰痛或腰腿痛在复旦大学附属金山医院骨科门诊或病房申请行腰椎MRI检查的患者,其中男管119例,女162例。对患者腰椎管横截面积及椎管矢状径进行定量测量,以腰椎管横截面积及椎矢状径是否狭窄进行分组,比较各组间神经根沉降征阳性率的差异。结果与结论:(1)单独以硬膜囊横截面积是否狭窄进行分组:神经根沉降征在重度腰椎管狭窄症患者中的阳性率为91.4%,在非狭窄患者中阳性率为39.6%,在轻度腰椎管狭窄患者中阳性率为53.5%,差异有显著性意义(P<0.05),但在轻、中度与中、重度狭窄患者中阳性率差异无显著性意义;(2)单独以腰椎管矢状径是否狭窄进行分组:非狭窄和狭窄患者的神经根沉降征阳性率差异有显著性意义(44.3%,76.1%,χ~2=21.469,P=0.000);(3)联合硬膜囊横截面积和腰椎管矢状径两个指标分组:硬膜囊横截面积<120 mm^2或者腰椎管矢状径<10 mm提示存在腰椎管狭窄,非狭窄和狭窄患者的神经根沉降征阳性率差异有显著性意义(40.6%,80.6%,χ~2=30.539,P=0.000);(4)结果表明,神经根沉降征是否可以作为诊断腰椎管狭窄症的一项指标仍有待进一步探讨,尽管在重度狭窄患者中阳性率较高,但在非狭窄人群中同样有较高的阳性率,单纯以沉降征诊断腰椎管狭窄存在假阳性,结合硬膜囊横截面积和椎管矢状径及神经根沉降征共同诊断腰椎管狭窄的意义较大。     

腰椎管内静脉血清中炎性因子与腰椎管狭窄的关系

背景：大量研究表明,局部腰椎管狭窄可导致机体免疫学异常和局部慢性炎症的发生,而慢性炎症才是导致疼痛的主要原因。目前对于炎性因子与腰椎管狭窄症的相关性研究主要集中于椎间盘、小关节及黄韧带上,腰椎管内静脉中炎性因子与腰椎管狭窄的关系尚未见相关报道。 目的：分析腰椎管内静脉血清中白细胞介素1α、肿瘤坏死因子α水平与腰椎管狭窄症的相关性。 方法：选取2011年9月至2013年12月上海市同济大学附属东方医院脊柱外科接受腰椎后路椎板切除减压治疗的腰椎管狭窄症及腰椎爆裂性骨折患者,共51例,评估治疗前腰腿痛目测类比评分及Oswestry功能障碍指数。收集退变性腰椎管狭窄症及腰椎爆裂性骨折患者外周静脉及椎管内静脉血,酶联免疫吸附剂法测定血清中白细胞介素1α及肿瘤坏死因子α水平。 结果与结论：退变性腰椎管狭窄症组椎管内静脉血清白细胞介素1α水平显著高于腰椎爆裂性骨折组,退变性腰椎管狭窄症组椎管内静脉血清白细胞介素1α水平显著高于外周静脉,差异均有显著性意义(P < 0.05)。退变性腰椎管狭窄症组腰椎管狭窄节段越多,静脉血清白细胞介素1α水平越高,但统计学差异不显著。线性相关分析显示,退变性腰椎管狭窄症组椎管内静脉血清白细胞介素1α水平与腰腿痛及功能障碍评分呈显著正相关(r²=0.359 3,P < 0.05;r²=0.526 4,P < 0.05)。提示腰椎管内静脉中炎性因子可能是导致退变性腰椎管狭窄患者腰腿痛及功能障碍的原因之一。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

气虚血瘀型腰椎管狭窄症患者增生肥厚与正常黄韧带之间的蛋白质表达差异

背景：从西医的病理机制来看,黄韧带增生肥厚是腰椎管狭窄症的关键致病因素,目前缺乏气虚血瘀型腰椎管狭窄症的生物学信息。目的：分析气虚血瘀型腰椎管狭窄症患者增生肥厚黄韧带与同证患者正常黄韧带之间的蛋白质表达差异。方法：选择2022年2-8月广东省第二中医院(黄埔医院)收治的气虚血瘀型腰椎管狭窄症患者6例,其中黄韧带增生肥厚者3例(实验组),黄韧带厚度正常者3例(对照组),采集所有患者黄韧带组织标本,进行4D Label free定量蛋白组学检测,筛选差异蛋白,运用GO、KEGG进行富集分析。结果与结论：(1)实验组与对照组表达差异的蛋白总数为183个,其中上调蛋白87个,下调蛋白96个;(2)表达差异蛋白的GO富集分析显示,生物进程主要集中在细胞进程、生物调节、对刺激的反应等;细胞组成则集中在细胞、细胞内、蛋白质复合物种;分子功能主要为连接、催化活性、分子功能调节剂等;(3)上调蛋白主要富集到溶酶体信号通路、类风湿性关节炎信号通路、金黄色葡萄球菌感染信号通路;下调蛋白共富集到8条信号通路,分别为p53信号通路、肾细胞癌信号通路、转化生长因子β信号通路、泛素介导的蛋白水解作用信号通路、Ca信...     

膝关节后交叉韧带断裂对内侧副韧带组织学的影响

背景：通过比较Ⅰ型胶原、Ⅲ型胶原相对数量和Ⅰ/Ⅲ型胶原的比值可以一定程度上判断韧带的组织学性能。 目的：观察膝关节后交叉韧带断裂兔保持较低生理负荷和活动度时内侧副韧带组织学的变化。 方法：24只成年雄性家兔双侧膝关节配对为自身对照,实验侧行后交叉韧带完全切断,对照侧只暴露后交叉韧带而不切断,造模后第8,16,24,40周随机处死6只实验兔。进行苏木精-伊红染色,天狼猩红染色检测Ⅰ型和Ⅲ型胶原的相对数量。 结果与结论：①苏木精-伊红染色结果：8,16,24周两组内侧副韧带胶原分布、排列无明显差别;40周时实验组胶原纤维较对照组稀疏。②天狼猩红染色结果：8,16,24周实验组内侧副韧带的Ⅰ型和Ⅲ型胶原纤维总和分别较对照组显著增加(P < 0.05);40周时实验组较对照组显著减少(P < 0.05);8周实验组和对照组之间内侧副韧带的Ⅰ/Ⅲ型胶原纤维的比值差异无显著性意义(P > 0.05);16,24,40周时实验组比值显著分别小于对照组(P < 0.05)。说明兔膝关节后交叉韧带损伤后短期内对内侧副韧带组织学特性无明显影响,随着时间延长,组织学特性显著下降。     

腺病毒介导hTGF-β1基因体内转染兔椎间盘对髓核细胞Ⅰ型、Ⅱ型胶原的影响

目的观察腺病毒载体介导外源性人转化生长因子(Ad/CMV-hTGF-β1)对兔椎间盘髓核细胞Ⅰ型、Ⅱ型胶原的影响.方法纯种成年新西兰大白兔20只,随机分为实验组和对照组,每组10只.于实验组兔腰3、4椎间盘髓核内注射Ad/CMV-hTGF-β1(6×106pfu),注射量为20μl,对照组则注射20μl磷酸盐缓冲液(PBS).术后3周取出椎间盘,免疫组织化学方法观察椎间盘髓核细胞中Ⅰ型、Ⅱ型胶原的表达情况,并用VIDAS图像分析系统进行半定量分析.结果免疫组织化学染色显示实验组椎间盘髓核细胞Ⅰ型胶原的表达比对照组低;而Ⅱ型胶原的表达则比对照组高,差别有统计学意义(P＜0.05).结论体内转染腺病毒介导的hTGF-β1基因能降低椎间盘髓核细胞Ⅰ型胶原的表达、提高Ⅱ型胶原的表达,提示hTGF-β1可以抑制椎间盘的退变.     

腺病毒介导hTGF-β1基因体内转染兔椎间盘对髓核细胞I型、II型胶原的影响

目的:观察腺病毒载体介导外源性人转化生长因子(Ad/CMV-hTGF-β1)对兔椎间盘髓核细胞Ⅰ型、Ⅱ型胶原的影响。方法:纯种成年新西兰大白兔20只,随机分为实验组和对照组,每组10只。于实验组兔腰3、4椎间盘髓核内注射Ad/CMV-hTGF-β1(6×106pfu),注射量为20μl,对照组则注射20!μl磷酸盐缓冲液(PBS)。术后3周取出椎间盘,免疫组织化学方法观察椎间盘髓核细胞中Ⅰ型、Ⅱ型胶原的表达情况,并用VIDAS图像分析系统进行半定量分析。结果:免疫组织化学染色显示:实验组椎间盘髓核细胞Ⅰ型胶原的表达比对照组低;而Ⅱ型胶原的表达则比对照组高,差别有统计学意义(P<0.05)。结论:体内转染腺病毒介导的hTGF-β1基因能降低椎间盘髓核细胞Ⅰ型胶原的表达、提高Ⅱ型胶原的表达,提示hTGF-β1可以抑制椎间盘的退变。     

腰椎管狭窄及肥厚黄韧带中细胞因子的表达

背景:临床上大多数研究都是针对肥厚黄韧带的形态学与组织学方面的研究,而对于黄韧带肥厚在腰椎管狭窄症中的病因学意义,目前尚缺乏统一的认识,尤其在细胞因子水平上的研究甚少。目的:通过在细胞因子水平的研究探讨腰椎黄韧带变性、肥厚的病因及其与腰椎管狭窄症的关系。方法:选择华北煤炭医学院附属骨科医院(唐山市第二医院)2008/2009腰椎管狭窄症和椎间盘突出症住院患者各25例,比较2组患者黄韧带中白细胞介素6、转化生长因子β1、肿瘤坏死因子α阳性表达程度及黄韧带中3种炎性因子阳性表达率。结果与结论:两组患者黄韧带中白细胞介素6、转化生长因子β1、肿瘤坏死因子α阳性表达程度比较,腰椎管狭窄症组明显高于腰椎间盘突出症组(P0.01)。提示白细胞介素6、转化生长因子β1、肿瘤坏死因子α在椎管狭窄症肥厚黄韧带中的表达呈相对一致性,有80%左右均明显增高。黄韧带变性、增殖、肥厚,也是无菌性炎性因子作用的结果。     

人参皂苷Rd干预体外培养肝储脂细胞胶原的表达

背景：肝储脂细胞产生胶原是导致肝硬化的直接原因,调控肝储脂细胞产生胶原的能力即可以防治肝硬化。 目的：观察人参皂苷Rd对体外培养肝储脂细胞Ⅰ,Ⅲ型胶原表达的影响。 方法：体外培养肝储脂细胞,随机分为对照组和实验组,实验组用100 mg/L人参皂苷Rd进行培养干扰,用免疫组织化学、免疫荧光技术检测Ⅰ,Ⅲ型胶原基因的表达。 结果与结论：实验组比对照组,Ⅰ,Ⅲ型胶原阳性产物吸光度和面积比值明显降低(P < 0.05),说明人参皂苷Rd对体外培养肝储脂细胞Ⅰ,Ⅲ型胶原的表达有明显调节作用,影响肝储脂细胞产生胶原纤维。     

腰椎肥厚黄韧带中细胞凋亡及凋亡因子caspase-3、fas、p53的表达

文题释义： 黄韧带：由左右两部分组成,韧带上下分别附着于上位椎板的前下方,下位椎板的上缘,连接椎弓板,参与围成椎管,控制脊柱过度前屈,维持脊柱稳定。黄韧带肥厚可造成椎管管腔减小及椎间孔狭窄,硬膜囊和脊神经根的压迫,从而产生临床症状。 免疫组织化学技术：是用标记的特异性抗体(或抗原)对组织内的抗原(或抗体)的分布进行定位、定性、定量检测,经过组织化学呈色反应在组织原位显示抗原(或抗体),如各种蛋白质、多肽、磷脂和多糖等成分的一门技术。 背景：腰椎管狭窄症是造成老年人步态紊乱和腰腿痛的关键原因之一,黄韧带肥厚是导致腰椎管狭窄症的主要病理机制,目前关于黄韧带的影像学及病理研究较多,关于细胞凋亡的研究较少。                                                   目的：检测肥厚黄韧带组织中的细胞凋亡率及凋亡因子caspase-3、fas、p53的表达,为深入了解黄韧带退变的机制提供实验依据。          方法：实验组50个经MRI及术后测量证实肥厚黄韧带标本(L₂-S₁)来自50例腰椎管狭窄症行后路减压手术自愿捐赠的患者,男22例,女28例,年龄32-74岁,平均54.46岁;对照组30个经MRI及术后测量证实非肥厚黄韧带标本(L₂-S₁)来自30例腰椎间盘突出症行手术及腰椎爆裂骨折行手术患者,男19例,女11例,年龄19-67岁,平均47.27岁。采用TUNEL染色法检测黄韧带中的凋亡细胞率,用SP免疫组织化学法检测caspase-3、fas、p53的表达。研究通过了新疆医科大学第六附属医院伦理委员会批准,伦理编号为LFYLLSJ2016007。                                           结果与结论：①TUNEL染色示实验组的平均凋亡细胞率高于对照组[(37.80±3.04)%,(13.18±1.34)%,t=41.83,P < 0.001];②SP免疫组织化学染色示实验组caspase-3、fas、p53阳性表达率均为100%,对照组caspase-3、fas、p53阳性表达率为13.3%,16.7%,10%,两组比较差异均有统计学意义(P < 0.001)。结果表明,腰椎肥厚黄韧带组织中细胞凋亡增加,肥厚黄韧带中细胞凋亡与caspase-3、fas、p53的表达上调具有一定的相关性。 ORCID: 0000-0002-0539-5510(张方新) 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Histological investigation of rabbit ligamentum flavum with special reference to differences in spinal levels

The structure of the ligamentum flavum has yet to be fully elucidated and no studies have investigated fine structural differences at different spinal levels in any animals. The aim of the present study was to clarify structural differences in the ligamentum flavum at different spinal levels (cervical: C3/4 and C5/6; upper thoracic: T2/3; lower thoracic: T9/10; lumbar: L3/4) using light and electron microscopy of rabbit specimens. Light microscopy using resorcin—fuchsin staining revealed that the distribution of elastic fibers was diffuse in the cervical and upper thoracic regions, but was generally dense in the lower thoracic and lumbar regions. Electron microscopy demonstrated that the cervical and upper thoracic regions were rich in collagen fibers. Conversely, the lower thoracic and lumbar regions were rich in elastic fibers. Quantitative image analyses displayed thick elastic fibers in the lower thoracic and lumbar regions, with high area ratios. Radiographic examinations revealed that ranges of motion were large at the cervical region, but small at the lower thoracic and lumbar regions. These findings suggest that structure of the ligamentum flavum varies at different spinal levels with respect to differences in motion.     

腰椎黄韧带肥厚骨化的数字化表现

目的　通过对腰椎退变黄韧带的数字化重建,为影像诊断和临床手术规划,提供立体直观的形态学依据。 方法　收集腰腿痛患者薄层螺旋CT影像资料,在后处理工作站中观察退变黄韧带形态及分布,选取轴位像中黄韧带厚度大于4 mm和/或有钙化患者63例,男31例,女32例,年龄32~80岁。将原始数据导入Mimics16.0软件重建图像,观察其形态、分布。 结果　315个腰椎节段中205个节段出现黄韧带肥厚和/或骨化。黄韧带单纯肥厚占总出现节段79.51%,单纯骨化占6.34%,肥厚伴骨化占14.15%。205个节段全部成功建模,肥厚黄韧带建模形态有合页状、不规则片状和柱状;骨化黄韧带建模形态有短柱状、短锥状、不规则片状;肥厚伴骨化黄韧带重建后形态各异。 结论　数字化技术重建黄韧带能清楚显示其分布、形态、邻近结构,还可将所建退变黄韧带模型与腰椎骨性模型随意组合、切割,便于立体直观地显示病变细节。     

大鼠腰椎管狭窄模型的制作及三维有限元分析

背景：腰椎管狭窄模型的制作方法有很多种,硅胶植入造成椎管狭窄跟人体退变造成的椎管狭窄结果相似。 目的：采用硅胶片植入大鼠椎管内建立腰椎管狭窄大鼠模型,用平板运动距离测量和三维有限元软件分析论证。 方法：30只雄性SD大鼠随机分为两组。将硅胶片植入实验组L4和L5阶段硬膜外间隙,造成椎管狭窄。对照组处理与实验组操作过程相同,但不植入硅胶片。 结果与结论：实验组平板运动距离较造模前明显减少(P < 0.05);脊髓压迫50%-70%。对照组正常椎管内密度CT值为(32.4±19.58) Hu,实验组相应狭窄阶段椎管内CT值为(101.96±32.85) Hu。结果表明,大鼠腰椎管狭窄模型制作成功,制作方法简单,经济有效。     

骨桥蛋白及其受体在黄韧带骨化症黄韧带细胞中的表达及其意义

BACKGROUND: The exact pathogenesis of ossification of ligamentum flavum has not been elucidated yet. And osteopontin may be an important factor involved in the ossification of ligamentum flavum. OBJECTIVE: To clarify the expression and significance of osteopontin and its receptors, CD44 and integrin-β3, in ligamentum flavum cells between normal controls and patients with ossification of ligamentum flavum.   METHODS: Ligamentum flavum tissues were obtained from normal adult controls and adult patients with ossification of ligamentum flavum (n=8 per group) who underwent thoracic/lumbar posterior decompression surgery. Ligmentum flavum cells were separated, cultured and identified in vitro, and osteopontin, CD44, integrin-β3 were stained using immunocytochemistry method and observed under inverted phase contrast microscope. And the mRNA expressions of osteopontin, CD44, integrin-β3 were measured by RT-PCR. RESULTS AND CONCLUSION: Immunocytochemistry results showed that the stronger positive staining for osteopontin, CD44, integrin-β3 was observed in the ossification of ligamentum flavum group than the control group (P < 0.01). The mRNA expressions of osteopontin, CD44 and integrin-β3 were also higher in the ossification of ligamentum flavum group than the control group (P < 0.05). These findings indicate that osteopontin and its receptors, CD44 and integrin-β3, in ligamentum flavum cells may play an important role in ossification of ligamentum flavum.      

Comparison of magnetic resonance imaging and computed tomography-myelography for quantitative evaluation of lumbar intracanalar cross-section

Purpose

A comparison of MRI and computed tomography-myelography (CTM) for lumbar intracanalar dimensions. To compare the capability and reproducibility of MRI and CTM in measuring the cross-sectional morphology of intracanalar lesions of the lumbar spine.

Materials and Methods

MRI and CTM of lumbar disc levels from 61 subjects with various lumbar spinal diseases were studied. Dural area, dural anteroposterior (AP) diameter, dural right-left diameter, and thickness of the ligamentum flavum were measured by two orthopedic surgeons. Each section was graded by degree of stenosis. Absolute value and intra- and inter-observer correlation coefficients (ICC) of these measurements and the associations between MRI and CTM values were determined.

Results

Except for MRI determination of ligament flavum thickness, CTM and MRI and intra- and ICC suggested sufficient reproducibility. When measurements of dural area, dural AP diameter, and RL diameter were compared, values in CTM were significantly (p = 0.01-0.004) larger than those in MRI (CTM/MRI ratios, 119%, 111%, and 105%, respectively). As spinal stenosis became more severe, discrepancies between CTM and MRI in measurements of the dural sac became larger.

Conclusion

Both CTM and MRI provided reproducible measurements of lumbar intracanalar dimensions. However, flavum thickness may be more accurately measured by CTM. Because the differences in the measurements between CTM and MRI are very slight and there is very little data to suggest that the precise degree of stenosis is related to symptoms or treatment outcome, the usefulness of the CTM over MRI needs to be confirmed in future studies.     

The Lumbar Ligamentum Flavum Does Not Have Two Layers and Is Confluent with the Interspinous Ligament: Anatomical Study with Application to Surgical and Interventional Pain Procedures

Numerous authors over the years have reported that the lumbar ligamentum flavum has two layers. Our routine cadaveric dissections raised the question whether this understanding is correct, as we always have observed only one layer. Thus, the goal of this cadaveric study was to reevaluate the layers of the ligamentum flavum. Twenty lumbar levels from five fresh-frozen cadaveric specimens were used in this study. After dissection of the lumbar spine, the ligamentum flavum and interspinous ligament were exposed. Each lumbar level was transected through the zygapophyseal joint, and hematoxylin and eosin staining, Masson's trichrome staining and Verhoeff-van Gieson staining were performed. Continuation of the interspinous ligament and ligamentum flavum were observed invariably. There was no evidence of the existence of a two-layered ligamentum flavum. The lumbar ligamentum flavum does not consist of two layers, but is confluent instead with the interspinous ligament that attaches to the zygapophyseal joints. To convey this anatomy better, we suggest describing the lumbar ligamentum flavum as a structure that consists of interlaminar and interspinous parts. Precise knowledge of the ligamentum flavum's anatomy can be of clinical value, particularly when epidural anesthesia or lumbar puncture are performed. Clin. Anat. 32:34–40, 2019. © 2019 Wiley Periodicals, Inc.     

Microfilamentous type VI collagen in the hyalinized stroma of the hypertrophied ligamentum flavum

Summary Thickened ligamenta flava obtained from 14 patients with spinal canal stenosis were examined with special reference to type VI collagen. The characteristic histological finding in the thickened area was rupture of normal elastic fibre meshwork with resultant fibrosis which usually appeared hyaline. Using an immunohistological method, collagen types VI, I and III were found to be present in the hyaline matrix. Ultrastructural study revealed many microfilamentous structures of type VI collagen admixed in loosely packed, banded collagen fibres. With differential salt precipitation of pepsin-extracted collagen the existence of type VI collagen was confirmed by SDS-polyacrylamide gel electrophoresis analysis and Western blotting analysis using anti-type VI collagen antibody. Quantification of type VI collagen in pepsin-extracted crude collagen samples by an inhibition enzyme-linked immunosorbent assay showed an increasing amount of type VI collagen in the thickened ligamenta flava compared to the normal ligaments. Thus, increase of type VI collagen is the main contribution to the thickening of the ligamentum flavum. This may represent an adaptational and reparative process associated with disruption of elastic fibres.     

经椎板间隙内窥镜下分开黄韧带切除椎间盘

背景：经椎板间隙途径内窥镜下间盘切除需游离黄韧带,后者如果辅助连续扩张器及工作通道进行操作,无论切口多小(甚至3-5 mm),均可完整保留黄韧带。 目的：介绍经椎板间隙内窥镜下分开黄韧带切除椎间盘的应用。 方法：采用经椎板间隙内窥镜下分开黄韧带椎间盘切除治疗16 例男性患者和14例女性患者,平均年龄(48±15)岁,主诉单下肢根性疼痛,病变位于L_3-4间隙1例,L_4-5间隙13例,L₅-S₁间隙16例,其中间盘向上脱出游离者4例,向下脱出游离者7例,所有患者术中电生理监测,在工作通道中分开黄韧带,间盘切除撤出工作通道后,黄韧带可自行复位。 结果与结论：操作时间20-40 min,治疗后随访时间(149±108) d。治疗中电生理监测无异常,椎间盘切除症状均得以改善。经核磁随访显示：脱出间盘组织已完全摘除,黄韧带保留完整,所有患者无相关并发症。结果可见经椎板间隙内窥镜下分开黄韧带切除脱出的间盘组织,是一种可行的操作方式。