腰椎间盘突出与有无临床症状的影像对照研究

目的：探讨应用区域定位评分法研究腰椎间盘突出（膨出、突出、脱出）有临床症状与无临床症状的相关性及原因分析。方法：将符合要求的CT病理分型为膨出、突出、脱出的体检或住院或门诊患者120例,按有临床症状与无临床症状分为2组,每组按CT病理分型分3组,年龄20-59岁,平均38．5岁,有临床症状与无临床症状两组间在性别、年龄、病程及椎间盘分布节段差异均无统计学意义;应用区域定位评分法对各组评分;用游标卡尺分别测量矢状径指数（SI）、盘黄韧带前间隙、侧隐窝上口宽度、硬膜囊前后径。CT值由X线断层扫描测定,分别测量3次,取平均值。结果：④腰椎间盘突出有临床症状与无临床症状两组在SI、CT值、CT评分、硬膜囊前后径之间差异无统计学意义（P〉0．05）;在侧隐窝上口宽度、盘黄韧带前间隙之间差异有统计学意义（P〈0．05）。②腰椎间盘突出有临床症状与无临床症状两组突出类型比较,差异有统计学意义（P〈0．05）;腰椎间盘脱出有临床症状与无临床症状两组突出节段比较,差异有统计学意义（P〈0．05）。结论：①腰椎间盘突出大小、部位、类型不一定与临床症状存在必然关系,腰椎间盘突出症与压迫程度无正比关系;②椎管内突出髓核是否导致相应的临床症状存在着诸多或必然因素,可能与椎间盘突出物可代偿的椎管储备容量、受累神经根对机械压迫的逃逸避让与弹性延长功能,以及受累神经根低氧消耗与抗缺血性损伤代偿作用等因素有关。     

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。     

The effect of spinal fusion on the collagen and proteoglycans of the canine intervertebral disc

The effects on disc composition of 16 months of lumbar spinal arthrodesis in the greyhound (a nonchondrodystrophoid breed) have been investigated using age-matched controls. The guanidinium chloride-extractable proteoglycans of the disc's nucleus pulposus and annulus fibrosus were compared using equilibrium density gradient ultracentrifugation under associative conditions. No differences in proteoglycan sedimentation behavior were detected between discs from experimental or control animals. Analysis of individual discs for collagen, total nitrogen, noncollagenous protein, uronic acid, or total hexosamine content also failed to demonstrate statistically significant differences between the experimental and control groups.     

A study on topographical change of proteoglycans in human lumbar disc

Proteoglycan aggregates, the binding of disc proteoglycan to hyaluronate, chondroitin sulfate chain length, hexosamine and amino acid compositions were measured in different regions of the L1/L2 and L4/L5 intervertebral discs from 3 spines aged 35, 49, and 60 years. The results were as follows: proteoglycan aggregates and the binding of disc proteoglycan to hyaluronate were shown to increase from the nucleus pulposus to the outer annulus, while only small differences were observed among the anterior, posterior and lateral regions in either the inner or the outer annulus within a given disc. Changes in chondroitin sulfate chain length were observed with aging. However, within a given disc, and furthermore, within a given spine, chondroitin sulfate chains were similar in length. Glucosamine/galactosamine molar ratios of disc proteoglycan were higher in the L1/L2 disc than the L4/L5 disc. Changes with age were also observed. Nevertheless, only minor differences among the anterior, posterior and lateral regions of the annulus fibrosus were found within a given disc. The amino acid compositions showed small differences when proteoglycans from various regions of a disc were compared. All of them had a high content of aspartic acid, threonine, serine, glutamic acid, proline and glycine. The results indicate that it seems there are only minor differences among the anterior, posterior and lateral regions of the annulus fibrosus in a number of the experimented parameters.     

关于"腰椎间盘突出危象"概念的探讨

[目的]提出“腰椎间盘突出危象”的概念即中央型腰椎间盘突出症出现马尾神经功能障碍，并分析其在临床上对诊断和治疗的指导意义。[方法]收集符合腰椎间盘突出危象诊断的46例中央型腰椎间盘突出症病人进行临床总结分析。[结果]术后随访12—36个月，平均随访24个月，42例马尾神经损伤完全恢复，2例大小便功能恢复，但鞍区麻木、阴茎不能勃起，2例出现大小便部分失禁，鞍区麻木、阴茎不能勃起。[结论]中央型腰椎间盘突出一旦出现腰椎间盘突出危象，即出现马尾神经功能障碍，应早期诊断、早期手术治疗。     

Immunohistological study of intervertebral disc herniation of lumbar spine

In order to observe histological changes in the extruded and sequestrated intervertebral disc, we conducted pathological and immunological examinations of herniated disc materials taken at the time of discectomy. There were 49 disc materials (from 38 men and 10 women [aged 19 to 78 years; average, 36.6 years]). The herniation was classified into four types, based on the intraoperative observations: protrusion (P), subligamentous extrusion (SE), transligamentous extrusion (TE), and sequestration (S). There were 19 P type discs, 3 SE type, 10 TE type, and 17 S type. The surgical specimens were stained with hematoxylin-eosin, as well as immunohistological staining with the labelled streptavidin biotin method, using human T-cell , human B-cell, and human macrophage antibodies. Inflammatory-cell infiltration was observed at the border of the disc. These findings were present in 19 discs (70%) of the 27 discs of TE and S types (10 TE and 17 S types), but were not seen in the 22 discs of P and SE types (19 P and 3 SE types). Immunohistological staining of the area with inflammatory-cell infiltration revealed the presence of T cells and macrophages, which suggested that this cell infiltration originated from T cells and macrophages, and that the spontaneous resorption of the disc may have resulted from the phagocytic activities of these cells. Received for publication on June 1, 1998; accepted on Nov. 8, 1999     

Articular cartilage and intervertebral disc proteoglycans differ in structure: an electron microscopic study

Articular cartilage and the intervertebral disc tissues have different material and biological properties and different patterns of aging and degeneration. To determine if the proteoglycans of these tissues differ in structure, we used the electron microscopic monolayer technique to compare baboon articular cartilage proteoglycans with baboon annulus fibrosus, transition zone, and nucleus pulposus proteoglycans. Intervertebral disc and articular cartilage proteoglycans differed significantly. Articular cartilage contained large proteoglycan aggregates formed from hyaluronic acid central filaments, multiple monomers, and large nonaggregated monomers. These molecules were identical to those of nasal cartilage, growth plate cartilage, chondrosarcomas, or menisci. In contrast, the intervertebral disc tissues contained only nonaggregated proteoglycan monomers and clusters of monomers without apparent central filaments. Intervertebral disc nonaggregated monomers were shorter and more variable in length than those from articular cartilage, and nucleus pulposus nonaggregated monomers were even shorter and more variable in length than transition zone and annulus fibrosus monomers. These observations suggest that significant differences in proteoglycan metabolism exist between articular cartilage and intervertebral disc.     

腰椎间盘退变研究的方法学选择与评价(二)

<正>随着研究的逐步深入,腰椎间盘退变的基础和临床工作不断取得进展,有关退变机理与病理变化的研究成果不断涌现,学者们日益重视相关研究方法、评估指标在退变中的作用和意义。     

无症状腰椎间盘突出再认识

腰椎间盘突出症确切致痛机制尚未完全明了，脊神经根的机械性压迫被认为与疼痛和特定节段神经功能障碍有关，然而无症状腰椎间盘突出的现象对此提出不同的解释。该文对近年来有关无症状腰椎间盘突出的机制进行了系统的研究，认为其与椎间盘突出物可代偿的椎管储备容量、受累神经根对机械压迫的逃逸避让与弹性延长功能，以及受累神经根低氧消耗与抗缺血性损伤代偿作用等因素有关。这将深化对下腰痛的理解并有助于相关领域的继续研究。     

手法治疗腰椎间盘突出症机理新进展

腰椎间盘突出症是临床常见的脊柱病 ,髓核突出不但引起椎管内强烈的化学反应 ,同时对神经根产生物理挤压 ,出现腰腿痛症状。手法是临床治疗本病的一种主要方法 ,能有效地缓解疼痛 ,目前对手法治疗本病的机理在生物力学、血流变、血生化、影像学等方面的研究取得了较大的进展 ,概括如下 :1　促进炎症介质和炎症细胞的吸收椎间盘髓核的突出程度并不一定与临床症状呈正比 ,神经根在有炎性改变时才对机械性刺激敏感 ,说明炎性反应是导致神经根性疼痛的主要原因之一。突出髓核可引起神经根及其周围组织的细胞因子、生化介质、炎性物质、免疫反应…     

Myxomatous degeneration of the lumbar intervertebral disc

Sixteen patients were operated on for lumbar pain and pain radiating into the sciatic nerve distribution. In all 16, when the anulus fibrosus was incised, soft, gray disc material extruded under pressure like toothpaste being squeezed from a tube. This syndrome of myxomatous degeneration is a distinct entity, different from classical fibrotic disc degeneration or herniated nucleus pulposus. Surgical removal associated with partial facetectomy produced excellent results. The concept of incompetence of the anulus fibrosis is discussed.     

单钉-沟槽柱翼钢板联合自行研制的椎间融合器治疗腰椎滑脱症

目的：评价单钉-沟槽柱翼钢板联合自行研制的椎间融合器治疗腰椎滑脱症的效果，并探讨其有关外科技术问题。方法：将2001年2月～2003年11月间收治的111例腰椎滑脱症患者分成两组，行单钉-沟槽柱翼钢板联合椎间融合器后路手术治疗的62例为观察组；行单钉-沟槽柱翼钢板内固定、后外侧植骨融合术治疗的49例为对照组。观察两组患者术前、术后和随访期间Tailard指数、Boxall指数、滑脱角、腰椎生理前凸角、椎间隙高度指数的变化；同时观察两组的临床疗效及融合率。结果：观察组62例平均随访17.3个月（14～35个月），术后与术前所有观察指标均有显著性差异（P〈0．01）；随访时与术后比较无显著性差异；优良率为93．5％，改善率96．8％，融合率100％。对照组49例平均随访16．7个月（13～32个月），术后与术前所有观察指标均有显著性差异（P〈0．01）：随访时与术后比较Tailard指数、Boxall指数、滑脱角有显著性差异（P〈0．05）；优良率为61．2％，改善率77．6％．融合率79.8％。结论：单钉-沟槽柱翼钢板联合自行研制的椎间融合器后路手术治疗腰椎滑脱症可避免取骨区并发症、维持椎间隙高度和节段稳定、融合率高。     

The influence of automated percutaneous lumbar discectomy (APLD) on the biomechanics of the lumbar intervertebral disc. An experimental study.

Twenty human lumbar motion segments were prepared and tested in an electromechanical materials testing machine in order to investigate the biomechanical changes, i.e. intradiscal pressure, radial extension and height of the intervertebral disc, after automated percutaneous lumbar discectomy (APLD) developed by Onik. The biomechanical data were statistically analyzed with the Friedman test (significance level p < 0.05). The APLD lasted 45 minutes in every segment. The mean weight of material removed was 4.6 g. The removal of 4.6 gram of nucleus pulposus material reduced the height of the disc by an average of 1.42 mm. The intradiscal pressure also decreased by an average of 5.7 bar. The radial bulge increased by an average of 0.45 mm. Our results show that the mechanism improving radicular pain in patients with herniated disc after treatment with percutaneous nucleotomy is still in question. While clinical studies show an improvement of 70% to 85% of patients treated with APLD for herniated disc, this in vitro study showed clearly that radial bulge increases after removal of nuclear material. We postulate that loss of height of the disc and, as a consequence, reduction of tension in the affected nerve root, plays a major role with regard to this improvement.     

扳提手法治疗腰椎间盘突出症的实验研究

作者借鉴Nachemson的方法,模拟扳提手法,动态测量了3具完整新鲜尸体髓核内压在手法中的变化情况。实验结果为L_3－4,L4－5间隙髓核内压在手法过程中呈增高变化,L₅－S₁间隙髓核内压在手法过程中呈降低变化。作者对实验结果进行了分析,认为扳提手法不能使突出的髓核还纳,而有可能使突出的髓核与受压的神经根之间的位置发生变化。     

腰椎弹性内固定对邻近椎间盘应力影响的比较分析

[目的]分析自行研制腰椎"U"形弹性内固定对邻近节段椎间盘应力的影响.[方法]采用有限元方法分别建立腰椎弹性内固定及刚性内固定术后三维有限元模型,施加垂直压缩、前屈、后伸、侧屈及旋转等各种生理载荷, 观察两种模型不同载荷时邻近节段椎间盘的应力变化.[结果]在各种载荷下弹性内固定后邻近节段椎间盘的平均有效应力均小于刚性内固定,椎间盘后外侧更加明显,差异均有统计学意义(P<0.05).[结论]腰椎"U"形弹性内固定与刚性内固定相比,术后能明显降低邻近节段椎间盘内应力,有利于减少和预防邻近节段退变,有望成为进行腰椎内固定较好的一种装置.