不同年龄的颈椎间盘蛋白多糖酶活性

目的 测定不同年龄组颈椎椎间盘中的蛋白多糖酶活性,探讨蛋白多糖酶活性与年龄之间的相关性.方法 对40个不同年龄颈椎间盘的蛋白多糖酶活性进行了测定,分别来自胎儿组、17～25岁组、40～60岁组以及60～75岁组,用含有10.0 mmol/L CaCl_2的0.05 mol/L Tris/HC对椎间盘中的蛋白多糖酶进行提取,用1 mmol/L APMA将其激活,与取自牛肩胛软骨的蛋白多糖单体底物进行反应,以酶标仪来测定蛋白多糖酶的活性.结果 胎儿组、17～25岁组、40～55岁组和60～75岁组颈椎间盘的蛋白多糖酶活性的吸光度值分别是1.911±0.21、0.881±0.155、1.720±0.19、1.777±0.142.胎儿组颈椎间盘与60～75岁组颈椎间盘的吸光度值最高,两者之间差异无统计学意义(P>0.05),胎儿组与17～25岁组、40～55岁组颈椎间盘的吸光度值结果差异有统计学意义(P<0.05),17～25岁组的吸光度值最低,与胎儿组、40～55岁组和60～75岁组的测得值差异有统计学意义(P<0.01),40～55岁组和60～75岁组的吸光度值差异无统计学意义(P>0.05).结论 颈椎间盘中的蛋白多糖酶活性与年龄明显相关.     

刺激颈交感神经对家兔心脏功能活动变化的影响

目的 探讨颈椎性类冠心病时颈交感神经受累对心脏功能的影响。方法 健康家兔30只，显露双侧颈上、颈下交感神经节及心下神经，对各部分逐一给以电刺激，采用生理多导仪分别记录刺激后不同时间点的心电图ST段(Electroccardiogram-ST,ECG-ST)、左心室内压(Left Ventricle Pressure,LVP)、左心室内压最大上升速率(Developed pressure/Developed time max,Dp/Dt max)的变化情况。结果 刺激颈上交感节后ECG-ST、LVP、Dp／Dt max均无变化；刺激颈下交感节和心下神经后LVP、Dp/Dt max值明显下降，ECG出现明显的ST-T改变。结论 下位颈椎病变可能更易刺激交感神经而出现心肌缺血性改变，并可影响心肌收缩性能。     

脂多糖对大鼠体外培养中性粒细胞p38MAPK和MMP-8 mRNA表达的影响

目的 探讨脂多糖(LPS)对大鼠体外培养中性粒细胞p38丝裂原活化蛋白激酶(p38MAPK)和中性粒细胞胶原酶(MMP-8)mRNA表达的影响.方法 抽取SD大鼠外周静脉血,分离培养中性粒细胞,制备细胞悬液,72孔细胞培养板中每孑L加入1 ml细胞悬液,共60孔,随机分为2组:LPS组(n=48)加入LPS 1 μg/ml进行培养,对照组(C组,n=12)加入等体积PBS液(不做培养,直接检测).LPS组于培养30 min(T1)、60 min(T2)、90 min(T3)和120 min(T4)时取出培养板,吸取细胞悬液应用免疫组化法测定p38MAPK表达,RT-PCR法测定MMP-8 mRNA表达.结果 与C组比较,LPS组各时点p38MAPK与MMP-8 mRNA表达均升高(P＜0.05或0.01).p38MAPK表达水平与MMP-8 mRNA表达水平呈正相关(r=0.793 6,P＜0.05).结论 LPS可上调大鼠体外培养中性粒细胞p38MAPK和MMP-8 mRNA的表达.     

封闭负压引流技术对人肉芽创面中MMP-1、MMP-2、MMP-13 mRNA表达的影响

目的　研究人慢性创面在经封闭负压引流 (Vacuum assistedclosure ,VAC)治疗前后 ,创面肉芽组织中基质金属蛋白酶MMP1、MMP2和MMP13mRNA的变化。方法　对 5例慢性创面患者给予VAC治疗 (- 12 0mmHg压力 ) ,分别于吸引前和吸引后 1、4、7d切取创面中央适当大小的肉芽组织 ,提取总RNA ,利用RT PCR方法测定MMP 1、MMP 2和MMP 13mRNA的表达情况 ,并对其定量结果进行统计学分析。结果　MMP 1、13mRNA在VAC治疗后表达下降 ,以MMP 13下降趋势尤为明显 (P <0 0 5 )。MMP 2mRNA表达呈现波动 ,但总体为下降趋势。结论　VAC通过抑制MMP 1、2、13的mRNA表达进而抑制MMP 1、2、13的蛋白合成 ,抑制胶原和明胶的降解 ,促进慢性创面的愈合。     

退行性改变对颈椎间盘影响机制的生物学研究进展

脊髓型颈椎病(cervical spondylotic myelopathy,CSM)是颈椎退行性改变导致脊髓受压或(和)脊髓供血障碍引起的脊髓功能障碍性疾病,其发病机制以椎间盘变性、颈椎力学性能异常为始发因素[1].CSM发病是一个连续的过程[2],从病理学角度可分为颈椎间盘或椎间关节退变、颈椎骨与软组织的继发性病理改变、脊髓及其血管的慢性压迫性病理改变3个阶段[3].其中颈椎间盘在维持颈椎关节稳定、充分发挥顺应性、缓冲及吸振、防止脆性等方面起着重要的作用.     

对颈椎间盘突出症的再认识

报告经ＣＴ、ＭＲＩ及手术证实的颈椎间盘突出症２７例，着重讨论了颈椎间盘突出症与颈椎病的关系，认为颈椎间盘退变是两者的共同病理基础。颈椎间盘突出不仅是单纯的髓核突出，晚期还可伴有骨赘增生、椎管狭窄、ＯＰＬＬ等改变。作者认为，凡是与颈椎间盘突出有关的颈椎病变都应归入颈椎间盘突出症的范畴。同时对颈椎间盘突出的诊断亦作了详细讨论     

Bryan人工颈椎间盘置换对颈椎功能影响的临床分析

目的 探讨Bryan人工颈椎间盘置换手术对颈椎功能的影响.方法 对2003年12月至2007年8月施行的164例患者200个椎间盘的人工颈椎间盘置换手术进行回顾性分析.164例患者中,男性102例,女性62例,年龄25～70岁,平均47岁;单间隙置换132例,双间隙置换28例,三间隙置换4例.均采用Bryan人工颈椎间盘假体.手术严格按照Bryan人工颈椎间盘假体植入的标准操作程序进行.术后颈托外固定2周.结果 随访时间2～44个月,平均26个月.JOA评分改善率56%.椎间活动度:矢状位术前平均活动度14.4°,术后1周5.7°,末次随访时平均14.7°,与手术前相比差异无统计学意义.邻近间隙矢状位术前平均活动度10.9°,术后1周5.5°,末次随访时平均8.2°,主要是由上邻接间隙的活动度没有达到术前水平所致.患者满意度94%.1例患者术后6个月假体松动,以后稳定;1例患者术后7个月假体发生1 mm下沉,以后稳定;3例后方融合.无前方融合、食管损伤、喉返神经损伤以及再手术病例.手术操作单间隙平均90 min,双间隙平均130 min.结论 人工颈椎间盘置换手术临床疗效良好.     

多节段颈椎间盘突出症的术式选择

[目的]探讨多节段颈椎间盘突出术式选择的基本原则和方法。[方法]根据每个病人影像学改变的特点分别采用前路开槽减压,植骨钛板内固定;钛网 钛板固定;主要节段钛网 钛板,次要节段环锯减压 Cage融合固定;以及前后路联合手术等多种方法进行治疗。经术后观察随访,对其取得的疗效进行分析总结。[结果]采用不同的方法对96例不同类型的颈椎病进行手术治疗,经过平均2年8个月的随访,效果满意,优良率达到90%。[结论]对多节段颈椎间盘突出或椎间盘退变的脊髓型颈椎病,根据病人不同的影像学改变和症状体征选择不同的手术方式。其关键是要分清主要节段、次要节段,广泛或局限,有无明显的发育性狭窄等不同情况,选择不同的治疗方法。多数病人均能通过颈前路的开槽减压内固定而取得满意效果。单节段椎间退变选择椎间隙减压植骨固定;2~3节段椎间退变一般选择开槽减压内固定;广泛性退变或椎管明显狭窄,连续型颈椎后纵韧带骨化等病例应结合后路减压扩大椎管才能达到有效治疗。手术方法的选择是取得颈椎病良好疗效的关键。     

人工颈椎间盘置换对邻近节段椎间盘的保护作用

[目的]探讨Bryan人工颈椎间盘置换治疗颈椎病和颈椎间盘突出症的临床疗效及对邻近节段椎间盘的保护作用。[方法]回顾分析2004年以来本科收治的254例颈椎病及颈椎间盘突出症患者。117例施行了Bryan人工椎间盘置换术,其中男性55例,女性62例;年龄33~65岁,平均46.6岁,89例行单节段人工椎间盘置换术,6例行双节段人工椎间盘置换术,22例行1节段人工椎间盘置换术和1节段椎间盘切除植骨融合术。137例行颈椎前路减压融合术,其中男性74例,女性63例;年龄29~81岁,平均47.8岁。术后评定患者神经功能恢复情况,测量邻近节段活动度的大小,并进行邻近节段颈椎间盘退变情况的X线评估。[结果]两组患者术后随访时间为6~60个月,平均26.4个月。两组患者术后神经功能均有明显改善,JOA评分平均较术前提高5.6分,平均改善率为62.9%,有效率为100%,两组间无统计学差异(P0.05)。测量邻近节段椎间隙活动度的结果显示融合组较非融合组变化明显,具有统计学意义(P0.05)。椎间盘退变的X线评估结果显示,融合组邻近节段颈椎间盘退变的发生率和严重程度明显高于非融合组,具有统计学意义(P0.05)。[结论]Bryan人工颈椎间盘置换治疗颈椎病和颈椎间盘突出症具有良好的疗效,较传统前路减压融合术,可以较好发挥其对邻近节段椎间盘的保护作用。     

Bryan人工颈椎间盘角对颈椎病疗效的影响

目的 探讨Bryan人工颈椎间盘角对颈椎病疗效的影响。方法 选择2016年1月～2018年1月本院收治的90例颈椎病患者,均采用Bryan人工颈椎间盘置换(cervical artificial disc replacement, CADR)治疗,术后7d测量Bryan人工颈椎间盘角,负值设为后凸组,正值设为正常组,分别为32例、58例。比较两组末次随访时的节段活动度、颈椎功能障碍指数(neck disability index, NDI)、颈椎总活动度、JOA评分等功能及影像指标,评价椎旁骨化(paravertebral ossification, PO)分级。结果 90例颈椎病患者术后Bryan人工颈椎间盘角为负值者32例,正值者58例,Bryan人工颈椎间盘角后凸率35.56%;两组颈椎总活动度差异无统计学意义(P>0.05),但后凸组的节段活动度显著低于正常组(P<0.05);两组NDI指数、JOA评分差异无统计学意义(P>0.05);后凸组PO分级较正常组更为严重(P<0.05)。结论 Bryan CADR手术治疗颈椎病后,易发生Bryan人工颈椎间盘...     

颈前动力失衡致兔颈肌及颈间盘变化的组织形态学研究

目的：观察颈前肌短缩痉挛所致颈椎动力失衡状态下,颈肌及颈间盘的组织形态学变化。方法：健康成年大耳白兔30只,体重(2.75±0.25) kg,雌雄各半。单纯随机法分成模型组、假手术组,每组15只。采用手术方法制备动物模型,模型组将双侧胸锁乳突肌肌束中部,用医用硅胶硬管垫起致其短缩,建立颈椎动力失衡模型;假手术组仅切开暴露双侧胸锁乳突肌。于术后2个月同一时间,观察两组颈肌及颈间盘的大体及组织形态学变化,同时对两组肌纤维的数量及横截面积进行比较。结果：术后2个月,模型组颈肌及颈间盘发生明显的组织形态学变化。假手术组未见明显形态学改变。模型组颈前肌与颈后肌肌纤维数量较假手术组均明显减少(P<0.05);同样,模型组颈前肌与颈后肌肌纤维横截面积亦变小(P<0.05),颈前肌变化较颈后肌明显。结论：颈前肌短缩痉挛所致颈椎动力失衡可导致颈肌及颈间盘组织发生病理改变,为研究颈前肌异常动力失衡引发的早期颈椎病发病提供实验证据。     

Strain on intervertebral discs after anterior cervical decompression and fusion

STUDY DESIGN: An analysis of the change in strain distribution of intervertebral discs present after anterior cervical decompression and fusion by an original method. The analytical results were compared to occurrence of herniation of the intervertebral disc on magnetic resonance imaging. OBJECTIVES: To elucidate the influence of anterior cervical decompression and fusion on the unfused segments of the spine. SUMMARY OF BACKGROUND DATA: There is no consensus regarding the exact significance of the biomechanical change in the unfused segment present after surgery. METHODS: Ninety-six patients subjected to anterior cervical decompression and fusion for herniation of intervertebral discs were examined. Shear strain and longitudinal strain of intervertebral discs were analyzed on pre- and postoperative lateral dynamic routine radiography of the cervical spine. Thirty of the 96 patients were examined by magnetic resonance imaging before and after surgery, and the relation between alteration in strains and postsurgical occurrence of disc herniation was examined. RESULTS: In the cases of double- or triple-level fusion, shear strain of adjacent segments had increased 20% on average 1 year after surgery. Thirteen intervertebral discs that had an abnormally high degree of strain showed an increase in longitudinal strain after surgery. Eleven (85%) of the 13 discs that showed an abnormal increase in longitudinal strain had herniation in the same intervertebral discs with compression of the spinal cord during the follow-up period. Relief of symptoms was significantly poor in the patients with recent herniation. CONCLUSIONS: Close attention should be paid to long-term biomechanical changes in the unfused segment.     

The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine

STUDY DESIGN: An anatomic study of the cervical intervertebral foramina, nerve roots, and intradural rootlets performed using a surgical microscope. OBJECTIVES: To investigate the anatomy of cervical root compression, and to obtain the anatomic findings related to cervical foraminotomy for the treatment of cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Cervical foraminotomy is a procedure performed frequently for the management of cervical radiculopathy. However, anatomic studies of cervical foraminotomy have not been fully elucidated. METHODS: In this study, 18 cadavers were obtained for the study of the cervical spine. All the soft tissues were dissected from the cervical spine. Thereafter, laminectomy and facetectomy were performed on C4 through T1 using a surgical microscope. The nerve roots and surrounding anatomic structures, including intervertebral discs and foramina, were exposed. In addition, the intradural rootlets and their intersegmental connections were observed. RESULTS: The shape of the intervertebral foramina approximated a funnel, the entrance zone being the most narrow part and the root sleeves conical, with their takeoff points from the central dural sac being the largest part. Therefore, compression of the nerve roots occurred at the entrance zone of the intervertebral foramina. Anteriorly, compression of the nerve roots was caused by protruding discs and osteophytes of the uncovertebral region, whereas the superior articular process, the ligamentum flavum, and the periradicular fibrous tissues affected the nerve posteriorly. The C5 nerve roots were found to exit over the middle aspect of the intervertebral disc, whereas the C6 and C7 nerve roots were found to traverse the proximal part of the disc. The C8 nerve roots had little overlap with the C7-T1 disc in the intervertebral foramen. The C6 and C7 rootlets passed two disc levels in the dural sac. Also, a high incidence of the intradural connections between the dorsal rootlets of C5, C6, and C7 segments was found. CONCLUSIONS: This study demonstrated the anatomy of the nerve roots, rootlets, and intervertebral foramina, and may aid in understanding the pathology of cervical radiculopathy. The presence of intradural connections between dorsal nerve roots and the relation between the course of the nerve root and the intervertebral disc may explain the clinical variation of symptoms resulting from-nerve root compression in the cervical spine. To perform cervical foraminotomy for cervical radiculopathy, it is necessary to understand the detailed anatomy of the intervertebral foramina thoroughly.     

基质金属蛋白酶-13、白细胞介素-1在大鼠 退变腰椎间盘组织中的表达及意义

目的探讨基质金属蛋白酶-13( MMP-13 )、白细胞介素-1( IL-1 )在去势大鼠退变腰椎间盘组 织中的表达及临床意义。方法 80只3月龄却rague-Dawiey ( SD )大鼠,随机均分为3组,每组10 只：基础对照组（BL组）手术组（0VX);手术对照组（Sham组）;BL组在手术开始前处死,其余2组 术后三个月处死,并与处死前10凿和4凿分别给予显色双荧光标记。L2-4椎体进行骨密度及硬组织 切片分析,蕴源-5进行HE常规染色、灾郧特殊染色及运用免疫组化检测MMP-13、L-1的表达,观察椎 间盘的病理学改变并据评分标准对腰椎间盘的退变程度（LVD)进行评分。结果1、大鼠腰椎骨量的 下降及椎间盘的退化：双侧卵巢切除组比手术对照组严重;2、免疫组化：双侧卵巢切除组与手术对照 组比较大鼠椎间盘中MMP-13、L-1表达明显升高（孕<0.05 )。结论基质金属蛋白酶-13、白细胞介 素-1表达量的增加是腰椎间盘退变形成和发展的重要因素。     

The internal mechanical properties of cervical intervertebral discs as revealed by stress profilometry

Extensive anatomical differences suggest that cervical and lumbar discs may have functional differences also. We investigated human cervical discs using “stress profilometry”. Forty-six cadaveric cervical motion segments aged 48-90 years were subjected to a compressive load of 200 N for 20 s, while compressive ‘stress’ was recorded along the posterior-anterior midline of the disc using a pressure transducer, side-mounted in a 0.9 mm diameter needle. Stress profiles were repeated with the transducer orientated horizontally and vertically, and with the specimen in neutral, flexed and extended postures. Profiles were repeated again following creep loading (150 N, 2 h) which simulated diurnal water loss in vivo. Stress profiles were reproducible, and measured “stress” at each location was proportional to applied load. Stress profiles usually showed a hydrostatic nucleus with regions of higher compressive stress concentrated anteriorly in flexion, and posteriorly in extension. Stress concentrations increased in degenerated discs and following creep. Some features were unique to cervical discs: many showed a stress gradient across their central regions, even though vertical and horizontal stresses were equal to each other, and stress concentrations in the posterior annulus were generally small. Central regions of many cervical discs show the characteristics of a “tethered fluid” which can equalise stress over small distances, but not large. This may be attributable to their fibrous texture. The small radial diameter of the cervical posterior annulus may facilitate buckling and thereby prevent it from sustaining high compressive stresses.     

突出颈椎间盘组织炎症反应机制的研究

目的:研究颈椎病发生中突出颈椎间盘组织的炎症反应机制,探讨炎症反应在颈椎间盘退变和颈椎病发病中的作用.方法:临床收集了31个脊髓型颈椎病病人的35个突出的颈椎间盘标本和3个成年人的7个正常颈椎间盘标本.将每个标本分为2份,1份作组织学检查,观察有无炎细胞浸润,1份用生物化学方法测定其中IL-1α,IL-6和TNF-α三种细胞因子含量.结果:35例突出颈间盘中,18例(51.4%)在边缘区域有大量炎细胞浸润,其余17例(48.6%)未见炎细胞浸润,对照组也未见炎细胞浸润.生物化学测定结果表明,突出颈间盘组织中IL-1α,IL-6和TNF-α三种细胞因子含量明显高于正常对照组.炎细胞浸润组与无炎细胞浸润组三种细胞因子含量相当,在统计学上无任何差异.结论:突出颈间盘组织具有炎症反应特性,炎症反应可能在颈椎间盘退变和颈椎病的发生发展中起重要作用.     

颈椎病突出椎间盘组织炎性反应特性的研究

目的：探讨颈椎病发生中突出颈椎间盘组织的炎症反应特性。方法：取31例脊髓型颈椎病患者的35个突出的颈椎间盘标本和3个成年人的7个正常颈椎间盘标本，将每个标本分为2份，1份作组织学检查，观察有无炎细胞浸润，1份用生物化学方法测定其中IL－1α、IL－6和TNF－α的含量。结果：35个突出颈椎间盘中，18个（51．4％）在边缘区域有大量炎细胞浸润，其余17个（48．6％）未见炎细胞浸润，对照组未见炎细胞浸润；35个突出颈椎间盘组织中IL－1α、IL－6和NTF－α含量明显高于正常椎间盘。结论：颈椎病患者突出椎间盘组织具有炎症反应特性，炎症反应可能在颈椎间盘退变和颈椎病的发生发展中起重要作用。