腰椎间盘退变中终板骨软骨炎的低场MRI诊断

目的探讨低场MRI对腰椎间盘退变中终板骨软骨炎的诊断价值。方法对60例腰椎间盘退变中终板骨软骨炎的低场MRI表现进行回顾性分析。结果 60例患者共累及终板136个,按Modic分型,Ⅰ型77个（56.6%）;Ⅱ型45个（33.1%）;Ⅲ型14个（10.3%）。多发累及49例（81.7%）;单发11例（18.3%）。好发于下腰段,累及双侧终板多见。结论低场MRI能准确显示腰椎间盘退变中终板骨软骨炎的部位、范围及各期信号特点,为临床制定合理的治疗方案提供了有力依据。     

114例腰椎间盘退变伴终板骨软骨炎的MRI诊断分析

目的探讨腰椎间盘退变伴终板骨软骨炎的磁共振成像(MRI)表现及临床意义。方法回顾性分析经临床及影像学确诊114例腰椎间盘退变伴终板骨软骨炎的MRI表现。结果 114例病例中共累及终板234个,按Modic分型其中Ⅰ型82个(35%);Ⅱ型136个(58.1%);Ⅲ型16个(6.8%);单发累及72例(63.2%),多发累及42例(36.8%);病变好发于下腰段。结论腰椎间盘退变伴终板骨软骨炎是造成临床上腰痛的重要原因之一,MRI是该病的有效检查方法,能够反映该病的临床特点。     

儿童颈椎间盘钙化症的影像诊断

目的 探讨儿童颈椎间盘钙化症的影像表现及诊断价值，并提高对本病的认识。方法 回顾分析16例儿童颈椎钙化性椎间盘病的影像表现。结果 16例患均行颈椎平片检查，5例行CT扫描并作了三维重建，8例行MRI检查。16例平片均显示了椎间盘钙化灶，均为单发，CT平扫加三维重建显示4例钙化呈卵圆形，1例钙化为不规则形。MRI检查不仅显示了椎间盘内改变还清晰显示了病变相邻椎体边缘信号改变，在T1、T2加权像上呈低信号。结论 平片检查可以显示椎间盘钙化；CT平扫加三维重建能清晰显示了钙化灶的大小、形态；MRI检查在显示受累椎体及周围组织的改变方面明显优于CT和平片。     

大鼠椎间盘软骨终板退变与细胞凋亡的形态计量学研究

 目的 观察研究增龄和负重对椎间盘软骨终板（cartilage endplate,CEP）形态与细胞凋亡的影响。方法 通过手术截肢及特殊饲养建立双后肢大鼠模型（n=45）,取同龄正常大鼠作为对照组（n=40）。在3、6、9、12月龄时实验组和对照组分别随机选取8只处死观察,取出L4-5椎间盘及相邻上下椎体组织。椎间盘取材后,行苏木精-伊红染色以及TUNEL染色。计数软骨终板区活细胞以及凋亡细胞数目,并且测量软骨终板厚度,计算软骨终板缺损程度。结果凋亡首先显著出现于软骨终板中,随着年龄的增加凋亡逐渐加剧,并直接导致细胞密度的显著降低。实验组软骨终板内软骨细胞的凋亡率在6月龄时较对照组明显增加,实验组6、9月龄组间比较差异有统计学意义（P<0.05）。相关分析显示,软骨终板活细胞数目与椎间盘软骨终板破损程度具有相关性,相关系数为-0.97（P<0.05）,呈高度相关。实验组的软骨终板结构较对照组发生更严重的退变,软骨终板钙化层明显增厚、非钙化层变薄并出现裂隙。结论除增龄因素外,负重是增加细胞凋亡、加重椎间盘软骨终板破损和退变的重要因素。     

腰椎间盘突出术后再发纤维软骨板剥脱症 9例临床分析

目的 :探讨腰椎间盘突出术后再发纤维软骨板剥脱症的发病机理和诊断治疗。 方法 :对 9例腰椎间盘突出术后 2年突发腰部剧痛并下肢放射痛和无力、经CT证实为纤维软骨板剥脱压迫神经根的患者行手术减压 ,摘除剥脱的纤维软骨板 ,同期行椎间或横突间植骨融合。 结果 :9例病人全部获得随访 ,时间 1～ 5年余 ,按Nakai临床疗效评定标准 :优 4例 ,良 3例 ,可 1例 ,差 1例 ,优良率为 77.8%。 结论 :对腰椎间盘突出患者初次行髓核摘除术时应尽量减少髓核切除量 ,如果切除过多不仅影响预后 ,而且很可能会损伤纤维软骨板 (术中医源性破坏 )。如果患者纤维软骨板发育不全 ,术后过早活动或活动不当 ,以及重手法推拿、重体力劳动等均可导致纤维软骨板破裂脱入椎管内 ,严重者可引起足下垂。尽早手术治疗可获得较满意的疗效。     

糖尿病肾病患者血清软骨寡聚基质蛋白水平及其与血管钙化的关系

目的：研究糖尿病肾病（DN）患者血清软骨寡聚基质蛋白（COMP）水平及其与血管钙化的关系。方法收集Ⅳ及Ⅴ期DN患者54例（DN组）及28例健康体检者（对照组）,采用ELISA法检测血清COMP水平。根据胸部X线片主动脉弓钙化情况,将DN患者分为无血管钙化组和血管钙化组,比较两组的血清COMP水平。根据合并心血管疾病（CVD）与否,将DN组患者分为合并组和非合并组,比较两组血清COMP水平。采用Logistic回归分析血清COMP水平与血管钙化、CVD发生率之间的关系。结果DN组患者血清COMP水平高于对照组;DN组主动脉弓钙化者占75．9％,其血清COMP水平高于无血管钙化组;合并CVD组患者血清COMP水平显著高于非合并组（P＜0．05）;血清COMP水平每升高10ng/mL,血管钙化发生风险增加1．324倍,CVD发生风险增高1．310倍。结论DN患者血清COMP升高,血管钙化和CVD发生风险增加。     

白细胞介素-6与腰椎间盘突出症

椎间盘突出所致的腰腿痛在临床上是一个常见病、多发病。研究表明，白细胞介素—6(IL—6)在突出的椎间盘组织及周围组织中有较高的表达活性，且与其他细胞因子和化学介质有密切关系，可能在椎间盘突出症发病机制中起一定的作用。     

Intervertebral disc degeneration and bone density in degenerative lumbar scoliosis: a comparative study between patients with degenerative lumbar scoliosis and patients with lumbar stenosis

Background  Degenerative lumbar scoliosis is common in older patients. Decreased bone density and the degeneration of intervertebral discs are considered to be correlated with degenerative lumbar scoliosis. A means of quantifying the relative signal intensity for degenerative disc disease has not been previously discussed. The purpose of this study was to compare bone mineral density and intervertebral disc degeneration between degenerative lumbar scoliosis and lumbar spinal stenosis patients in a nine-year retrospective study.

Methods  From January 2001 to August 2010, 96 patients with degenerative lumbar scoliosis were retrospectively enrolled and 96 patients with lumbar spinal stenosis were selected as controls. Cobb angle, height of the apical disc and the contiguous disc superiorly and inferiorly on convex and concave sides, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly were measured in the scoliosis group. The height of L2/L3, L3/L4, L4/L5 discs and the height of L2/L4 vertebral body was measured in the control group. The grade of intervertebral disc degeneration was evaluated using T2WI sagittal images in both groups. The bone density of lumbar vertebrae was measured with dual-energy X-ray.

Results  In scoliosis group, the intervertebral disc height on the convex side was greater than the height on the concave side (P <0.001). The vertebral body height on the convex side was greater than the height on the concave side (P=0.016). There was a significant difference between the scoliosis group and the control group (P=0.003), and between T-value and the rate of osteoporosis between the two groups (both P <0.001). Results were verified using multiple linear regression analysis.

Conclusions  Degenerative lumbar scoliosis is accompanied by height asymmetry between the intervertebral disc and vertebral body regarding the convex and concave surfaces. There is a positive correlation between the angle of scoliosis and the disc index, the degree of degeneration of the intervertebral disc, and a negative correlation between the angle of scoliosis and bone density.

     

核转录因子kappa B在兔椎间盘退变中表达的相关研究

目的通过建立兔退变模型,分析核转录因子kB（NF-kB）在其中表达的关系,观察在不同的时间点核转录因子kB表达情况,了解其在椎间盘退变的作用。方法①实验新西兰大白兔采用自体对照,12只前路行椎间盘穿刺,来建立动物椎间盘退变的模型。②通过应用免疫组化的方法检测在不同时间点退变椎间盘与自身对照椎间盘中核转录因子kB的表达情况。③应用Image pro plus 6.0图象分析免疫组化切片所得各数据经SPSS 13.0统计学软件进行统计学分析。结果经免疫组化染色分析NF-kB在椎间盘退变过程中在不同的时间表达的情况不同,在早期表达明显,随着时间及退变的加重表达在下降。结论 NF-kB在椎间盘退变的早期起促进作用。     

退变颈椎间盘致炎机制的实验研究

目的:检测退变颈椎间盘中炎症反应标志物含量变化,从生物化学角度探讨颈椎病的发生机制。方法：20只新西兰兔随机分为造模与对照组2组,每组再分3个月和8个月2个观察亚组。切除造模组动物颈棘上、棘间韧带及分离颈椎后旁两侧肌肉,造成颈椎力学上的失衡而诱导兔颈椎间盘退行性改变。在术后3个月和8个月时分别处死动物,取颈椎间盘组织,行病理学检查并测定其中组织胺、5-羟色胺、PGE2和6-酮-PGF1α含量。结果：造模组动物颈椎间盘中4种炎症介质含量均明显高于相应观察点的对照组;而造模组动物术后8个月的颈椎间盘中4种炎症介质含量均与术后3个月无显著差异(P>0.05)。结论：退变颈椎间盘是致炎的,退变颈椎间盘中产生的炎症介质可能直接参与颈椎病的发病过程。     

RNA干扰技术及其在椎间盘退变研究中的进展

RNA干扰(RNA interference,RNAi)是近年来发展起来的一种新兴的基因沉默技术,它是由双链RNA介导的靶向基因序列特异性转录后的沉默机制.RNA干扰序列特异性的抑制效应较反义DNA、抗体封闭技术等传统基因调节方法 有着明显的优势.在哺乳动物细胞中,RNAi可由21～25个核苷酸长度的小干扰RNA(sm...     

绝经年限与腰椎间盘退变的相关性

目的：借助MRI评估不同绝经年限的健康绝经后妇女L1～S1椎间盘的退变程度,进而探讨绝经年限与腰椎间盘退变的相关性。方法：按照纳入标准筛选出589例健康自然绝经后妇女,记录其年龄、身高、体质量、绝经年龄及绝经年限。按改良Pfirmmann椎间盘退变分级系统在1.5TMRI图像上进行分级。结果：所有绝经后妇女腰椎间盘均发生退变。调整年龄、身高、体质量,当绝经年限≤15年时,绝经年限与L1/L2（r=0.235）、L2/L3（r=0.161）、L3/L4（r=0.173）、L4/L5（r=0.146）、L5/S1（r=0.137）以及总体椎间盘（r=0.259）退变程度均呈正相关（P＜0.05,0.01）;按绝经年限分三组（绝经后1～5年、6～10年、11～15年）,组间退变程度差异有统计学意义（P＜0.05）。当绝经年限＞15年时,绝经年限与各腰椎间盘退变均无显著相关性（P＞0.05）;三组间（绝经后16～20年、21～25年、26～30年）退变程度差异无统计学意义（P＞0.05）。多元逐步回归分析结果显示,绝经年限对各椎间盘退变变异贡献大小分别为：L1/L2（40.3%）、L2/L3（29.1%）、L3/L4（27.6%）、L4/L5（18.2%）、L5/S1（16.3%）、总体（42.9%）。结论：绝经年限与腰椎间盘退变存在一定的相关性。退变过程主要发生在绝经后15年内,表明绝经后雌激素的减少可能在一定时间内会加快腰椎间盘退变。     

椎间盘退变相关基因单核苷酸多态性的研究进展

椎间盘退变具有一定程度的遗传易感性,可能与人群中存在基因多态性有关。近年来,椎间盘退变与基因单核苷酸多态性的相关性研究逐渐增加并取得长足进展,目前研究的基因主要包括3类:(1)与椎间盘稳定性相关的基因,包括结构相关基因和代谢相关基因;(2)炎症相关基因;(3)疼痛信号通路相关基因。研究椎间盘退变相关基因单核苷酸多态性将有助于揭示椎间盘退变的遗传学机制,从而为个性化预防和治疗椎间盘退变疾病开辟新的道路。     

An animal model to create intervertebral disc degeneration characterized by radiography and molecular biology

Objectives:To develop a rabbit model of intervertebral disc degeneration that more exactly simulates the pathological changes of human intervertebral disc degeneration.Methods:Twelve New Zealand white rabbits were utilized to establish three different disc injury models according to the following protocol;group A:anulus punctures were done with a 18-gauge needle at L2-L3 and L5-L6; Group B:intradiscal injection of interleukin-1 IL-1βwith a 23-gauge needle at L3-L4;and Group C:intradiscal injection of phosphate buffer saline(PBS)with a 23-gauge needle at L4-L5.The L1-L2 level was used as a control.Rabbits were killed after 24 weeks.The intervertebral disc height was measured by lateral plain radiographs.After the radiographic measurements were obtained,the interver- tebral discs were removed and analyzed for DNA,sulfated glycosaminoglycan(s-GAG)and water contents of nucleus pulposus.Results: The intervertebral disc height,s-GAG,and water contents in anulus needle punctures were significantly decreased in Group A,but the DNA content in the nucleus pulposus was significantly increased when compared to the control.The significant decrease of disc height and water contents were demonstrated,only the s-GAG and DNA contents did not show a significant difference in Group B when compared to the control.The significant decrease of disc height,s-GAG,water,and DNA contents did not show in Group C when compared to the control.Conclusion:The 18-gauge puncture models produced the most consistent disc degeneration in the rabbit lumbar spine.     

An animal model to create intervertebral disc degeneration characterized by radiography and molecular biology

Objectives： To develop a rabbit model of intervertebral disc degeneration that more exactly simulates the pathological changes of human intervertebral disc degeneration. Methods： Twelve New Zealand white rabbits were utilized to establish three different disc injury models according to the following protocol; group A： anulus punctures were done with a 18-gauge needle at L2-L3 and L5-L6; Group B： intradiscal injection of interleukin-1 IL-1β with a 23-gauge needle at L3-L4; and Group C： intradiscal injection of phosphate buffer saline（PBS） with a 23-gauge needle at L4-LS. The L1-L2 level was used as a control. Rabbits were killed after 24 weeks. The intervertebral disc height was measured by lateral plain radiographs. After the radiographic measurements were obtained, the intervertebral discs were removed and analyzed for DNA, sulfated glycosaminoglycan（s-GAG） and water contents of nucleus pulposus. Results： The intervertebral disc height, s-GAG, and water contents in anulus needle punctures were significantly decreased in Group A, but the DNA content in the nucleus pulposus was significantly increased when compared to the control. The significant decrease of disc height and water contents were demonstrated, only the s-GAG and DNA contents did not show a significant difference in Group B when compared to the control. The significant decrease of disc height, s-GAG, water, and DNA contents did not show in Group C when compared to the control. Conclusion： The 18-gauge puncture models produced the most consistent disc degeneration in the rabbit lumbar spine.     

腰椎间盘突出部位与受压腰骶神经根的异常关系及其原因分析

目的：观察腰椎间盘突出部位与受压腰骶神经根之间存在的异常关系。方法：分析３９０例腰椎间盘突出症病例椎间盘突出部位与受压腰骶神经根之间的对应关系,根据影像学资料及术中所见,探讨异常关系的原因。结果：腰椎间盘突出压迫同序数椎间孔神经根者占６．４％,主要原因为向上游离型椎间盘突出物的位移以及极外侧型椎间盘突出;压迫下２个出口的神经根者占５．９％,主要原因为向下游离型椎间盘突出物的位移、中央或偏中央型椎间     

肥胖与腰椎间盘退变的关联性临床研究

目的探讨肥胖与腰椎间盘退变的关联性。方法筛选符合既定相关标准的研究对象150例,分为病例观察组60例、病例对照组60例、健康组30例,均进行MRI检查,再根据Pfirrmann分级方法判断腰椎间盘退变的程度,然后运用统计软件对所得资料进行分析。结果病例观察组及病例对照组腰椎间盘退变为Ⅴ级与健康组腰椎间盘退变为Ⅴ级所占比例比较差异有统计学意义（P〈0．05）;病例对照组中,肥胖者腰椎间盘退变为Ⅳ～Ⅴ级所占比例与超重及正常体重者间腰椎间盘退变为Ⅳ～Ⅴ级所占比例相比较差异有统计学意义（P〈0．05）,健康组中,肥胖者的腰椎间盘退变程度也比超重及正常体重者严重。结论体质指数越大,腰椎间盘退变的程度越高,肥胖可能是引发腰椎间盘退变的危险因素之一。     

纤维环穿刺法诱导兔椎间盘退变模型的组织学和影像学分析

目的探讨纤维环穿刺法诱导椎间盘退变模型的可行性和科学性。方法新西兰大白兔18只,经右侧腹膜外入路用弯血管钳夹持16G穿刺针准确刺入L3-4、L4-5、L5-6椎间盘的纤维环,深度控制在5 mm。于术前及术后4、8、12周对造模后的椎间盘及对照组的椎间盘（以L1-2、L2-3、L6-7为对照）行计算机X线摄影（computed radiography,CR）、MRI检查,并进行组织学观察。结果从手术后第4～12周,造模后的椎间盘高度指数（disc height index,DHI）呈递减趋势,MRI T2WI信号呈现持续减弱趋势（P〈0.01）;组织学观察发现4、8周造模组髓核细胞逐渐减少,12周组髓核细胞几乎被纤维软骨组织替代,纤维环排列不整齐,与髓核界限不清。结论纤维环穿刺法可以诱导兔椎间盘的缓慢退变,为临床深入研究椎间盘的退行性变提供了切实可行的动物模型。     

Association between intervertebral disc degeneration and disturbances of blood supply to the vertebrae

Low back pain is a common public health problem in western industrialized societies and the world as well.Studies indicate that the prevalence rate ranges to 35%, with around 10% of patients from 12% becoming chronically disabled. It also places an enormous economic burden on society. Although the exact cause of low back pain has yet to be defined, intervertebral disc degeneration is considered a major source of it. Since patients with degenerative discs are often asymptomatic, the mechanisms of it are still unclear.     

巨噬细胞与椎间盘退变的研究进展

椎间盘退变是以椎间盘脱水、细胞外基质降解、蛋白多糖含量下降、胶原类型转变及纤维环外层破裂等为特征的一系列退行性病变,是造成患者运动功能缺失、生活质量低下的主要原因。椎间盘退变的发生率高、致残率高、社会和家庭经济负担大、患者生活质量低下,是全球亟需解决的卫生问题之一。巨噬细胞作为体内主要的吞噬细胞,在机体生长发育的早期就与机体建立了密切联系。研究显示巨噬细胞是唯一的渗透进入封闭髓核的炎症细胞,且巨噬细胞的数量与椎间盘退变的程度呈正相关。研究表明,作为炎症细胞的巨噬细胞可能直接发挥吞噬作用或通过神经-免疫机制协同调节椎间盘的代谢,而巨噬细胞功能失调可引起炎性因子的聚集、趋化和扩散,进而导致椎间盘细胞外基质降解和椎间盘退变。本文通过总结和归纳近年来巨噬细胞参与椎间盘退变相关机制的研究进展,进一步了解椎间盘退变的分子机制,以促进临床治疗模式的改革和进步。