青少年特发性脊柱侧凸患者椎间盘纤维环胶原的分布及其意义

目的:研究青少年特发性脊柱侧凸(AIS)患者侧凸区椎间盘不同部位纤维环Ⅰ型、Ⅱ型胶原的分布,探讨胶原分布异常在AIS发生发展中的作用。方法:顶椎为腰椎的AIS患者共27例(AIS组),同时选15例同年龄段先天性脊柱侧凸(CS)患者为对照(CS组)。在脊柱侧凸前路手术时取L1/2或L2/3椎间盘。AIS组取材节段为侧凸顶椎区,CS组则为侧凸的下终椎区。采用胃蛋白酶-乙酸(0.5mol/L)体系提取胶原组织,SDS-聚丙烯酰胺凝胶电泳法及抗原抗体Western印记法进行胶原的分类和定量测定。在GelWork图像分析系统中进行泳道的对比定量分析。分别计算AIS组凹侧、凸侧和CS组纤维环中Ⅰ型、Ⅱ型胶原含量,并进行统计学分析。结果:AIS组患者纤维环中Ⅰ型、Ⅱ型胶原的含量在凹侧明显低于凸侧,有显著性差异(P<0.05),而且凹、凸侧胶原含量的差异与侧凸Cobb角有明显的相关。AIS组Ⅰ型、Ⅱ型胶原的含量比CS组也有显著下降(P<0.01)。结论:AIS椎间盘纤维环存在胶原代谢异常,AIS凹侧纤维环Ⅰ型、Ⅱ型胶原明显低于凸侧,且随Cobb角的增大差值越明显,提示椎间盘胶原代谢异常可能和AIS的发生发展有密切的联系。     

特发性脊柱侧凸患者两侧椎旁肌中肌梭与运动终板病理学变化的对比研究

目的：对青少年特发性脊柱侧凸（AIS）患者两侧椎旁肌中肌梭与运动终板的病理学变化进行对比研究，探讨其与脊柱侧凸病因学可能存在的关系。方法：选取手术治疗的脊柱病变患者共41例．分3组．其中AIS组20例，平均年龄15．3岁，平均Cobb角56．8^o，顶椎位于T7～T12；先天性脊柱侧凸（CS）组ll例。平均年龄13．9岁，平均Cobb角66．7^o，顶椎位于T7～T12；对照组10例，均为非脊柱侧凸病例，其中l例腰椎滑脱、l例腰椎管肿瘤、2例Scheuermann’s病、6例腰椎间盘突出症，平均年龄17．3岁。经患者知情同意，所有病例均于术中取材，AIS组和CS组取顶椎区两侧椎旁肌，对照组取非病变区两侧椎旁肌。标本分别行HE染色和非特异性酯酶（ANAE）染色，对3组病例两侧椎旁肌中肌梭的形态结构、梭内肌纤维数目、平均横截面积以及运动终板的类型进行比较。结果：AIS组患者两侧椎旁肌标本共发现19个肌梭，CS组患者两侧椎旁肌标本共发现13个肌梭，对照组两侧椎旁肌标本共发现5个肌梭。AIS和CS组患者凸侧椎旁肌肌梭内的肌纤维数目及平均横截面积显著大于凹侧椎旁肌（P〈0．05）。AIS和CS组凹侧椎旁肌哟型终板数目和病变终板数目均显著多于凸侧椎旁肌（Pl〈0．05）。对照组两侧椎旁肌哟型终板数目和病变终板数目无显著差异（P＞0．05）。结论：AIS患者两侧椎旁肌中肌梭的形态结构和运动终板的类型存在差异，这种差异可能是脊柱侧凸的继发性改变。     

青少年特发性脊柱侧凸软骨Sox9表达及意义

[目的]检测Sox9及软骨特异性标记物Ⅱ型胶原及Aggrecan在青少年特发性脊柱侧凸(adolescent idiopathic scoliosis, AIS)患者关节突软骨细胞中的表达,探讨其与AIS发生、发展的关系。[方法]收集我院行后路脊柱侧凸矫形术的15例AIS患者的关节突软骨标本,设为AIS组;取同年龄段无脊柱侧凸行脊柱融合术的10例患者正常软骨标本,设为对照组。分别分离软骨细胞体外培养,分别采用RT-PCR,免疫组化,免疫荧光染色和Westen-blotting等方法检测AIS组及对照组软骨Sox9及Ⅱ型胶原及Aggrecan的表达情况,进行两组间比较和AIS组凸侧与凹侧间比较。[结果] AIS组患者软骨细胞内的Sox9及软骨特异性标记物CollagenⅡ及Aggrecan的表达明显高于非AIS组患者。相比于凹侧,AIS患者顶椎凸侧原代软骨细胞中Sox9及软骨特异性标记物CollagenⅡ及Aggrecan表达明显升高。[结论] Sox9在AIS患者体内及原代软骨细胞中的表达异常是AIS患者体内软骨发育异常及脊柱不平衡生长的重要原因,可能是AIS发生、发展的原因之一。     

青少年特发性脊柱侧凸患者下关节突软骨的组织形态学研究

目的：观察青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者上、下端椎及顶椎凸、凹侧下关节突软骨组织学分级和软骨细胞的增殖与凋亡，探讨其软骨内成骨性生长在侧凸进展中的作用。方法：16例AIS患者，平均年龄13．5岁。取上、下端椎和顶椎凸、凹侧下关节突进行组织学观察及免疫组织化学测定其软骨细胞的增殖指数（proliferation cell nuclear antigen，PCNA）和凋亡指数（Poly ADP-ribose pdymerase，PARP）。采用PCN/PARP比值及组织学分级作为软骨内成骨活跃程度的指标，并对其进行比较。结果：AIS患者上、下端椎和顶椎凸、凹侧下关节突软骨组织学分级、软骨细胞的增殖指数（PCNA）、凋亡指数（PARP）和PCNA／PARP比值的比较均没有统计学差异（P〉0．05）。结论：AIS患者上、下端椎和顶椎凸、凹侧下关节突软骨内成骨活跃程度没有差异，关节突软骨内成骨性生长发育可能对脊柱侧凸进展没有明显的作用。     

青少年特发性脊柱侧凸与神经源性脊柱侧凸患者椎体和椎间盘的楔形变及其临床意义

目的:观察青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)与神经源性脊柱侧凸(neurological scoliosis,NS)患者的椎体和椎间盘的楔形变情况,探讨其临床意义。方法:对35例AIS患者和31例NS患者(继发于Chiari畸形)应用Cobb法测量胸椎和腰椎每个侧凸范围内顶椎及其上、下各两个椎体和相应椎间盘的楔变角,计算其占整个侧凸角度的百分比(楔变率),得出侧凸范围内5个椎体的平均楔变率和4个椎间盘的平均楔变率。应用SPSS10.0统计软件进行统计分析,组间比较采用单因素方差分析。结果:相同病因、相同侧凸部位、相同Cobb角分组情况下,椎体与椎间盘的楔变率存在显著性差异(P0.05)。相同病因、相同侧凸部位,Cobb角60°组的椎体楔变率和椎间盘楔变率与Cobb角≥60°组比较均无显著性差异(P0.05)。相同侧凸部位、相同Cobb角分组,AIS组椎体和椎间盘的楔变率分别与NS组比较均无显著性差异(P0.05)。结论:AIS与NS患者椎体与椎间盘的相对楔形变方式相同,AIS患者的椎体楔形变可能是继发的。在治疗脊柱侧凸时,即便是较小角度的脊柱侧凸,都应该考虑到其存在椎体和椎间盘的楔形变。     

Ⅱ型胶原、转化生长因子β1和碱性成纤维细胞生长因子在脊柱侧凸患者关节突软骨中分布及表达的实验研究

目的研究青少年特发性脊柱侧凸（AIS）和先天性脊柱侧凸（CS）畸形最严重部位一顶椎凸、凹侧下关节突软骨中Ⅱ型胶原、转化生长因子β1（TGF—β1）和碱性成纤维细胞生长因子（bFGF）的表达特点。方法22例AIS患者,18例CS患者作为研究对象。取两组患者的顶椎和端椎凸、凹侧的下关节突,采用苏木素-伊红（HE）染色、免疫组化和原位杂交方法观察关节突的病理改变和Ⅱ型胶原、TGF-β1及bFGF在关节突中分布的特点。将所得的免疫组化和原位杂交图像输入图像分析系统,进行半定量分析,并作统计学分析。结果Ⅱ型胶原、TGF-β1、bFGF在AIS和CS中的有基本相似的表达特点,免疫组化和原位杂交方法均显示顶椎凹侧的表达高于凸侧,差异有统计学意义（P〈0．05）;上下端椎的凸凹侧之间及凸凹侧的上下端椎之间的表达差异无统计学意义,顶椎、上下端椎各对应部位在AIS与CS之间的表达差异无统计学意义;Ⅱ型胶原在凸侧与凹侧顶椎的表达高于同侧上、下端椎,差异有统计学意义（P〈0．05）。结论AIS和CS顶椎关节突软骨呈现退变及发育不全等征象,凹侧较凸侧明显。AIS和CS中Ⅱ型胶原、TGF—β1及bFGF在顶椎凹侧表达的增高可能为脊柱畸形后异常的生物力学引起了关节突细胞间基质重建而进行代偿的结果。压应力可引起TGF—β1及bFGF的表达增高;压应力和张应力均可以引起Ⅱ型胶原的表达增高,但顶椎凹侧压应力比凸侧张应力的影响更大。     

脊髓空洞源性脊柱侧凸椎旁肌肌纤维分型及群化的对比研究

目的分析脊髓空洞源性脊柱侧凸患者椎旁肌肌纤维分型及群化的特征,探讨其与脊柱侧凸发病的关系.方法病例分为三组：脊髓空洞源性脊柱侧凸（SS）组20例,青少年特发性脊柱侧凸（AIS）组16例,非脊柱侧凸（NS）组10例.术中切取两侧椎旁肌组织,统计三组的椎旁肌肌纤维分型及群化,并进行对比.结果SS组凸侧Ⅰ型肌纤维比例和横截面积均小于凹侧,差异无统计学意义;AIS组凸侧Ⅰ型肌纤维比例和横截面积均显著高于凹侧;NS组左、右侧之间差异无统计学意义.各组间比较显示：（1）凸侧Ⅰ型肌纤维所占比例,SS组和AIS组均高于NS组;凹侧Ⅰ型肌纤维所占比例,SS组高于AIS组和NS组.（2）凸侧Ⅰ型肌纤维横截面积,SS组低于AIS组;凹侧Ⅰ型肌纤维横截面积,AIS组低于NS组.（3）凸侧Ⅱ型肌纤维横截面积,SS组＜AIS组＜NS组;凹侧Ⅱ型肌纤维横截面积,SS组和AIS组均低于NS组.SS组中11例观察到椎旁肌Ⅰ型肌纤维群化,凹侧群化程度大于凸侧,但差异无统计学意义.AIS组中8例观察到凸侧Ⅰ型肌纤维群化,无凹侧肌纤维群化和Ⅱ型肌纤维群化.NS组左、右两侧均未见肌纤维群化.结论SS组患者椎旁肌肌纤维分型及群化的特征与AIS组明显不同,提示椎旁肌存在原发性失神经支配,可能与脊柱侧凸的发生、发展有一定相关性.     

青少年特发性脊柱侧凸软骨终板蛋白质组学研究

目的 通过对青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者侧凸顶椎椎间盘软骨终板进行蛋白质组学鉴定,尝试寻找诱发或加重椎间盘不均衡发育的分子因素.方法 经一期前路脊柱侧凸矫形术获取6例AIS患者主弯顶椎椎间盘的软骨终板组织,提取蛋白组织,用Brad-ford法对所获取蛋白质样品进行浓度测定;通过SDS-聚丙烯酰胺凝胶蛋白电泳(sodium dodecyl sulfate-polyacrylamide gel electrophoresis,SDS-PAGE)对蛋白质总量和分子量范围进行初步鉴定;最后用鸟枪法蛋白质组鉴定技术比较凸、凹侧所含蛋白成分的异同,分析蛋白的种类和功能.结果 Bradford法测量软骨组织中获得的平均蛋白质浓度为3.02 mg/ml;SDS-PAGE显示顶椎凸侧终板软骨内所含蛋白质的种类明显多于凹侧;从凸侧软骨终板中鉴定出103种蛋白质,凹侧软骨终板内鉴定出55种蛋白质,其中凸侧特有蛋白58种,凹侧特有蛋白10种.结论 对AIS患者侧凸顶椎软骨终板蛋白质进行分类研究后表明侧凸顶椎软骨终板凸、凹两侧的特有蛋白与脊柱侧凸顶椎椎间盘的不对称发育存在一定的联系.     

脊柱侧凸椎旁肌肌纤维群化现象的研究

目的对椎旁肌肌纤维群化现象与青少年特发性脊柱侧凸(adolescent id iopath ic scoliosis,AIS)的发生、发展之间的关系进行研究。方法本实验分三组,AIS组:20例,平均年龄15.3岁,平均Cobb角56.8°。顶椎位于T7~12。其中Cobb角>50°11例,Cobb角≤50°9例。先天性脊柱侧凸(congen ital scoliosis,CS)组:11例,平均年龄13.9岁,平均Cobb角66.7,°顶椎位于T7~12。对照组:取10例非脊柱侧凸病例作为对照。AIS和CS组取顶椎区两侧椎旁肌,对照组取非病变区两侧椎旁肌行病理分析。结果AIS和CS组均存在凸侧椎旁肌Ⅰ型肌纤维群化现象,对照组未观察到肌纤维群化现象。CS组的肌纤维群化程度显著高于AIS组(P<0.05),AIS组中Cobb角>50°的患者肌纤维群化程度显著高于Cobb角≤50°的患者(P<0.05)。结论脊柱侧凸凸侧椎旁肌Ⅰ型肌纤维群化现象系继发性改变,且与侧凸的严重性呈正相关。     

青少年特发性脊柱侧凸患者椎体生长板中Runx2及X型胶原表达

目的：观察青少年特发性脊柱侧凸（AIS）患者上、下端椎和顶椎椎体生长板凸、凹侧软骨细胞的生物活性差异．探讨其在AIS发生和发展中的作用。方法：在对12例AIS患者行胸椎侧凸前路松解手术或前路矫形手术时获取上、下终椎和顶椎椎体生长板，分成凸、凹侧2组，共72枚标本，应用免疫组织化学方法检测Runx2和X型胶原蛋白的表达．原位杂交方法检测Runx2mRNA表达。所有染色结果通过图像分析系统进行半定量分析。结果：AIS患者顶椎椎体生长板凸、凹两侧的X型胶原、Runx2和Runx2 mRNA表达总量存在显著性差异（P〈0．05）。顶椎椎体生长板凹侧X型胶原的表达总量低于下终椎椎体生长板凹侧的表达总量（P〈0．05）。顶椎椎体生长板凹侧Runx2的表达总量低于上、下终椎椎体生长板凹侧的表达总量（P〈0．05）。顶椎椎体生长板凹侧单一软骨细胞Runx2表达量高于凸侧和上、下终椎椎体生长板凹侧单一软骨细胞的表达（P〈0.05）。顶椎椎体生长板凹侧高倍视野下平均Runx2mRNA表达总量低于上、下终椎椎体生长板的凹侧（P〈0．05）。顶椎椎体生长板凸侧单一细胞Runx2 mRNA表达量低于凹侧（P〈0.05）。顶椎椎体生长板凹侧高倍视野下平均X型胶原阳性细胞密度和Runx2阳性细胞密度低于凸侧和上、下终椎椎体生长板凹侧阳性细胞密度（P〈0．05）。结论：AIS患者上、下终椎和顶椎椎体生长板凸、凹侧软骨细胞存在不同的生物活性和细胞动力学，这可能是力学条件改变后的一种继发性改变，但其可能在AIS的进展中发挥重要作用。     

退变性腰椎侧凸形成和发展的相关因素分析

目的 探讨退变性腰椎侧凸患者椎问盘的不对称指数、腰椎间盘退变程度以及骨密度降低对侧凸角度的影响.方法 采用回顾性研究的方法,选取2002年1月至2010年8月,共96例退变性腰椎侧凸患者为研究对象(侧凸组);2002年1月至2010年8月确诊为腰椎管狭窄症并且资料齐全的患者96例为对照组;两组间性别、年龄、体质量指数匹配.侧凸组:在腰椎正位X线片上测量凸凹侧顶椎间盘及其上下椎间盘的高度和顶椎及其上下椎体的高度,利用Adobe Photoshop 6.0软件,测量MRI图像T2WI顶椎及其上下椎间盘内髓核与脑脊液的相对信号强度.对照组:取2～3、L3-4、L4-5这3个椎间盘为研究对象测定上述指标.应用双能X线吸收法测定两组患者腰椎(L2-4)及股骨颈、股骨粗隆和Ward's三角的T值.结果 侧凸组凸侧椎间盘高度和为(40±7)mm高于凹侧的(28±7)mm(P<0.01),凸侧椎体高度和为(76±12)mm高于凹侧的(72±10)mm(P=0.016):两组之间的椎间盘退变程度差异有统计学差异(P=0.003);两组之间骨密度T值的平均值和骨质疏松的发生率差异有统计学意义(均P<0.01).通过多元线性回归分析结果 显示患者椎间盘的不对称指数、椎间盘的退变程度、骨密度T值影响退变性腰椎侧凸角度.结论 退变性腰椎侧凸常伴有凸凹两侧椎间盘高度以及椎体高度不对称.侧凸角度与椎间盘的不对称指数、椎间盘的退变程度呈正相关,与骨密度值T值呈负相关.

Abstract：

Objectives To investigate the correlation between scoliosis angle and the asymmetric index of degenerative lumbar scoliosis, the degree of intervertebral disc degeneration, decreased bone density. Methods As a retrospectively study, a total of 96 patients with degenerative lumbar scoliosis were retrospectively enrolled from January 2002 to August 2010 as scoliosis group, meanwhile % patients with lumbar spinal stenosis matched in gender, age and body mass index (BMI) were selected as control group.All patients were studied with plain radiographs, MRI and dual energy X-ray absorptiometry at presentation. Radiographic measurements include Cobb angle, the height of the convex and concave side of the apical disc and the contiguous disc superiorly and inferiorly, the height of the convex and concave side of the apical and the contiguous vertebral body superiorly and inferiorly in scoliosis group, the height of L2-3, L3-4, L4-5 discs and the height of L2-4 vertebral body in control group. The average relative signal intensity of lumbar intervertebral disc and cerebrospinal fluid in T2WI sagittal image was measured in apex intervertebral disc and adjacent discs by Adobe Photoshop 6.0 in scoliosis group, which was measured in L2-3, L3-4, L4-5 disc in control group. The bone density of lumbar, femoral neck, trochanter, and Ward's triangle regions were measured with dual-energy X-ray absorptiometry. Results The intervertebral disc height in convex side was greater than the height in the concave side [(40 ± 7) mm vs. (28 ± 7) mm, P < 0. 01] , the vertebral body height in convex side was greater than the height in the concave side [(76 ± 12) mm vs. (72 ± 10) mm, P =0.016] in scoliosis group. There was significant statistically difference in the degenerative degree of intervertebral discs between two groups (P = 0. 003). There was significant statistically difference of the average T-value and the rate of osteoporosis between two groups (P < 0. 01). Multiple linear regression analysis showed that the asymmetric disc index, the degenerative degree of intervertebral disc and osteoporosis were the predominant correlative factors, which affected the development of degenerative lumbar scoliosis. Conclusions Degenerative lumbar scoliosis is always accompanied by the height asymmetry of intervertebral discs and vertebral body from convex and concavity sides. There is positive correlation between the angle of scoliosis and the asymmetric disc index, the degeneration of intervertebral disc, and negative correlation between the angle of scoliosis and the bone density (T-value).     

Analysis of vertebral morphology in idiopathic scoliosis with use of magnetic resonance imaging and multiplanar reconstruction

BACKGROUND: Several studies have provided data on the vertebral morphology of normal spines, but there is a paucity of data on the vertebral morphology in patients with idiopathic scoliosis. METHODS: The morphology of the pedicles and bodies of 307 vertebrae as well as the distance between the pedicles and the dural sac (the epidural space) in twenty-six patients with right-sided thoracic idiopathic scoliosis were analyzed with use of magnetic resonance imaging and multiplanar reconstruction. RESULTS: A distinct vertebral asymmetry was found at the apical region of the thoracic curves, with significantly thinner pedicles on the concave side than on the convex side (p < 0.05). The degree of intravertebral deformity diminished farther away from the apex, with vertebral symmetry restored at the neutral level. In the thoracic spine, the transverse endosteal width of the apical pedicles measured between 2.3 mm and 3.2 mm on the concave side and between 3.9 mm and 4.4 mm on the convex side (p < 0.05). In the lumbar spine, the pedicle width measured between 4.6 mm at the cephalad part of the curve and 7.9 mm at the caudad part of the curve. The chord length and the pedicle length gradually increased from 34 mm and 18 mm, respectively, at the fourth thoracic vertebra to 51 mm and 25 mm, respectively, at the third lumbar vertebra. The transverse pedicle angle measured 15 in the cephalad aspect of the thoracic spine, decreased to 7 at the twelfth thoracic vertebra, and increased again to 16 at the fourth lumbar vertebra. The width of the epidural space was <1 mm at the thoracic apical vertebral levels and averaged 1 mm at the lumbar apical vertebral levels on the concave side, whereas it was between 3 mm and 5 mm on the convex side (p < 0.05). CONCLUSION: Idiopathic scoliosis is associated with distinctive intravertebral deformity, with smaller pedicles on the concave side and a shift of the dural sac toward the concavity.     

青少年特发性胸椎侧凸患者胸椎椎弓根横径的分型及其临床意义

目的 探讨胸椎椎弓根横径的测量及分型在青少年特发性胸椎侧凸患者治疗中的临床意义.方法 对2008年10月至2009年7月收治的30例青少年特发性胸椎侧凸患者(侧凸组)和2008年8月至2009年7月于本院就诊的20例年龄匹配的非侧凸青少年患者(对照组)采用螺旋CT行胸椎连续扫描,在图像编档和通信系统(PACS)上逐层阅片,选择胸椎椎弓根显示最清楚的层面对椎弓根横径进行测量,并根据测量结果将其分为4型.分别对侧凸组凹凸侧和对照组左右侧椎弓根横径进行对比,并对侧凸组与对照组椎弓根分型的构成比进行分析.结果 两组患者胸椎椎弓根横径T1～4逐渐减少,T5～12逐渐增加.对照组同节段双侧胸椎椎弓根横径差异无统计学意义(P>0.05).侧凸组顶椎区凹侧的椎弓根横径明显小于凸侧,差异有统计学意义(P<0.05).侧凸组中4型椎弓根的比例明显高于对照组,1型椎弓根的比例低于对照组,差异均有统计学意义(P<0.05).结论 青少年特发性胸椎侧凸患者胸椎椎弓根横径常较小,术前应根据CT胸椎椎弓根形态制定置钉策略,以减少经胸椎椎弓根置入螺钉的并发症的发生.     

Spinal decompensation in degenerative lumbar scoliosis

Due to the aging population, degenerative scoliosis is a growing clinical problem. It is associated with back pain and radicular symptoms. The pathogenesis of degenerative scoliosis lies in degenerative changes of the spinal structures, such as the intervertebral disc, the facet joints and the vertebrae itself. Possibly muscle weakness also plays a role. However, it is not clear what exactly causes the decompensation to occur and what determines the direction of the curve. It is known that in the normal spine a pre-existing rotation exists at the thoracic level, but not at the lumbar level. In this retrospective study we have investigated if a predominant curve pattern can be found in degenerative scoliosis and whether symptoms are predominantly present at one side relative to the curve direction. The lumbar curves of 88 patients with degenerative scoliosis were analyzed and symptoms were recorded. It was found that curve direction depended significantly on the apical level of the curve. The majority of curves with an apex above L2 were convex to the right, whereas curves with an apex below L2 were more frequently convex to the left. This would indicate that also in degenerative scoliosis the innate curvature and rotational pattern of the spine plays a role in the direction of the curve. Unilateral symptoms were not coupled to the curve direction. It is believed that the symptoms are related to local and more specific degenerative changes besides the scoliotic curve itself.     

特发性脊柱侧凸双侧椎旁肌褪黑素受体含量的差异性比较研究

目的研究特发性脊柱侧凸椎旁肌中褪黑素受体含量的变化,并探讨其与特发性脊柱侧凸病因学的关系。方法本实验共分3组:特发性脊柱侧凸组:20例,平均Cobb角56°±16°,顶椎位于T6-11。其中Cobb角>50°10例,Cobb角≤50°10例。先天性脊柱侧凸组:12例,平均Cobb角59°±33°,顶椎位于T7-12。对照组:取10例非脊柱侧凸病例作为对照。采用RT-PCR方法检测所有病例两侧椎旁肌中褪黑素受体两种亚型MT1、MT2mRNA的表达量。结果特发性脊柱侧凸和先天性脊柱侧凸组顶椎区凹侧椎旁肌MT2mRNA的表达量明显小于凸侧(P<0·05),MT1mRNA的表达量两侧无显著差异(P>0·05)。特发性脊柱侧凸组中Cobb角>50°的病例顶椎区凹凸侧椎旁肌MT2mRNA表达量的比值与Cobb角≤50°的病例无显著差异(P>0·05)。对照组两侧椎旁肌MT1、MT2mRNA的表达量无显著差异(P>0·05)。结论特发性脊柱侧凸患者两侧椎旁肌MT2mRNA的表达量存在差异,这种差异可能为继发性改变,在特发性脊柱侧凸的发病中不起主要作用。     

Histomorphological study of the spinal growth plates from the convex side and the concave side in adolescent idiopathic scoliosis

Asymmetrical growth of the vertebrae has been implicated as one possible etiologic factor in the pathogenesis of adolescent idiopathic scoliosis. The longitudinal vertebral growth derives from the endochondral ossification of the vertebral growth plate. In the present study, the growth plates from the convex and concave side of the vertebrae were characterized by the method of histology and immunohistochemistry to evaluate the growth activity, cell proliferation, and apoptosis. Normal zoned architectures were observed in the convex side of the growth plate and disorganized architectures in the concave side. The histological grades were significantly different between the convex and the concave side of the growth plate in the apex vertebrae (P < 0.05). The histological difference was also found significant statistically between end vertebrae and apex vertebrae in the concave side of vertebral growth plates (P < 0.05). The proliferative potential indexes and apoptosis indexes of chondrocytes in the proliferative and hypertrophic zone in the convex side were significantly higher than that in the concave side in the apex vertebral growth plate (P < 0.05). There was a significant difference of the proliferative potential index (proliferating cell nuclear antigen, PCNA index) between convex side and concave side at the upper end vertebra (P < 0.05). The difference of the proliferative potential index and apoptosis index were found significant statistically in the concave side of the vertebral growth plate between end vertebrae and apex vertebrae (P < 0.05). The same result was also found for the apoptosis index (terminal deoxynucleotidyl transferase mediated deoxyuridine triphosphate biotin nick end labeling assay, TUNEL index) in the convex side of vertebral growth plate between end vertebrae and apex vertebrae (P < 0.05). Some correlation were found between radiographic measurements and proliferation and apoptosis indexes. The difference in histological grades and cellular activity between the convex and concave side indicated that the bilateral growth plate of the vertebrae in AIS patients have different growth kinetics which may affect the curve progression.     

青少年特发性脊柱侧凸患者脊柱柔韧性的影响因素

目的:探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者脊柱柔韧性的可能影响因素.方法:选取2006年12月～2008年4月在我院脊柱外科手术治疗的204例AIS患者,男性36例,女性168例,平均年龄15.0岁;平均Cobb角50.1°;平均Risser征3.4度;主弯跨度平均6.8个椎体;主弯顶椎旋转度平均2.0度.摄站立位全脊柱正侧位及仰卧左右侧屈位X线片,计算主弯柔韧性.采用相关分析研究各临床指标与主弯柔韧性的相关性.结果:女性AIS患者的脊柱柔韧性明显高于男性(P<0.05);胸腰弯组和腰弯组AIS患者的脊柱柔韧性显著大于胸弯组(P<0.05),胸腰弯和腰弯组之间无显著性差异(P>0.05).女性AIS患者中的年龄及主弯Cobb角(站立位与侧屈位)均与脊柱柔韧性显著负相关(P<0.05),且胸弯女性AIS患者的月经初潮至手术时间及顶椎旋转度也与脊柱柔韧性显著负相关(P<0.05).男性胸弯AIS患者中侧屈位主弯Cobb角、胸腰弯/腰弯组中主弯Cobb角(站立位与侧屈位)均与脊柱柔韧性显著负相关(P<0.05).主弯跨度及Risser征与脊柱柔韧性均无明显相关性(P>0.05).结论:女性AIS患者脊住柔韧性受年龄、月经初潮至手术时间、主弯Cobb角(站立位与侧屈位)、弯型及顶椎旋转度等因素影响;男性AIS患者的脊柱侧凸柔韧性主要受主弯Cobb角及弯型影响.