In vivo remodeling of intervertebral discs in response to short‐ and long‐term dynamic compression

This study evaluated how dynamic compression induced changes in gene expression, tissue composition, and structural properties of the intervertebral disc using a rat tail model. We hypothesized that daily exposure to dynamic compression for short durations would result in anabolic remodeling with increased matrix protein expression and proteoglycan content, and that increased daily load exposure time and experiment duration would retain these changes but also accumulate changes representative of mild degeneration. Sprague‐Dawley rats (n = 100) were instrumented with an Ilizarov‐type device and divided into three dynamic compression (2 week–1.5 h/day, 2 week–8 h/day, 8 week–8 h/day at 1 MPa and 1 Hz) and two sham (2 week, 8 week) groups. Dynamic compression resulted in anabolic remodeling with increased matrix mRNA expression, minimal changes in catabolic genes or disc structure and stiffness, and increased glysosaminoglycans (GAG) content in the nucleus pulposus. Some accumulation of mild degeneration with 8 week–8 h included loss of annulus fibrosus GAG and disc height although 8‐week shams also had loss of disc height, water content, and minor structural alterations. We conclude that dynamic compression is consistent with a notion of “healthy” loading that is able to maintain or promote matrix biosynthesis without substantially disrupting disc structural integrity. A slow accumulation of changes similar to human disc degeneration occurred when dynamic compression was applied for excessive durations, but this degenerative shift was mild when compared to static compression, bending, or other interventions that create greater structural disruption. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res     

骨髓间充质干细胞修复退变椎间盘中营养和分化效应的变化

目的 观察骨髓间充质干细胞(MSCs)移植在椎间盘退变修复过程中营养效应与类髓核分化效应的变化.方法 用针吸髓核法建立兔的椎间盘退变模型,采取体外细胞培养技术,培养MSCs,并用含有绿色荧光蛋白(GFP)标记的腺病毒转染使之携带有GFP,在造成退变模型2周后以5×106个细胞/ml的浓度植入手术节段的椎间盘内.1、2、4、8周末用间接免疫荧光双标结合激光共聚焦显微镜观测MSCs表达的转化生长因子(TGF)-β1、胰岛素样生长因子(IGF)-1和低氧诱导因子(HIF)-1α、Ⅱ型胶原等在不同时间点上的表达及定量分析.结果 MSCs表达的TGF-β1、IGF-1在2周左右达到高峰,分别为(22.68±6.83)%、(35.67±6.56)%,之后开始降低;HIF-1α、Ⅱ型胶原在8周中均呈上升趋势,8周最高,分别为(55.35±14.06)%、(37.23±9.53)%,2～4周过程中上升最明显.结论 早期(2周时)MSCs以发挥营养效应为主,后期(4周后)以发挥类髓核分化效应为主.     

桡尺远侧关节内三角纤维复合体的应用解剖学研究

目的:对三角纤维软骨复合体(triangular fibrocartilage complex,TFCC)进行解剖研究,提供TFCC的解剖学资料。方法:采用福尔马林固定的及部分新鲜成人尸体上肢标本对TFCC的结构进行解剖观测。结果:TFCC是由多种结构成分组成的复合体,包括腕关节盘、关节盘同系物、桡尺远侧掌背侧韧带、尺侧腕伸肌腱鞘、尺侧囊、尺三角韧带及尺月韧带等。发现茎突前隐窝开口有三个类型,即:窄开口型(74%)、宽开口型(13%)和闭口型(13%)。结论:TF-CC是由各组成结构纵横交错排列形成的一个复杂的复合体,是桡尺远侧关节的最主要稳定结构,是尺侧腕的支持结构。     

骶髂关节错位的手法治疗

骶髂关节是骶骨和髂骨耳状面相互交错嵌插的滑膜关节,是组成骨盆的重要关节。骶骨关节面为凹面,髂骨关节面呈凸面,关节面上有关节软骨,两侧参差不齐的关节面相互交错,为一微动的关节,一般认为不易发生错位,但是笔者在临床诊疗过程中,发现骶髂关节错位的发病率非常高,是引发腰腿痛的主要原因之一。患者往往以腰椎间盘突出来诊,自诉腰及臀部疼痛或伴有受累侧下肢疼痛麻木,临床上极易误诊为腰椎间盘突出症。如按腰椎间盘突出症治疗,无明显疗效,笔者于2006年1月至2007年12月采用整脊手法治疗骶髂关节错位患者126例,取得满意疗效。     

内镜下腰椎间盘切除并发症的初步分析

通过对应用腰椎间盘镜技术(microendoscopic disectomy,MED)治疗腰椎间盘突出症并发症的分析和与常规开放式手术对比,探讨MED手术治疗腰椎间盘突出症的优、缺点.MED手术具有创伤小、手术时间短、术后恢复快、痛苦轻等优点,但并发症较多,需合理的掌握手术指征,不断提高技术技能.     

破裂型椎间盘突出动物模型重吸收过程中自身免疫反应的研究

目的 探讨自身免疫反应在椎间盘突出后重吸收过程中的作用机制.方法 将20只SD雄性大鼠随机分成对照组,实验组.实验组经手术切除尾椎椎间盘,埋植在背部硬膜外.动物30天后处死,取埋植的髓核组织,进行HE染色,流式细胞仪检测.对照组,将线团埋植在硬膜外,30天后处死作对照试验.结果 对照组与实验组突出组织的形态结构与T,B细胞含量有明显差异.结论 破裂型椎间盘突出的髓核组织能够吸引活性的T,B细胞,引发自身免疫反应.     

经皮激光腰椎间盘减压术治疗腰椎间盘突出症

目的探讨经皮激光椎间盘减压术（PLDD）治疗腰椎间盘突出症效果,研究适宜激光照射量。方法使用ND：YAG激光治疗腰椎间盘突出症40例（L4～5椎间盘突出32例,L5～S1和L4～5同时突出8例）,C臂X线机透视下将激光光纤沿穿刺针插入椎间盘髓核中进行汽化,每节激光总量CT分级Ⅰ级为500J,Ⅱ级为700J能量进行汽化,减轻椎间盘内压力。结果椎间盘内压力减低,神经根受压解除,突出的椎间盘组织回缩,采用Machab标准评定疗效：优26例,良6例,可6例,差2例,优良率为80%。结论PLDD是一种安全、简单、有效的治疗椎间盘突出症的微创方法。     

等离子刀颈椎间盘髓核成形术效能及安全研究

目的探讨不同能量颈椎间盘等离子刀髓核成形术（CN）效能及安全性。方法对40个C3～T1羊椎间盘按照不同能量分1档（A组,80W）、2档（B组,100W）、3档（C组,120W）3个实验组,每组10个椎间盘;另设假手术组作为对照组（10个间盘,仅作穿刺）。分别通过相同时间（40s）不同能量组行羊颈椎间盘CN,观察CN在椎间盘所形成的消融腔截面积大小,记录椎间盘前缘、后缘、椎间孔处温度变化并对其进行统计学分析。结果A、B、C组手术消融腔、对照组穿刺腔截面积分别为（3.000±0.449）mm^2、（9.436±1.271）mm^2、（27.359±2.001）mm^2、（2.010±0.000）mm^2,其中B、C档组与对照组比较差异有显著性（P〈0.05）。A、B、C3个实验组、对照组温度分别为：（28.697±1.571）℃、（35.470±0.617）℃、（41.733±0.345）℃、（20.600±0.582）℃,3个实验组温度与对照组比较差异有显著性（P〈0.05）。3种能量手术时,2档温度在安全范围内,3档形成的有效消融腔截面积最大,消融腔、温度与能量成正相关。结论等离子刀髓核成形术的效能、温度变化与能量成正相关,临床使用2档行颈椎间盘CN消融效能和安全性最高。     

Biomechanical characterization of an annulus-sparing spinal disc prosthesis

Background contextCurrent spine arthroplasty devices require disruption of the annulus fibrosus for implantation. Preliminary studies of a unique annulus-sparing intervertebral prosthetic disc (IPD) found that preservation of the annulus resulted in load sharing of the annulus with the prosthesis.PurposeDetermine flexibility of the IPD versus fusion constructs in normal and degenerated human spines.Study design/settingBiomechanical comparison of motion segments in the intact, fusion and mechanical nucleus replacement states for normal and degenerated states.Patient settingThirty lumbar motion segments.Outcomes measuresIntervertebral height; motion segment range of motion, neutral zone, stiffness.MethodsMotion segments had multidirectional flexibility testing to 7.5 Nm for intact discs, discs reconstructed using the IPD (n=12), or after anterior/posterior fusions (n=18). Interbody height and axial compression stiffness changes were determined for the reconstructed discs by applying axial compression to 1,500 N. Analysis included stratifying results to normal mobile versus rigid degenerated intact motion segments.ResultsThe mean interbody height increase was 1.5 mm for IPD reconstructed discs versus 3.0 mm for fused segments. Axial compression stiffness was 3.0±0.9 kN/mm for intact compared with 1.2±0.4 kN/mm for IPD reconstructed segments. Reconstructed disc ROM was 9.0°±3.7° in flexion extension, 10.6°±3.4° in lateral bending, and 2.8°±1.4° in axial torsion that was similar to intact values and significantly greater than respective fusion values (p<.001). Mobile intact segments exhibited significantly greater rotation after fusion versus their more rigid counterparts (p<.05); however, intact motion was not related to motion after IPD reconstruction. The NZ and rotational stiffness followed similar trends. Differences in NZ between mobile and rigid intact specimens tended to decrease in the IPD reconstructed state.ConclusionThe annulus-sparing IPD generally reproduced the intact segment biomechanics in terms of ROM, NZ, and stiffness. Furthermore, the IPD reconstructed discs imparted stability by maintaining a small neutral zone. The IPD reconstructed discs were significantly less rigid than the fusion constructs and may be an attractive alternative for the treatment of degenerative disc disease.     

凝固椎间盘髓核的生物力学研究

目的观察凝固髓核的轴向抗压缩能力,探讨其临床应用的可行性。方法将12只杂种犬的16个椎间盘分为4组：空白对照组4个,明矾溶液1组（注入明矾溶液3d）4个,明矾溶液2组（注入明矾溶液2周）4个,明矾溶液3组（注入明矾溶液1个月）4个。外接压力泵,并维持160kPa压力5min,将0．15ml10％明矾溶液缓慢注入椎间盘髓核,使椎间盘髓核凝固以实验椎间盘为中心,取一个脊柱功能单位作为生物力学检测的标本。检测标本的轴向载荷位移曲线及使标本髓核突出的轴向载荷。结果轴向载荷500N时,明矾溶液凝固的髓核（3个时间组）与正常椎间盘被压缩的位移无统计学差异;轴向载荷2058N（210kg）时,正常椎间盘髓核可被挤出;轴向载荷2538N（259kg）时,明矾溶液凝固的髓核（1个月）被挤出。结论明矾溶液可使椎间盘髓核产生凝固,凝固髓核的轴向抗压能力略有增强,可达到强化髓核的目的。