腰椎椎体终板后缘骨坏死病理演变过程的观察

目的：研究腰椎椎体终板后缘骨坏死的病理演变过程和Schmorl结节的形成机制。方法：对13例腰椎椎体终板后缘骨坏死症患者腰椎后路减压术中切除的完整病灶标本行组织病理学检查，观察不同年龄和不同阶段病变的组织学变化。结果：1例儿童和6例成人患者发病时间较短，其病灶的组织学特征表现为软骨终板明显增厚、变性，软骨终板下的骨组织坏死，部分坏死区为纤维组织替代，局部出现修复性新生骨。另6例成人患者发病时间较长，其病灶的组织学特征表现为软骨终板下的成熟骨组织。结论：腰椎椎体终板后缘先发生软骨终板下的骨组织坏死，然后出现修复性新生骨，新生的骨组织由于硬度较低，在压力的作用下发生塌陷，随着爬行替代的完成及骨骼的成熟，逐渐形成凸向椎管内的骨块，表明病变已发展至晚期，处于相对静止状态。腰椎椎体终板后缘骨坏死的病理演变过程实际上也是发生于腰椎椎体终板后缘Schmorl结节的形成过程。

Study on pathogenic developmental course of the osteonecrosis of the lumbar posterior end-plate

Objective:To study the pathogenic developmental course of the osteonecrosis of the lumbar post-erior end-plate and the mechanism of the Schmorl's node formation.Method:13samples removed from lumbar posterior operation were used for pathological examination to observe histologic changes of pathogenic develop-mental course.Result:The study in cluded a child and6adults who had relative short duration of the illness.Their histologic characteristics of the osteonecrotic zone of lumbar posterior end-plate showed the obvious thickering and degeneration of the cartilaginous end-plate,and the osteonecrosis beneath cartilaginous end-plate,the local fibrous tissue substitution and repaired neoformative woven bone in osteonecrosis zone,which should be considered as early pathological characteristics.Another6adults had relative long duration of ill-ness.Their histologic characteristics of the osteonecrotic zone presented the maturation bone tissue,which indi-cated that the lesions had developed to later period.Conclusion:The osteonecrosis occurs firstly in the lumbar posterior end-plate,then appears repaired neoformative bone.Stress or load lead to collapse of the neoforma-tive bone owing to its decreased stiffness.As creeping substitution and bone maturation of necrotic bone were completed,bony piece of posterior lumbar end-plate protruding into spinal canal is formed.The pathogenic de-velopmental course of the osteonecrosis of the lumbar posterior end-plate in fact is the formation course of Schmorl's nodes.