青少年特发性脊柱侧凸患者脊柱前后柱骨骺软骨的组织形态学对比研究

目的：探讨青少年特发性脊柱侧凸（adolescentid iopathic scoliosis，AIS）患者脊柱前后柱软骨组织学和软骨细胞的增殖与凋亡有无差异及其对脊柱侧凸发生、进展的影响。方法：26例11～16岁AIS患者随机分为2组．A组12例行前路松解术或前路矫形内固定术；B组14例行后路矫形内固定术。A组取胸弯上端椎、顶椎和下端椎椎体生长板，B组取下关节突软骨．进行组织学观察及免疫组织化学测定其软骨细胞的细胞增殖核抗原（proliferation cell nuclear antigen，PCNA）指数和聚腺苷二磷酸-核糖聚合酶（poly ADP-ribose polymerase，PARP）指数。采用组织学分级作为生长潜能的指标，PCNA指数和PARP指数分别代表细胞增殖指数和凋亡指数作为软骨内成骨活跃度的指标。结果：A组AIS患者前柱椎体生长板组织学分级、增殖-肥大层软骨细胞的增殖指数（PCNA）和凋亡指数（PARP）均明显高于B组AIS患者后柱下关节突软骨．且有统计学差异（P〈0．05）。结论：相同年龄段AIS患者脊柱前、后柱生长潜能和软骨内成骨活跃程度存在差异．可能导致前柱生长过快、后柱生长缓慢，从而可能对脊柱侧凸的发生和进展发挥重要作用。

Histomorphological study of cartilaginous growth plates between anterior and posterior column of spine in adolescent idiopathic scoliosis

Objective:To investigate the difference of histological grades of growth plates and proliferation and apoptosis of chondrocytes in cartilaginous growth plates between vertebrae and inferior facet processes in adolescent idiopathic scoliosis(AIS) patients and the role of these differences in the development and progression of AIS.Method:26 AIS patients with age of 11~16 years old were divided into two groups randomly.Group A included 12 patients who underwent anterior release or anterior instrumentation and fusion.Group B included 16 patients who underwent posterior instrumentation and fusion.The growth plates of upper end,apex and lower end vertebrae in group A and inferior facet processes of upper end,apex and lower end vertebrae in group B were obtained intraoperatively.The histological grades were conducted under the light microscope.The proliferation potential index(proliferation cell nuclear antigen,PCNA-index),apoptosis index(poly ADP-ribose polymerase,PARP-index) were examined by immunohistochemistry.The histological grades were considered as an index of growth potential.The PCNA index and PARP index were defined as indexes of endochondral bone formation activity.These indexes were compared between group A and group B.Result:Significant difference in histological grades of growth plates,proliferation potential index and apoptosis index of chondrocytes in the proliferative-hypertrophic zone were found between vertebral growth plates in group A and cartilages of inferior articular process in group B(P<0.05).Conclusion:The difference of growth potential and the difference of endochondral bone formation activity indicate a growth difference may exist between anterior and posterior column of spine,the relatively shorter posterior column acting as a tether may play important roles in the development and progression of AIS.