本文選題：椎間盤/病理學(xué) + 模型��； 參考：《福建中醫(yī)學(xué)院》2008年碩士論文

【摘要】： 目的:模擬人后路髓核摘除術(shù),采用后外側(cè)入路經(jīng)纖維環(huán)穿刺抽吸髓核建立兔椎間盤退變動(dòng)物模型,分析其可行性和優(yōu)點(diǎn),并通過影像學(xué)和病理學(xué)檢測分析,再現(xiàn)椎間盤退變過程的客觀發(fā)展規(guī)律,為研究椎間盤退變提供更為理想的動(dòng)物模型,并為運(yùn)用組織工程等方法修復(fù)重建椎間盤提供實(shí)驗(yàn)基礎(chǔ)。 方法:日本大耳白兔20只,將每只兔的L1/2和L3/4椎間盤納入實(shí)驗(yàn)組,L2/3椎間盤納入對(duì)照組。術(shù)前用速眠新行肌注麻醉,常規(guī)術(shù)前準(zhǔn)備,取左側(cè)臥位,采用右后外側(cè)入路,沿兔L1/2和L3/4右后外側(cè)肌間隙分離,暴露橫突和倒“八”字區(qū)域后外側(cè)纖維環(huán),直視下用10ml無菌一次性注射器配合21G穿刺針,用無菌塑料套簡套住穿刺針,使其尖端保留5mm長度,于纖維環(huán)后外側(cè)方平行終板方向刺入,深度控制在5mm,然后注射器回抽約10ml,吸出5.0-8.0mg髓核。逐層縫合關(guān)閉切口。動(dòng)物蘇醒后隨機(jī)分為2、4、8、12周4個(gè)模型組,每組5只,分籠常規(guī)飼養(yǎng)。術(shù)后予以肌注慶大霉素3天預(yù)防切口感染。術(shù)前及術(shù)后2、4、8、12周分別對(duì)實(shí)驗(yàn)組和對(duì)照組椎間盤行CR及MRI檢查后,分別將兔子處死,取L1/2、L3/4和L2/3椎間盤進(jìn)行Masson染色,觀察椎間盤組織病理學(xué)變化。 結(jié)果:(1)影像學(xué)分析顯示,術(shù)后第2周到第12周,X線可見實(shí)驗(yàn)組椎間隙變窄,DHI%隨造模時(shí)間延長而減小,與對(duì)照組相比各時(shí)間段的差異均有顯著性意義(P＜0.05),軟骨終板和椎體邊緣骨質(zhì)密度增高。MRI可見實(shí)驗(yàn)組椎間盤髓核面積縮小,纖維環(huán)面積增大,髓核內(nèi)MRI T2加權(quán)信號(hào)降低。髓核信號(hào)強(qiáng)度呈逐漸降低趨勢,與對(duì)照組相比各階段MRI改良Thompson分級(jí)逐漸偏向嚴(yán)重分級(jí),結(jié)果差異有顯著性意義(P＜0.05)。(2)病理學(xué)檢測顯示,Masson染色可見對(duì)照組髓核組織中髓核形態(tài)規(guī)則,與纖維環(huán)界線清晰,髓核細(xì)胞較多,纖維環(huán)排列整齊致密;實(shí)驗(yàn)組髓核裂隙形成,膠原排列紊亂,髓核細(xì)胞數(shù)量不斷減少;隨時(shí)間增長,類軟骨細(xì)胞數(shù)量減少,髓核組織逐漸纖維化,纖維環(huán)逐漸分層紊亂、扭曲、斷裂。與對(duì)照組相比各時(shí)間段Nishimura椎間盤病理分級(jí)差異有顯著性意義(P＜0.05)。 結(jié)論:(1)本實(shí)驗(yàn)通過影像學(xué)分析和組織病理學(xué)檢測證實(shí)了兔椎間盤退變的基本特征;(2)模擬人后路髓核摘除術(shù),進(jìn)行后外側(cè)纖維環(huán)穿刺抽吸髓核可以誘導(dǎo)兔椎間盤緩慢退變,能再現(xiàn)椎間盤退變病變發(fā)展客觀規(guī)律,而且模型制作簡單,重復(fù)性好,是研究椎間盤退變病因?qū)W、病理生理學(xué)等理想的動(dòng)物模型,而且為研究臨床上椎間盤突出癥術(shù)后復(fù)發(fā)及檢驗(yàn)可靠、有效的治療椎間盤退變的新方法,例如生長因子療法、基因療法、細(xì)胞療法、組織工程等提供實(shí)驗(yàn)基礎(chǔ)。
[Abstract]:Objective: to establish a rabbit model of degenerative nucleus pulposus by posterolateral approach with posterior approach of nucleus pulposus extraction, and to analyze its feasibility and advantages, and to analyze the feasibility and advantages of the model by imaging and pathological examination. The objective development law of disc degeneration is reproduced, which provides a more ideal animal model for the study of disc degeneration, and provides an experimental basis for the repair and reconstruction of intervertebral disc by means of tissue engineering. Methods: L1 / 2 and L3 / 4 intervertebral discs of each rabbit were included in the control group. Intramuscular anaesthesia was performed with Shumian before operation. Routine preoperative preparation was performed in the left lateral position. The right posterolateral approach was used to separate the right posterolateral muscle space along the L1 / 2 and L3 / 4 spaces of the right posterolateral muscle, and the transverse process and the backward "eight" region were exposed to the posterolateral fibrous ring. 10ml sterile disposable syringe was used in direct view with 21G puncture needle, and the needle was simply covered with sterile plastic sleeve to keep the length of 5mm at the tip of the needle. The needle was punctured in the direction of parallel end plate on the outer side of the fiber ring. The depth was controlled at 5 mm, then the syringe was pumped back about 10 ml and the 5.0-8.0mg nucleus pulposus was sucked out. Close the incision layer by layer. After waking up, the animals were randomly divided into 4 model groups with 5 rats in each group. After operation, gentamicin was injected intramuscularly for 3 days to prevent incision infection. The intervertebral discs of the experimental group and the control group were examined by CR and MRI respectively before operation and at 812 weeks after operation. The rabbits were killed, and the intervertebral discs of L 1 / 2 / 2, L 3 / 4 and L 2 / 3 were taken for Masson staining to observe the histopathological changes of the intervertebral discs. Results the imaging analysis showed that the narrowing of the vertebral space in the experimental group decreased with the prolongation of the time of modeling, and the X ray showed that the narrowing of the vertebral space in the experimental group decreased with the prolongation of the time of modeling at the 2nd week and 12th week after operation. Compared with the control group, the difference was significant (P < 0.05). The density of cartilage endplate and margin of vertebral body was increased. MRI showed that the area of nucleus pulposus decreased, the area of fibrous ring increased, and the signal intensity of T2-weighted MRI in nucleus pulposus decreased in the experimental group. The signal intensity of the nucleus pulposus decreased gradually, and the improved Thompson grading was more severe than that in the control group. Results the difference was significant (P < 0.05) pathological examination showed that the morphology of nucleus pulposus in the control group was regular, the boundary of the nucleus pulposus was clear, the nucleus pulposus cells were more, and the fibrous ring was arranged neatly and compactly, the fissure of nucleus pulposus was formed in the experimental group. With the increase of time, the number of chondroid cells decreased, the tissue of nucleus pulposus became fibrosis, and the fibrous ring was gradually stratified, distorted and broken. Compared with the control group, the pathological grade of Nishimura intervertebral disc was significantly different from that of the control group (P < 0.05). Conclusion (1) the basic characteristic of rabbit disc degeneration was confirmed by imaging analysis and histopathological examination. (2) the posterior approach nucleus pulpotomy can induce the slow degeneration of the intervertebral disc in rabbits, and the nucleus pulposus can be sucked through the posterolateral fibrous ring to induce the slow degeneration of the intervertebral disc. It is an ideal animal model for studying the etiology and pathophysiology of intervertebral disc degeneration, which can reproduce the objective law of the degenerative lesion of intervertebral disc, and the model is simple and reproducible. It also provides experimental basis for the study of clinical recurrence of intervertebral disc herniation and the reliable and effective treatment of disc degeneration, such as growth factor therapy, gene therapy, cell therapy, tissue engineering and so on.
【學(xué)位授予單位】：福建中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2008
【分類號(hào)】：R681.53;R-332

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