人颈椎软骨终板的结构改变与椎间盘退变的相关性分析
发布时间：2018-10-29 11:04
【摘要】：目的:观察人体软骨终板超微结构及颈椎间盘退变的关系。方法:收集泸州医学院附属第一医院脊柱外科2013年6月至2015年4月诊断明确并行手术治疗的颈椎病患者软骨终板及椎间盘85例,同期收集外伤致颈椎骨折(非寰枢椎骨折,术前无颈椎病症状与体征)并行手术治疗的软骨终板及椎间盘12例作为对照。将颈椎病患者按年龄分组,A组为20~29岁,B组30~39岁,C组40~49岁,D组50~59岁,E组60~70岁,F组为对照组年龄28~46岁,每组包含4个病例。术前所有病例均行X线,核磁共振等常规检查。术后观察各组颈椎软骨终板及椎间盘HE染色,根据Thompson椎间盘退变病理分级标准对其退变程度进行分级;Masson染色、透射电镜照片观察超微结构;Tunel免疫组化,观察软骨终板及椎间盘凋亡细胞。计量资料采用均数±标准差(x±s)表示。组间差异比较采用单因素方差分析,P0.05为差异有统计学意义。结果:HE染色A组,软骨终板中陷窝细胞较多,亦可见清晰细胞核,细胞周围纤维结构紧密,镜下可见少量玻璃样变性;椎间盘中可见少量细胞结构,纤维组织排列紧密,无断裂现象。B组,软骨终板中陷窝细胞数量明显减少,细胞中仍可见细胞核等结构,细胞周围纤维组织排列杂乱;椎间盘中细胞较少,纤维组织排列较疏松。C组,软骨终板中陷窝细胞结构欠清晰,部分细胞中未见细胞核,大量细胞水肿,细胞周围可见大量的玻璃样变性;椎间盘中纤维大量断裂,胶原纤维变稀疏、杂乱。D组,软骨终板陷窝细胞结构欠清晰,大量细胞核消失,出现空泡现象,细胞周围结缔组织大量玻璃样变性;椎间盘可见大量断裂的纤维,未见细胞。e组,软骨终板中陷窝细胞明显减少,细胞结构不清晰,细胞周围大量玻璃样变性及粘液样变性;椎间盘可见大量断裂的胶原纤维,胶原纤维十分稀疏,软骨终板内甚至出现钙化等一系列退变晚期的表现。而对照组(f组)软骨终板中细胞数量较多,大部分胞核清晰可见,细胞周围软骨纤维排列紧密;椎间盘含大量紧密排列的胶原纤维,其中可见少量细胞,胞核清晰可见。thompson分级,各组椎间盘及软骨终板病理变化情况为a组i级8个,Ⅱ级2个,Ⅲ级2个,Ⅳ级0个,Ⅴ级0个。b组i级2个,Ⅱ级4个,Ⅲ级2个,Ⅳ级4个,Ⅴ级0个。c组i级1个,Ⅱ级4个,Ⅲ级4个,Ⅳ级3个,Ⅴ级0个。d组i级0个,Ⅱ级1个,Ⅲ级6个,Ⅳ级5个,Ⅴ级0个。e组i级0个,Ⅱ级1个,Ⅲ级4个,Ⅳ级7个,Ⅴ级0个。f组i级11个,Ⅱ级1个,Ⅲ级0个,Ⅳ级0个,Ⅴ级0个。masson染色见实验组切片含有大量淡蓝色均一染色结构,考虑为退变后的淀粉样变,部分胶原纤维排列紊乱松散;对照组masson染色见较多深蓝色纤维组织,排列紧密,未见淀粉样变。扫描电镜见颈椎病患者软骨终板细胞存在不同程度的退变,随着年龄增加呈现出退变程度递增的趋势,部分细胞可见核变性、溶解,细胞质内出现大量的脂质、空泡甚至钙化,细胞器消失,细胞功能不完整;细胞周围软骨囊结构紊乱,软骨囊壁厚度不一;纤维组织亦可见清晰的纤维结构被大量玻璃样变填充,周期性横纹减少,结构欠佳。对照组的软骨终板细胞,其细胞核圆滑完整,细胞质均匀,内质网及线粒体等细胞器清晰可见,细胞功能良好;细胞周围软骨囊结构完整,软骨囊壁厚度均匀;软骨终板细胞外基质丰富,胶原纤维密集,有明显的周期性横纹。tunel免疫组化染色,计算凋亡率为:a组凋亡率21.5±2.55%,B组凋亡率42.1±2.57%,C组凋亡率47.5±4.68%,D组凋亡率67.4±4.52%,E组凋亡率78.6±4.91%;F组凋亡率15.2±3.12%。实验组凋亡率均不同程度高于对照组,差异有统计学意义(P0.05),且随年龄呈递增趋势;其中每组内上下终板凋亡率比较,上终板凋亡率虽然在数值上低于相应阶段下终板,差异无统计学意义(P0.05)。病变节段椎间盘细胞凋亡率低于其相邻上下软骨终板细胞凋亡率(P0.05),且差异有统计学意义。结论:(1)颈椎病患者软骨终板结构的改变与颈椎间盘退变密切相关,且随年龄增加呈递增趋势。(2)颈椎软骨终板退变的发生重于颈椎椎间盘退变,颈椎软骨终板的退变可能是导致颈椎椎间盘退变的启动因素。
[Abstract]:Objective: To observe the relationship between the ultrastructure of cartilage end plate of human body and the degeneration of cervical intervertebral disc. Methods: From June 2013 to April 2015, we collected 85 cases of cervical spondylosis with cervical spondylosis treated by parallel operation from June 2013 to April 2015, and collected trauma-induced cervical fracture (non-atlas vertebral fracture) during the same period. There were 12 cases of cartilage endplates and 12 cases of intervertebral disc treated in parallel operation without symptoms and signs of cervical syndrome before operation. Patients with cervical spondylosis were divided into age group, group A was 20 ~ 29 years, group B was 30 ~ 39 years, group C was 40 ~ 49 years old, group D was 50 ~ 59 years, group E was 60 ~ 70 years old, and F group was 28 ~ 46 years old, including 4 cases in each group. All cases before operation were routine examination such as X-ray and nuclear magnetic resonance. After the operation, the cervical cartilage end plate and intervertebral disc HE staining were observed, and the degree of retrogradation was graded according to the pathological grading standard of Thompson's disc. The ultrastructure was observed by Masson staining and transmission electron microscope. Tunel immunohistochemistry was used to observe the cartilage end plate and intervertebral disc apoptosis cells. The measured data is represented by the standard deviation (x% s). A single factor of variance analysis was used to compare the differences among the groups, and the difference was statistically significant. Results: In the HE staining group A, the cells in the cartilage end plate were more and could also be seen in the clear nucleus, the fiber structure around the cells was compact, a small amount of glass-like degeneration can be seen under the endoscope, a small number of cell structures were seen in the intervertebral disc, and the fibrous tissue was arranged tightly and without fracture. In group B, the number of lacunae cells in the cartilage end plates was significantly reduced, and the cell nucleus and other structures were still visible in the cells, and there was a disordered arrangement of fibrous tissue around the cells, and the cells in the intervertebral disc were less and the fibrous tissue was more loose. In group C, the structure of lacunae cells in the cartilage end plates was not clear, no nuclei were found in some cells, a large number of cell edema was found, a large number of glass-like degeneration was found around the cells, and the fibers in the intervertebral disc were broken in large numbers, and the collagen fibers were sparse and disordered. In group D, the structure of the alveolar cell of the cartilage end plate is clear, a large number of nuclei disappear, a vacuole phenomenon occurs, a large amount of glass-like degeneration around the cell is observed, and a large number of broken fibers can be seen in the intervertebral disc, and the cells are not seen. In e group, the cells in the cartilage end plate were obviously reduced, the cell structure was not clear, a lot of glass-like degeneration and mucus-like degeneration around the cells were found, and a large number of broken collagen fibers were seen in the intervertebral disc, the collagen fibers were very sparse, and there was even calcification in the cartilage end plates. In contrast, the number of cells in the cartilage endplate of the control group (f group) is much larger, most of the nuclei are clearly visible, the pericellular cartilage fibers are arranged tightly, and a large number of closely-arranged collagen fibers are contained in the intervertebral disc, a small amount of cells can be seen, and the nuclei are clearly visible. Thelson classification, the pathological changes of intervertebral disc and cartilage endplate in each group were 8, 鈪，
本文编号：2297515
[Abstract]:Objective: To observe the relationship between the ultrastructure of cartilage end plate of human body and the degeneration of cervical intervertebral disc. Methods: From June 2013 to April 2015, we collected 85 cases of cervical spondylosis with cervical spondylosis treated by parallel operation from June 2013 to April 2015, and collected trauma-induced cervical fracture (non-atlas vertebral fracture) during the same period. There were 12 cases of cartilage endplates and 12 cases of intervertebral disc treated in parallel operation without symptoms and signs of cervical syndrome before operation. Patients with cervical spondylosis were divided into age group, group A was 20 ~ 29 years, group B was 30 ~ 39 years, group C was 40 ~ 49 years old, group D was 50 ~ 59 years, group E was 60 ~ 70 years old, and F group was 28 ~ 46 years old, including 4 cases in each group. All cases before operation were routine examination such as X-ray and nuclear magnetic resonance. After the operation, the cervical cartilage end plate and intervertebral disc HE staining were observed, and the degree of retrogradation was graded according to the pathological grading standard of Thompson's disc. The ultrastructure was observed by Masson staining and transmission electron microscope. Tunel immunohistochemistry was used to observe the cartilage end plate and intervertebral disc apoptosis cells. The measured data is represented by the standard deviation (x% s). A single factor of variance analysis was used to compare the differences among the groups, and the difference was statistically significant. Results: In the HE staining group A, the cells in the cartilage end plate were more and could also be seen in the clear nucleus, the fiber structure around the cells was compact, a small amount of glass-like degeneration can be seen under the endoscope, a small number of cell structures were seen in the intervertebral disc, and the fibrous tissue was arranged tightly and without fracture. In group B, the number of lacunae cells in the cartilage end plates was significantly reduced, and the cell nucleus and other structures were still visible in the cells, and there was a disordered arrangement of fibrous tissue around the cells, and the cells in the intervertebral disc were less and the fibrous tissue was more loose. In group C, the structure of lacunae cells in the cartilage end plates was not clear, no nuclei were found in some cells, a large number of cell edema was found, a large number of glass-like degeneration was found around the cells, and the fibers in the intervertebral disc were broken in large numbers, and the collagen fibers were sparse and disordered. In group D, the structure of the alveolar cell of the cartilage end plate is clear, a large number of nuclei disappear, a vacuole phenomenon occurs, a large amount of glass-like degeneration around the cell is observed, and a large number of broken fibers can be seen in the intervertebral disc, and the cells are not seen. In e group, the cells in the cartilage end plate were obviously reduced, the cell structure was not clear, a lot of glass-like degeneration and mucus-like degeneration around the cells were found, and a large number of broken collagen fibers were seen in the intervertebral disc, the collagen fibers were very sparse, and there was even calcification in the cartilage end plates. In contrast, the number of cells in the cartilage endplate of the control group (f group) is much larger, most of the nuclei are clearly visible, the pericellular cartilage fibers are arranged tightly, and a large number of closely-arranged collagen fibers are contained in the intervertebral disc, a small amount of cells can be seen, and the nuclei are clearly visible. Thelson classification, the pathological changes of intervertebral disc and cartilage endplate in each group were 8, 鈪，
本文编号：2297515
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