【作者】 田鹏；

【导师】 马信龙； 田融； 江汉；

【作者基本信息】 天津医科大学 ， 外科学， 2010， 硕士

【摘要】 目的观察损伤疝出型、退变突出型腰椎间盘组织病理和免疫病理特点,探索白细胞介素-17(IL-17)和软骨细胞在腰椎间盘突出症中的作用及不同类型椎间盘组织的局部免疫状态,进一步理解两种不同病理类型腰椎间盘突出症的实质。方法选取天津医科大学总医院骨科和天津医院脊柱外科收治确诊并接受手术治疗单节段腰椎间盘突出症50例,根据临床诊断标准、影像学(CT及MRI)检查结果以及手术所见将病例分为：①损伤疝出型椎间盘突出组：共计35例,可见突出病变部位后纵韧带后纤维环破裂髓核组织与椎间盘母体分离,质软较易取出；②退变突出型椎间盘突出组：共计15例。病变部位后纵韧带较完整,切开浅层后总韧带可见纤维环完整,质硬必须用器械切除。收集椎间盘标本,采用HE染色、甲苯胺蓝染色和免疫组化染色等方法观察椎间盘标本。结果病理学检查发现损伤疝出组中肉芽组织、新生血管化明显高于退变突出组,损伤疝出组新生血管化率为88.6%,而退变突出组血管化率为13.3%；甲苯胺蓝染色观察软骨细胞成簇和增生发现于损伤疝出组中椎间盘标本组织,软骨细胞增生在损伤疝出组所占比例为74.3%,而在退变突出组所占比例为6.7%。免疫组化染色示损伤疝出组标本中IL-17阳性细胞数明显高于退变突出组。结论1.腰椎间盘突出症的病理分型为损伤疝出型和退变突出型,其病变机理存在差异,应加以区分；2.损伤疝出型椎间盘引起间盘神经微环境的改变如肉芽组织形成和新生血管化明显证实髓核暴露后引起突出间盘神经根局部炎症反应；3.软骨细胞增生和软骨细胞簇可能是椎间盘完整性破坏后椎间盘自我修复反应的一个表现；4.IL-17在损伤疝出型椎间盘表达明显证实了IL-17介导间盘神经根微环境免疫炎症变化；5.局部炎症和自身免疫反应在损伤疝出型腰椎间盘突出症的病理生理过程中均发挥作用,软骨细胞在椎间盘损伤后的修复中发挥作用。更多还原

【Abstract】 Objective:To observe histological and immunohistochemical characteristics of the disc specimens in patients with lumbar disc herniation(LDH) which contain injured disc herniation and degenerative disc herniation, and explore the interleukin-17 (IL-17) and chondrocytes in the role of the pathogenesis of lumbar disc herniation(LDH)with different types, further make out the essence between the two types of lumbar disc herniation.Methods:Fifty patients with LDH were eligible for surgery in the orthopedic department of the General Hospital of Tianjin Medical University and spinal surgery department of Tianjin Hospital, according to the clinical diagnostic criteria, imaging (CT and MRI) examination results, and operative findings, the patients were divided into two groups as follows:①injured disc herniation (IDH) group:35 cases, prominent lesions of the posterior longitudinal ligament,the disruption of annulus fibrosus and separation between nucleus pulposus and maternal,soft and easily removed;②degenerative disc herniation (DDH) group:15 cases, annulus fibrosus was complete after shallow incision of posterior longitudinal ligament, hard and removed by equipment. All disc specimens were tested using HE staining, toluidine blue staining and immunohistochemical staining.ResuIts:Histological analysis using HE staining showed granulation tissue and neovascularization in the disc specimens of IDH group were more than those of the DDH group. The rate of neovascularization in IDH group was 88.6%, but that in DDH group was 13.3%; Histological examination using toluidine blue staining revealed chondrocyte proliferation(CP) and cartilage cells clusters were found in specimens of IDH group,chondrocyte proliferation in IDH group accounted for 74.3%, while chondrocyte proliferation in DDH group accounted for 6.7%. Analysis of immunohistochemical staining manifestated IL-17 positive cells in the specimens of IDH group were significantly higher than those in the DDH group.Conclusion:1.The pathological type of lumbar disc herniation should be divide into injured disc herniaton and degenerative disc herniation,the differences between the pathogenesis of LDH should be distinguished;2.Injured herniated disc causes the changes of disc-nerve root micro-enviroment such as granulation tissue formation and angiogenesis,which demonstrated that the exposure of nucleus pulposus induced the local inflammatory response;3.Chondrocyte proliferation and cartilage cell clusters might be some performances of self-healing response of intervertebral disc after the complete destruction of intervertebral disc;4.IL-17 found in the chondrocytes of injured herniated disc demonstrates that IL-17 could involve in the immune and inflammatory changes of disc nerve root microenvironment;5.Local inflammation and autoimmune response play important parts in the pathophysiology of LDH with injured disc herniation, chondrocyte could invovle in the process of disc repair after injury.更多还原