胸椎黄韧带骨化症的外科治疗

目的探讨胸椎黄韧带骨化症的诊断与手术治疗方法，分析其手术时机、手术技巧、手术效果及并发症处理。方法回顾性总结56例患者的外科治疗过程，采用胸椎管后壁切除减压及侧后方入路，术中体感诱发电位监护。结果术后55例经随访1年以上，1例随访2个月。39例，良8例，可5例，差4例。结论胸椎黄韧带骨化所致的脊髓压迫症须早期手术治疗，可根据不同情况选择胸椎管后壁切除减压及侧后方入路的次环状减压的手术方式。     

Ossification of the ligamentum flavum of the thoracic spine in adult kyphosis

Summary Ossification of the ligamentum flavum has been recognised as a definite clinical entity as is ossification of the posterior longitudinal ligament. The incidence of both is high in Japan. This study demonstrates that the incidence of ossification of the ligamentum flavum in persons who have a kyphosis of the thoracic or lumbar spine is higher than in those who do not. It is considered that localised mechanical stress affecting the ligamentum flavum is a contributing factor to the development of ossification, together with the generalised factors which may favour bone formation. However, the aetiology of this lesion is still obscure as is that of ossification of the posterior longitudinal ligament.

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Résumé L'ossification du ligament jaune représente une entité clinique définie, de même que celle du ligament longitudinal postérieur. Les deux affections sont fréquentes au Japon. Cette étude montre que l'ossification du ligament jaune s'observe plus souvent chez les sujets qui présentent une cyphose dorsale ou lombaire. On peut penser que les contraintes mécaniques localisées au ligament jaune constituent un facteur contribuant au développement de l'ossification, et s'ajoutant aux facteurs généraux susceptibles de favoriser la formation osseuse. Cependant, l'étiologie de cette affection demeure mystérieuse de même que l'ossification du ligament longitudinal postérieur.

     

L－缬氨酸菌种选育

以硫酸二乙酯（ＤＥＳ）诱变处理黄色短杆菌（Ｂｒｅｖｉｂａｃｔｅｒｉｕｍｆｌａｖｕｍ）ＸＱ５１２２，得到突变株Ｖ３－３６＜Ｌｅｕ￣１、α－ＡＢ￣ｒ、ＡＨＶ￣ｒ），在１０％葡萄糖培养基中可积累２．３％Ｌ－缬氨酸。以亚硝基胍（ＮＴＧ）诱变Ｖ４－１５３，得到一株突变株（Ｌｅｕ￣１、α－ＡＢ￣ｒ、ＡＨＶ￣ｒ、２－ＴＡ￣ｒ），再进行单菌落分离，得到突变株ＺＱ－２，能在培养基中积累Ｌ－缬氨酸４．２％～４．５％，最高达５．５７％．     

Regional difference in the appearance of apoptotic cell death in the ligamentum flavum of the human cervical spine

Ossification or calcification of the ligamentum flavum (LF) is relatively common in the middle and lower cervical, thoracic, and lumbar spine but extremely rare in the upper cervical region. This clinical fact suggests that there exist local factors promoting or preventing ossification or calcification of LF. However, little is known about the differences in the ultrastructure and cellular alterations of the LF between the different spinal levels, even in the cervical spine. With electron microscopy, we examined samples of LF collected surgically from the upper and lower cervical spine regions; we then studied the apoptotic appearance of ligament cells using a preferential labeling method. We found direct evidence of apoptosis of ligament cells in the LF. Apoptosis was more apparent in the upper region samples than in the lower region samples. The spaces around the normal fibroblasts were filled with thick collagen fibrils, but the collagen fibrils disappeared around the apoptotic bodies and thin fibrils were formed. The difference of the level of apoptosis may correlate to the ultrastructual difference of LF, and our data will benefit further investigations seeking to clarify the mechanism of various pathological conditions in the human LF.     

Microfilamentous type VI collagen in the hyalinized stroma of the hypertrophied ligamentum flavum

Summary Thickened ligamenta flava obtained from 14 patients with spinal canal stenosis were examined with special reference to type VI collagen. The characteristic histological finding in the thickened area was rupture of normal elastic fibre meshwork with resultant fibrosis which usually appeared hyaline. Using an immunohistological method, collagen types VI, I and III were found to be present in the hyaline matrix. Ultrastructural study revealed many microfilamentous structures of type VI collagen admixed in loosely packed, banded collagen fibres. With differential salt precipitation of pepsin-extracted collagen the existence of type VI collagen was confirmed by SDS-polyacrylamide gel electrophoresis analysis and Western blotting analysis using anti-type VI collagen antibody. Quantification of type VI collagen in pepsin-extracted crude collagen samples by an inhibition enzyme-linked immunosorbent assay showed an increasing amount of type VI collagen in the thickened ligamenta flava compared to the normal ligaments. Thus, increase of type VI collagen is the main contribution to the thickening of the ligamentum flavum. This may represent an adaptational and reparative process associated with disruption of elastic fibres.     

Retroesophageal right subclavian artery with persistent ductus arteriosus

We report an adult male cadaver with persistence of the ductus arteriosus and a right retroesophageal artery. The retroesophageal artery was first appreciated as a retropharyngeal mass during the dissection of this area. Both the left and right vertebral arteries originated in normal fashion. The thoracic duct of our specimen drained into the junction of the left internal jugular and left subclavian veins. We believe this to be the first report of simultaneous right retroesophageal subclavian artery and patent ductus arteriosus. The anatomy and embryology of these two anomalies in the same specimen are discussed.     

尸体胸椎黄韧带骨化的病理观察

研究兴柱黄韧带骨化的病理特征。方法：随机选择２１具尸体胸椎标本，矢状剖开１８具，冠状剖开３具，观察每一节段黄韧带病理学特征，对骨化标本进行病理学研究。结果；２１具标本中，９具５９节段骨化，其中增生骨化４具，２３节段占３９％，单纯骨化７具，累积３６节段，病理表现呈３层结构。     

A Double‐blind,Randomized, Prospective Study of Epidural Steroid Injection vs. The mild® Procedure in Patients with Symptomatic Lumbar Spinal Stenosis

Background: Epidural steroid injections (ESIs) are commonly used to treat low back pain, including symptomatic lumbar spinal stenosis (LSS). Reports on LSS treatment with ESIs have not differentiated between neurogenic claudication, which is believed to result from nerve root compression, and lumbar radicular pain, thought to be caused by inflammation. While there is overlap between these groups, the clinical relevance of ESI treatment cannot be generalized between these 2 distinct diseases with completely different pathophysiological causes. Methods: This was a double‐blind, randomized, prospective study of ESI vs. the mild procedure in patients with symptomatic LSS, conducted at a single pain management center. Patient reported outcome measures included Visual Analog Scale, Oswestry Disability Index, and Zurich Claudication Questionnaire (ZCQ) patient satisfaction. Results: Thirty‐eight patients were randomized into 2 treatment groups, 21 in mild and 17 in ESI. At 6‐ and 12‐week follow‐up, patients treated with mild reported significantly greater pain decrease over time (P < 0.0001), and significantly greater functional mobility improvement over time (P < 0.0018) than ESI patients. At week 6, mild ZCQ patient satisfaction score of 2.2 indicated a higher level of satisfaction than for ESI with a score of 2.8. In addition, 12‐week ZCQ satisfaction score was 1.8, demonstrating sustained near‐term satisfaction in the mild group. No major mild or ESI device or procedure‐related complications were reported. Conclusions: This study demonstrated that in LSS patients suffering with neurogenic claudication, mild provides statistically significantly better pain reduction and improved functional mobility vs. treatment with ESI.     

Lumbar spinal stenosis in a young individual as a result of ligamantum flavum ossification: A case report

INTRODUCTIONSymtomatic lumbar ligamantum flavum calcification is quite rare in the young age group.PRESENTATION OF CASEThe authors report a case of young adult with diagnosis of lumbar spinal stenosis, presenting with leg pain and neurological deficits. Computerized tomography (CT) scan and magnetic resonance (MR) imaging studies revealed ossification of the ligamantum flavum as the causative factor of the disease and the patient recovered completely after the decompressive operation.DISCUSSIONIt is emphasized that attention should be given to this rare etiological factor of lumbar spinal stenosis.CONCLUSIONComplete relief can be achieved with early and adequate surgery.     

山梨醇增加糖尿病患者腰椎管狭窄症炎性反应因子的表达

目的探讨糖尿病腰椎管狭窄患者黄韧带增生肥厚的发生机制。方法 24例糖尿病和20例非糖尿病的腰椎管狭窄患者列为研究对象,观测黄韧带标本结构,D-Sorbitol/Xylitol试剂盒检测山梨醇水平。体外实验中使用小鼠成纤维细胞(NIH3T3)细胞系,用Western blot及q PCR分别检测高糖培养条件及醛糖还原酶抑制剂(ARI):依帕司他(EP)作用对细胞炎性反应因子及TGF-β表达水平的影响。结果糖尿病组较非糖尿病组的山梨醇水平更高、黄韧带平均厚度更大、标本弹力纤维降解、胶原纤维增生更为显著、免疫组化CD68阳性染色率更高(P0.01);体外实验中,NIH3T3细胞系在高糖培养与正常糖浓度培养相比山梨醇、促炎性细胞因子和TGF-β表达水平更高,而山梨醇、促炎性细胞因子和TGF-β增高的表达水平可被醛糖还原酶抑制剂所抑制并且呈剂量依赖(P0.05)。结论糖尿病腰椎管狭窄患者黄韧带中山梨醇水平显著增高,进而促进炎性反应因子及纤维化相关因子TGF-β表达增加,使得黄韧带炎性增生。