椎间盘突出介绍

椎间盘突出症脊柱解剖脊柱解剖结构关系锥体的结构关系脊柱运动单元ALLPLLILLFIDSEPIEPSEP=上终版ID=椎间盘IEP=下终板ALL=前纵韧带PLL=后纵韧带IF=椎间孔LF=黄韧带IL=脊突间韧带IF椎间孔椎间孔结构关系Tanakaetal.,Spine1999颈椎间孔解剖椎间盘示意图椎间盘的功能保持高度维持曲度保持椎间孔

联结椎体保证活动支撑身体力量传导缓冲外力FunctionoftheMUShockabsorptionisNOTthemaintaskoftheintervertebraldisc!

LoadedUnloaded

Wislederetal.,Spine2001Shocks

aremainlyabsorbedbythebendingofthespine.FunctionoftheMUPressuredistribution

ontheadjacentendplatesEdwardsetal.,Spine2001FunctionoftheMUHomogenious

stressdistributioninthenormaldiscinaxial

compressionDolanandAdams.,Clin

Biomech2001FunctionoftheMUSittingStandingVaryingstressdistributionduetodifferentposturesDolanandAdams,Clin

Biomech2001纤维环的组织学90%胶原纤维

1型胶原纤维2型胶原纤维10%弹性纤维少量proteoglycans纤维环的解剖和组织学Collagenfibersoftheannulusarefixedintheepiphysisannularis胶原纤维的分层和排列方向NucleuspulposusTheeffectofageonthelateraldistensionofthenucleus0–20years40–60years

65+yearsThenucleuspulposusbecomesmorerigidwithage(Hall,1987)椎间盘突出NutritionTheadultdiscisavascular

NutritionofthecellsdependsondiffusionthroughthematrixPathway1:Diffusionthroughthehyalinecartilage(80%)Holm,1990Pathway2:vesselssurroundingthediscVraneyetal.,1999NutritionLesionsinthehyalincartilagecanleadtoproliferationofmarrowvesselsintothediscus

Rauber

Kopsch,1987VertebralMarrowHyalinCartilageProliferatingVesselsLesionInnervationNervescanonlybefoundintheouterlayersoftheannulusfibrosusImmunostainingwithsynaptophysinantibody,Palmgrenetal.,1999ImmunostainingwithsubstancePantibody,Palmgrenetal.,1999NucleuspulposusHydrostaticswellingpressure

(~0.1to3Mpa)ViscoelasticBehaviorThenucleusisaporoelasticsolid

(Laibleetal.,1993;Simonetal.,1985and1996)HighresistancetoinitalloadingCreepinginlonglastingloadingPathologyDiscDegenerationStructuraldesintegrationduetoUnderinflation=lowpressureStructuraldesintegrationduetoWaterloss=lowswellingpressureW.Kirkaldy-Willis身体活动和椎间盘突出AnnulusfibrosusRotationisresistedbythetensionofthecollagenfibersoftheannulusTaskDolanandAdams,Clin

Biomech2001Inhomogenious

stressdi