交感型颈椎病的可能病因研究
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摘要
研究目的
探讨交感型颈椎病(sympathic cervical spondylosis)的发病机制。
方法
在颈椎前路椎间盘切除减压内固定术(anterior cervical discectomy and fusion,ACDF)中收集7位交感型颈椎病患者的11个病变颈椎间盘作为A组,同时收集8位脊髓型颈椎病患者的生理老化椎间盘12个作为B组,及既往无颈椎病史的7位颈椎外伤患者的10个正常对照椎间盘作为C组。椎间盘标本包括前纵韧带、纤维环及髓核。将这些椎间盘标本行组织学检查和神经丝蛋白(neural filament,NF)、神经肽Y(neuropeptides Y,NPY)的免疫组织化学染色检查
结果
1.组织学观察
正常椎间盘:纤维环中胶原纤维板层结构排列规则,呈纵向横向排列的纤维界线清晰。髓核中胶原纤维网稀疏,排列不规则,其间可见软骨细胞。前纵韧带和最表层纤维环内常可见一些血管。生理老化椎间盘:纤维环板层结构基本规则,常见中、内板层结构排列紊乱、断裂。髓核与内层纤维环的分界不清,年龄越大,分界越不明显,髓核中软骨细胞常呈岛状分布。纤维环外层及前纵韧带的血管较正常对照椎间盘多,但中、内层未见血管组织。交感型颈椎病的病变颈椎间盘:大多有一条从外层纤维环至髓核的不规则的血管化肉芽组织条带区,肉芽组织及血管化程度不一,有的仅为瘢痕化胶原组织,有的已经有新鲜的血管与肉芽组织,肉芽组织结构紊乱,髓核中透明软骨细胞核大而胞浆深染,多聚集成团,肉芽组织条带外的纤维环内血管明显增多。
2.免疫组织化学观察
NF和NPY2种抗体的免疫组化染色阳性的神经纤维分布在3种椎间盘的部位和比例各不相同:(1)在正常对照椎间盘,仅在纤维环的最外层有稀疏的神经分布,其中NF免疫组化染色阳性的神经纤维见于3个椎间盘(30%);NPY阳性神经纤维见于其中的2个椎间盘。(2)生理老化颈椎间盘,除2个椎间盘在纤维环中层有NF免疫组化染色阳性神经纤维分布外,其余椎间盘也仅见于纤维环最外层。(3)交感型颈椎的病变颈椎间盘中,2种神经肽阳性神经纤维分布数量和比例较正常对照椎间盘和生理老化椎间盘明显增多。神经纤维主要沿着血管肉芽组织条带分布,甚至裂隙边缘的软骨细胞群落中也可见NF和NPY染色阳性的神经纤维分布。
结论
以神经肽Y为递质的交感神经纤维通过椎间盘裂隙中的肉芽组织,向椎间盘重新长入,可能是交感型颈椎病的发病机制之一。
Objectives
To study the pathogenesis of the sympathic cervical spondylosis.
Methods
11 specimens of cervical intervertabral discs from 7 patients with sympathic cervical spondylosis, 12 physiologically aging discs and 10 normal control discs were collected during anterior cervical discectomy and fusion . These discs contain anterior longitudinal ligament, annulus fibrosus and nucleus pulposus.And use these discs to investigate the morphologic features and innervation containing neuropeptides Y(NPY) and neural filament(NF).
Results
1. The morphologic feature
The normal discs:
The collagen fiber in annulus fibrosus structure with the rules.The network of collagen fibers in nucleus pulposus were sparse,and some hyaline cartilage cells were founded in nucleus pulposus. Anterior longitudinal ligament and surface of annulus fibrosus often the most visible some blood vessels. The physiologically aging discs:
The structures of the aging discs showed the age related changes.Lamellar structure of annulus fibrosus basic rules,the boundaries between nucleus pulposus and the inner layer of annulus fibrosus unclear. Many hyaline cartilage cellmass were founded in the nucleus pulposus.More blood vessels were founded in outer annulus fibrosus and anterior longitudinal ligament than the normal discs.
The disc from the patient with sympathic cervical spondylosis:
The distinct morphologic characteristic of the disc from the patient with sympathic cervical spondylosis was the formation of the strip zone vascularized granulation tissue from the nucleus pulposus to the outer part of the annulus fibrosus in which there was one or several fissures.Many hyaline cartilage cellmass were founded in the annulus fibrosus beyond the strip zone of granulation tissuse,these hyaline cartilage cells nuclear large and deeply stained cytoplasm.The blood vessels in annulus fibrosus increased.
2. Immunohistochemistry
The innervation of NF and NPY immunoreactive nerve fibers in the discs from the patient with sympathic cervical spondylosis was more extensive compared with the aging discs and control discs.
The normal discs:
Only in the most outer layer of annulus fibrosus were sparse distribution of nerve. Which NF-positive immunohistochemical staining of nerve fibers in the three disc, NPY-immunoreactive nerve fibers in the two disc.
The physiologically aging discs:
There were two discs can found immunohistochemical staining of NF-positive nerve fibers in the middle annulus fibrosus, The remaining nerve fibers were only found in the outermost annulus fibrosus of the discs.
The disc from the patient with sympathic cervical spondylosis:
The innervation of NF and NPY immunoreactive nerve fibers in the discs from the patient with sympathic cervical spondylosis was more extensive compared with the aging discs and control discs. The nerve ingrowth deep into annulus fibrosus and nucleus pulposus was observed mainly along the strip zone of granulation tissue and hyaline cartilage cellmass in the discs from the patient with sympathic cervical spondylosis.
Conclusions
The sympathetic fiber ingrowth deep into annulus fibrosus and nucleus pulposus through the strip zone of granulation tissue, maybe an importmant factor in the pathogenesis of the sympathic cervical spondylosis.
探讨交感型颈椎病(sympathic cervical spondylosis)的发病机制。
方法
在颈椎前路椎间盘切除减压内固定术(anterior cervical discectomy and fusion,ACDF)中收集7位交感型颈椎病患者的11个病变颈椎间盘作为A组,同时收集8位脊髓型颈椎病患者的生理老化椎间盘12个作为B组,及既往无颈椎病史的7位颈椎外伤患者的10个正常对照椎间盘作为C组。椎间盘标本包括前纵韧带、纤维环及髓核。将这些椎间盘标本行组织学检查和神经丝蛋白(neural filament,NF)、神经肽Y(neuropeptides Y,NPY)的免疫组织化学染色检查
结果
1.组织学观察
正常椎间盘:纤维环中胶原纤维板层结构排列规则,呈纵向横向排列的纤维界线清晰。髓核中胶原纤维网稀疏,排列不规则,其间可见软骨细胞。前纵韧带和最表层纤维环内常可见一些血管。生理老化椎间盘:纤维环板层结构基本规则,常见中、内板层结构排列紊乱、断裂。髓核与内层纤维环的分界不清,年龄越大,分界越不明显,髓核中软骨细胞常呈岛状分布。纤维环外层及前纵韧带的血管较正常对照椎间盘多,但中、内层未见血管组织。交感型颈椎病的病变颈椎间盘:大多有一条从外层纤维环至髓核的不规则的血管化肉芽组织条带区,肉芽组织及血管化程度不一,有的仅为瘢痕化胶原组织,有的已经有新鲜的血管与肉芽组织,肉芽组织结构紊乱,髓核中透明软骨细胞核大而胞浆深染,多聚集成团,肉芽组织条带外的纤维环内血管明显增多。
2.免疫组织化学观察
NF和NPY2种抗体的免疫组化染色阳性的神经纤维分布在3种椎间盘的部位和比例各不相同:(1)在正常对照椎间盘,仅在纤维环的最外层有稀疏的神经分布,其中NF免疫组化染色阳性的神经纤维见于3个椎间盘(30%);NPY阳性神经纤维见于其中的2个椎间盘。(2)生理老化颈椎间盘,除2个椎间盘在纤维环中层有NF免疫组化染色阳性神经纤维分布外,其余椎间盘也仅见于纤维环最外层。(3)交感型颈椎的病变颈椎间盘中,2种神经肽阳性神经纤维分布数量和比例较正常对照椎间盘和生理老化椎间盘明显增多。神经纤维主要沿着血管肉芽组织条带分布,甚至裂隙边缘的软骨细胞群落中也可见NF和NPY染色阳性的神经纤维分布。
结论
以神经肽Y为递质的交感神经纤维通过椎间盘裂隙中的肉芽组织,向椎间盘重新长入,可能是交感型颈椎病的发病机制之一。
Objectives
To study the pathogenesis of the sympathic cervical spondylosis.
Methods
11 specimens of cervical intervertabral discs from 7 patients with sympathic cervical spondylosis, 12 physiologically aging discs and 10 normal control discs were collected during anterior cervical discectomy and fusion . These discs contain anterior longitudinal ligament, annulus fibrosus and nucleus pulposus.And use these discs to investigate the morphologic features and innervation containing neuropeptides Y(NPY) and neural filament(NF).
Results
1. The morphologic feature
The normal discs:
The collagen fiber in annulus fibrosus structure with the rules.The network of collagen fibers in nucleus pulposus were sparse,and some hyaline cartilage cells were founded in nucleus pulposus. Anterior longitudinal ligament and surface of annulus fibrosus often the most visible some blood vessels. The physiologically aging discs:
The structures of the aging discs showed the age related changes.Lamellar structure of annulus fibrosus basic rules,the boundaries between nucleus pulposus and the inner layer of annulus fibrosus unclear. Many hyaline cartilage cellmass were founded in the nucleus pulposus.More blood vessels were founded in outer annulus fibrosus and anterior longitudinal ligament than the normal discs.
The disc from the patient with sympathic cervical spondylosis:
The distinct morphologic characteristic of the disc from the patient with sympathic cervical spondylosis was the formation of the strip zone vascularized granulation tissue from the nucleus pulposus to the outer part of the annulus fibrosus in which there was one or several fissures.Many hyaline cartilage cellmass were founded in the annulus fibrosus beyond the strip zone of granulation tissuse,these hyaline cartilage cells nuclear large and deeply stained cytoplasm.The blood vessels in annulus fibrosus increased.
2. Immunohistochemistry
The innervation of NF and NPY immunoreactive nerve fibers in the discs from the patient with sympathic cervical spondylosis was more extensive compared with the aging discs and control discs.
The normal discs:
Only in the most outer layer of annulus fibrosus were sparse distribution of nerve. Which NF-positive immunohistochemical staining of nerve fibers in the three disc, NPY-immunoreactive nerve fibers in the two disc.
The physiologically aging discs:
There were two discs can found immunohistochemical staining of NF-positive nerve fibers in the middle annulus fibrosus, The remaining nerve fibers were only found in the outermost annulus fibrosus of the discs.
The disc from the patient with sympathic cervical spondylosis:
The innervation of NF and NPY immunoreactive nerve fibers in the discs from the patient with sympathic cervical spondylosis was more extensive compared with the aging discs and control discs. The nerve ingrowth deep into annulus fibrosus and nucleus pulposus was observed mainly along the strip zone of granulation tissue and hyaline cartilage cellmass in the discs from the patient with sympathic cervical spondylosis.
Conclusions
The sympathetic fiber ingrowth deep into annulus fibrosus and nucleus pulposus through the strip zone of granulation tissue, maybe an importmant factor in the pathogenesis of the sympathic cervical spondylosis.
引文
[1] Pearce JMS. Barre- lieou“Syndrome”[J]. Journal of Neurology Neurosurgery and Psychiatry, 2004,75:319.
[2]孙宇,李贵存.第二届颈椎病专题座谈会纪要[J].解放军医学杂志,1994,19(2):156-158.
[3]林庆光,赵新建,冯宗权.颈性眩晕及其手术治疗机制的探讨[J].中国脊柱脊髓杂志, 1998, 8: 249.
[4]何海龙,贾连顺,李家顺.椎动脉阻断对小脑后下叶功能影响的实验研究[J].中国脊柱脊髓杂志, 2002,12:23-26.
[5]Laurigainen E,David K,Annr D.Stellate ganglion drives sympathetic regulation of cochlear blood flow[J].Hearing Research,1993,64(2):199-204.
[6]李淳德,刘宪义,马忠泰.颈椎节段不稳在交感型颈椎病中的作用[J].中华外科杂志2002,40:730-732.
[7]于泽生,刘忠军,党耕町.颈椎不稳致交感型颈椎病的诊断和治疗[J].中华外科杂志,2001,3: 282-284.
[8] WU Guangsen, MA Yuanzheng, CHEN Xing. Anterior cervical corpectomy with titanium mesh and bone graft fusion for the treatment of sympathetic cervical spondylosis [J].Chinese Journal of Spine and Spinal Cord. 2008, 18( 4) : 261-265.
[9]彭宝淦,候树勋,吴仕良.颈椎病突出椎间盘组织炎性及应特性的研究[J].中国脊柱脊髓杂志,2002,12:38-40
[10]杨有庚,任宪盛,程杰平.经皮激光椎间盘减压术治疗颈性眩晕的临床研究[J].脊柱外科杂志, 2005, 3: 65 - 68
[11]朱杰诚,镇万新,万多,等.经皮激光颈椎间盘减压术的临床应用[J].中华骨科杂志, 2003, 23: 49 - 52
[12]Peng B,Wu W,Hou S,et al.The pathogenesis of discogenic low back pain[J]. J Bone Jiont Surg Br,2005,87(1):62-67.
[13]Ozawa T,Ohtori S,Inoue G, et al.The degenerated lumbar intervertebral disc is innervated primarily by peptide-containing sensory nerve fibers in humans [J].Spine, 2006, 31(21):2418-2422.
[14]苏彩风,邵增务.腰椎间盘内神经浸润生长[J].Int J Orthop,2007,28(1):41-43.
[15]Suseki K,Takahashi Y,Takahashi K,et al.Sensory nerve fibres from lumbar intervertebral discs pass through rami communicantes.A possible pathway for discogenic low back pain[J].J Bone Joint Surg Br,1998,80(4):737-742.
[16] Kiray A,Arman C,Naderi S, et al. Surgical anatomy of the cervical sympathetic trunk[J].J Clinical Anatomy,2005,18:179-185.
[17]Johnson GM. The sensory and sympathetic nerve supply within the cervical spine: review of recent observations[J].J Man Ther,2004,9(2):71-76.
[18]Imai S, Konttinen YT, Tokunaga Y, et al. An ultrastructural study of alcitonin generelated peptide immunoreactive nerve fibers innervating the rat posterior longitudinal ligament. A morphologic basis for their possible efferent actions[J].Spine,1997,22(17):1941-1947.
[19]Ahmed M, Bjurholm A, Kreicbergs A, et al. Neuropeptide Y,tyrosine hydroxylase and vasoactive intestinal polypeptide immunoreactive nerve fibers in the vertebral bodies, discs, duramater,and spinal ligaments of the rat lumbar spine[J]. Spine,1993, 18(2):268-273.
[20]Kanerva A,Kommonen B,Gronblad M,et al.Inflammatory cells in experimental intervertebral disc injury[J].Spine,1997,22:2711-2715.
[21]Kapa E,Han X,Holm S,et al.Collagen synthesis and typesⅠ,Ⅲ,Ⅳ,andⅥcollagens in an animal model of disc degeneration[J].Spine,1995,20:59-67.
[22]Burke JG,Watson RW,McCormack D,et al.Intervertebral idscs which cause low back pain secrete high levels of proinflammatory mediators[J].J Bone Joint Surg Br,2002,84:196-201.
[23]Gu Tao,Wang Xinwei,Yuan Wen,et al.Sympathetic nerve fibers of the cervical intervertebral disc and posterior longitudinal ligament:anatomical research and the role in cervical discogenic pain[J].J Spinal Surg,2007,5(6):36-39.
[24]Imai S, Hukuda S, Maeda T. Dually innervating nocicep tive networks in the rat lumbar posterior longitudinal ligaments[J].Spine,1995,20(19):2086-2092.
[1]孙宇,陈琪福.第二届颈椎病专题座谈会纪要[J].中华外科杂志,1993,31 (8):472.
[2]Pearce JMS. Barre- lieou“Syndrome”[J]. Journal of Neurology Neurosurgery and Psychiatry, 2004,75:319.
[3]林庆光,赵新建,冯宗权.颈性眩晕及其手术治疗机制的探讨[J].中国脊柱脊髓杂志, 1998, 8: 249.
[4]何海龙,贾连顺,李家顺.椎动脉阻断对小脑后下叶功能影响的实验研究[J].中国脊柱脊髓杂志, 2002,12:23-26.
[5]李淳德,刘宪义,马忠泰.颈椎节段不稳在交感型颈椎病中的作用[J].中华外科杂志,2002, 40:730-732.
[6]于泽生,刘忠军,党耕町.颈椎不稳致交感型颈椎病的诊断和治疗[J].中华外科杂志,2001,3: 282-284
[7] Kiray A,Arman C,Naderi S, et al. Surgical anatomy of the cervical sympathetic trunk[J].J Clinical Anatomy,2005,18:179-185.
[8]Yamada H,Honda T,Yaginuma H,et al. Comparison of sensory and sympathetic innervation of the dura mater and posterior longitudinal ligament in the cervical spine after removal of the stellate ganglion[J]. J Comp Neurol, 2001, 434: 86-100.
[9]夏玉军,于腾波.刺激颈部交感神经节对椎动脉血流影响的实验研究[J].中国临床解剖学杂志,2002,20: 380-382.
[10]冯世庆,杨敏杰,陈君长,等.椎动脉外膜剥离术的基础和临床研究[J].中国脊柱脊髓杂志, 1998, 8: 6.
[11]Ozawa T,Ohtori S,Inoue G,et al.The degenerated lumbar intervertebral disc is innervated primarily by peptide-containing sensory nerve fibers in humans[J]. Spine, 2006,31(21):2418-2422.
[12]杨有庚,任宪盛,程杰平.经皮激光椎间盘减压术治疗颈性眩晕的临床研究[J].脊柱外科杂志, 2005, 3: 65-68.
[13]朱杰诚,镇万新,万多,等.经皮激光颈椎间盘减压术的临床应用[J].中华骨科杂志, 2003, 23: 49-52.
[14] WU Guangsen, MA Yuanzheng, CHEN Xing. Anter ior cervical corpectomy with titanium mesh and bone gr aft fusion for the treatment of sympathetic cervical spondylosis[J]. Chinese Journal of Spine and Spinal Cord, 2008, 18(4):261-265.
[2]孙宇,李贵存.第二届颈椎病专题座谈会纪要[J].解放军医学杂志,1994,19(2):156-158.
[3]林庆光,赵新建,冯宗权.颈性眩晕及其手术治疗机制的探讨[J].中国脊柱脊髓杂志, 1998, 8: 249.
[4]何海龙,贾连顺,李家顺.椎动脉阻断对小脑后下叶功能影响的实验研究[J].中国脊柱脊髓杂志, 2002,12:23-26.
[5]Laurigainen E,David K,Annr D.Stellate ganglion drives sympathetic regulation of cochlear blood flow[J].Hearing Research,1993,64(2):199-204.
[6]李淳德,刘宪义,马忠泰.颈椎节段不稳在交感型颈椎病中的作用[J].中华外科杂志2002,40:730-732.
[7]于泽生,刘忠军,党耕町.颈椎不稳致交感型颈椎病的诊断和治疗[J].中华外科杂志,2001,3: 282-284.
[8] WU Guangsen, MA Yuanzheng, CHEN Xing. Anterior cervical corpectomy with titanium mesh and bone graft fusion for the treatment of sympathetic cervical spondylosis [J].Chinese Journal of Spine and Spinal Cord. 2008, 18( 4) : 261-265.
[9]彭宝淦,候树勋,吴仕良.颈椎病突出椎间盘组织炎性及应特性的研究[J].中国脊柱脊髓杂志,2002,12:38-40
[10]杨有庚,任宪盛,程杰平.经皮激光椎间盘减压术治疗颈性眩晕的临床研究[J].脊柱外科杂志, 2005, 3: 65 - 68
[11]朱杰诚,镇万新,万多,等.经皮激光颈椎间盘减压术的临床应用[J].中华骨科杂志, 2003, 23: 49 - 52
[12]Peng B,Wu W,Hou S,et al.The pathogenesis of discogenic low back pain[J]. J Bone Jiont Surg Br,2005,87(1):62-67.
[13]Ozawa T,Ohtori S,Inoue G, et al.The degenerated lumbar intervertebral disc is innervated primarily by peptide-containing sensory nerve fibers in humans [J].Spine, 2006, 31(21):2418-2422.
[14]苏彩风,邵增务.腰椎间盘内神经浸润生长[J].Int J Orthop,2007,28(1):41-43.
[15]Suseki K,Takahashi Y,Takahashi K,et al.Sensory nerve fibres from lumbar intervertebral discs pass through rami communicantes.A possible pathway for discogenic low back pain[J].J Bone Joint Surg Br,1998,80(4):737-742.
[16] Kiray A,Arman C,Naderi S, et al. Surgical anatomy of the cervical sympathetic trunk[J].J Clinical Anatomy,2005,18:179-185.
[17]Johnson GM. The sensory and sympathetic nerve supply within the cervical spine: review of recent observations[J].J Man Ther,2004,9(2):71-76.
[18]Imai S, Konttinen YT, Tokunaga Y, et al. An ultrastructural study of alcitonin generelated peptide immunoreactive nerve fibers innervating the rat posterior longitudinal ligament. A morphologic basis for their possible efferent actions[J].Spine,1997,22(17):1941-1947.
[19]Ahmed M, Bjurholm A, Kreicbergs A, et al. Neuropeptide Y,tyrosine hydroxylase and vasoactive intestinal polypeptide immunoreactive nerve fibers in the vertebral bodies, discs, duramater,and spinal ligaments of the rat lumbar spine[J]. Spine,1993, 18(2):268-273.
[20]Kanerva A,Kommonen B,Gronblad M,et al.Inflammatory cells in experimental intervertebral disc injury[J].Spine,1997,22:2711-2715.
[21]Kapa E,Han X,Holm S,et al.Collagen synthesis and typesⅠ,Ⅲ,Ⅳ,andⅥcollagens in an animal model of disc degeneration[J].Spine,1995,20:59-67.
[22]Burke JG,Watson RW,McCormack D,et al.Intervertebral idscs which cause low back pain secrete high levels of proinflammatory mediators[J].J Bone Joint Surg Br,2002,84:196-201.
[23]Gu Tao,Wang Xinwei,Yuan Wen,et al.Sympathetic nerve fibers of the cervical intervertebral disc and posterior longitudinal ligament:anatomical research and the role in cervical discogenic pain[J].J Spinal Surg,2007,5(6):36-39.
[24]Imai S, Hukuda S, Maeda T. Dually innervating nocicep tive networks in the rat lumbar posterior longitudinal ligaments[J].Spine,1995,20(19):2086-2092.
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