EXPERIMENTAL STUDY ON EFFECT OF THREE DIFFERENT OPERATIVE WAYS OF ANNULUS FIBROSUS INCISION ON INTERVERTEBRAL DISC BIOMECHANICAL STRENGTH_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIPengfei ¹ , JIANan ¹ , SHENYaxin ² ,  JINXianhui ¹ , SHENYong ³ , DINGWenyuan ³ , ZHANGWei ³

1. Department of Orthopaedics, Harrison International Peace Hospital, Hengshui Hebei, 053000, P. R. China;
2. Department of Surgery, Hebei Medical University;
3. Department of Spine Surgery, the Third Hospital of Hebei Medical University;

Corresponding author：

JINXianhui, Email: pengflyl@163.com

Keywords：

Intervertebral disc nucleus pulposus extraction; Incision type; Biomechanics; Annulus fibrosus; Goat

DOI：

10.7507/1002-1892.20160041

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Objective To discuss the effect of three different ways of annulus fibrosus incision on the biomechanical strength of intervertebral disc. Methods A total of 30 goats underwent intervertebral disc nucleus pulposus extraction at L_{3, 4} and L_{4, 5} by the working channel in group A (n=10), by circular incision in group B (n=10), and by square incision in group C (n=10). The body weight, male and female ratio, age, intraoperative blood loss, and wound healing time were recorded and compared among 3 groups. The survival rate and wound healing situation were observed after operation. At 24 weeks after operation, the goats were sacrificed, MRI images were taken to observe the signal intensity of nucleus pulposus. The disc height of L_{3, 4} and L_{4, 5} was measured to calculate the loss of disc height; biomechanical test was used to assess the strength of the disc and anulus. Histological staining was also conducted to observe the repair effect at L_{4, 5}. Results There was no significant difference in body weight, male to female ratio, age, intraoperative blood loss, and wound healing time among groups (P>0.05). All goats survived to the end of the experiment. MRI examination showed decreased signal intensity in 3 groups, indicating intervertebral disc degeneration. According to modified Thompson classification method, the degree of intervertebral disc degeneration of group A was significantly higher than that of groups B and C (P<0.05), but no significant difference was found between groups B and C (P>0.05). Difference was not significant in intervertebral space height before operation among 3 groups (P>0.05). But after 24 weeks, the intervertebral space height in group A was significantly higher than that in groups B and C (P<0.05), and the intervertebral space height loss in group A was significantly lower than that in groups B and C (P<0.05). The biomechanical strength in group A was also significantly higher than that in groups B and C (P<0.05), but no significant difference was found between group B and group C (P>0.05). HE and Masson staining showed good continuity of annulus fibrosus and clear layers in group A; poor continuity of annulus fibrosus and obvious scar tissues were observed in groups B and C. Conclusion Application of working channel may have less destruction of annulus fibrosus, it plays a positive role in the maintenance of biomechanical strength and repair of annulus fibrosus.

Citation： LIPengfei, JIANan, SHENYaxin, JINXianhui, SHENYong, DINGWenyuan, ZHANGWei. EXPERIMENTAL STUDY ON EFFECT OF THREE DIFFERENT OPERATIVE WAYS OF ANNULUS FIBROSUS INCISION ON INTERVERTEBRAL DISC BIOMECHANICAL STRENGTH. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(2): 202-207. doi: 10.7507/1002-1892.20160041 Copy

1.	汪巍, 李广松, 曹赫基, 等. 经皮穿刺射频热凝术与后路椎管减压突出髓核摘除术治疗椎间孔型腰椎间盘突出症临床疗效比较. 颈腰痛杂志, 2014, 35(6):405-408.
2.	Ledet EH, Jeshuran W, Glennon JC, et al. Small intestinal submucosa for anular defect closure:long-term response in an in vivo sheep model. Spine (Phlia Pa 1976), 2009, 34(14):1457-1463.
3.	杨进, 孔清泉, 宋跃明. 三种经皮内镜椎间盘髓核摘除术治疗伴有高髂嵴的L₅~S₁椎间盘突出症. 中国骨与关节杂志, 2014, 3(8):608-614.
4.	刘俊良, 镇万新, 高国勇, 等. 椎间孔镜与椎板开窗治疗腰椎间盘突出症的前瞻性对照研究. 中国骨与关节杂志, 2014, 3(4):245-250.
5.	Masuda K, Aota Y, Muehleman C, et al. A novel rabbit model of mild, reproducible disc degeneration by an anulus needle puncture:correlation between the degree of disc injury and radiological and histological appearances of disc degeneration. Spine (Phila Pa 1976), 2005, 30(1):5-14.
6.	刘元彬, 张智, 郑佳状, 等. 单纯髓核摘除术与髓核摘除联合动态稳定系统治疗腰椎间盘突出症的短期对比研究. 中国骨与关节杂志, 2015, 4(6):488-493.
7.	Hegewald AA, Ringe J, Sittinger M, et al. Regenerative treatment strategies in spinal surgery. Front Biosci, 2008, 13:1507-1525.
8.	李展振, 龙亨国, 祝海炳, 等. 经皮穿刺髓核成形术治疗腰椎间盘突出症初步临床报道. 骨与关节损伤杂志, 2002, 17(1):20-21.
9.	辛洪奎, 张超, 阮狄克. 骨形态发生蛋白-7及其对椎间盘退变修复作用的研究进展. 中国脊柱脊髓杂志, 2011, 21(5):416-418.
10.	张福勇, 吴小涛, 王运涛. 纤维环退变及其修复的研究现状. 中国脊柱脊髓杂志, 2008, 18(9):715-719.
11.	丁文元, 申勇, 郭金库, 等. 人工生物膜修复椎间盘纤维环的研究. 中华实验外科杂志, 2010, 27(11):1636-1638.
12.	Bron JL, Helder MN, Meisel HJ, et al. Repair, regenerative and supportive therapies of the annulus fibrosus:achievements and challenges. Eur Spine J, 2009, 18(3):301-303.
13.	Michalek AJ, Gardner-Morse MG, Iatridis JC. Large residual strains are present in the intervertebral disc annulus fibrosus in the unloaded state. J Biomech, 2012, 45(7):1227-1231.
14.	Knell SC, Bürki A, Hurter K, et al. Biomechanical comparison after in vitro laminar vertebral stabilization and vertebral body plating of the first and second lumbar vertebrae in specimens obtained from canine cadavers. Am J Vet Res, 2011, 72(12):1681-1686.
15.	Melrose J, Shu C, Young C, et al. Mechanical destabilization induced by controlled annular incision of the intervertebral disc dysregulates metalloproteinase expression and induces disc degeneration. Spine (Phlia Pa 1976), 2012, 37(1):18-25.
16.	单治, 范顺武, 赵凤东. 腰椎间盘纤维环的生物力学性能研究进展. 中华骨科杂志, 2014, 34(3):330-335.
17.	李晓龙, 孔清泉. 纤维环组织工程的发展及挑战. 中国修复重建外科杂志, 2015, 29(4):498-502.
18.	Otani K, Arai I, Mao GP, et al. Nucleus pulposus-induced nerve root injury:relationship between blood flow and motor nerve conduction velocity. Neurosurgery, 1999, 45(3):614-619.
19.	Kayama S, Konno S, Olmarker K, et al. Incision of the annulus fibrosus induces nerve root morphologic, vascular and functional changes. An experiment study. Spine (Phila Pa 1976), 1996, 21(22):2539-2543.
20.	黄卫国, 易军飞, 白瑞飞, 等. 阔筋膜修复腰椎间盘纤维环的组织学观察. 中国脊柱脊髓杂志, 2010, 20(11):902-906.
21.	周超, 田永昊, 郑燕平, 等. 腰椎椎间盘突出症术后症状复发原因分析. 脊柱外科杂志, 2015, 13(2):98-100.
22.	张寅, 朱辉, 周晓中. 去端肽胶原包埋骨髓基质干细胞修复兔椎间盘退变. 中华实验外科杂志, 2014, 31(4):837.
23.	刘铖祎, 田纪伟. 纤维环修复及其再生的研究进展. 中国矫形外科杂志, 2010, 18(17):1437-1439.

1. 汪巍, 李广松, 曹赫基, 等. 经皮穿刺射频热凝术与后路椎管减压突出髓核摘除术治疗椎间孔型腰椎间盘突出症临床疗效比较. 颈腰痛杂志, 2014, 35(6):405-408.
2. Ledet EH, Jeshuran W, Glennon JC, et al. Small intestinal submucosa for anular defect closure:long-term response in an in vivo sheep model. Spine (Phlia Pa 1976), 2009, 34(14):1457-1463.
3. 杨进, 孔清泉, 宋跃明. 三种经皮内镜椎间盘髓核摘除术治疗伴有高髂嵴的L₅~S₁椎间盘突出症. 中国骨与关节杂志, 2014, 3(8):608-614.
4. 刘俊良, 镇万新, 高国勇, 等. 椎间孔镜与椎板开窗治疗腰椎间盘突出症的前瞻性对照研究. 中国骨与关节杂志, 2014, 3(4):245-250.
5. Masuda K, Aota Y, Muehleman C, et al. A novel rabbit model of mild, reproducible disc degeneration by an anulus needle puncture:correlation between the degree of disc injury and radiological and histological appearances of disc degeneration. Spine (Phila Pa 1976), 2005, 30(1):5-14.
6. 刘元彬, 张智, 郑佳状, 等. 单纯髓核摘除术与髓核摘除联合动态稳定系统治疗腰椎间盘突出症的短期对比研究. 中国骨与关节杂志, 2015, 4(6):488-493.
7. Hegewald AA, Ringe J, Sittinger M, et al. Regenerative treatment strategies in spinal surgery. Front Biosci, 2008, 13:1507-1525.
8. 李展振, 龙亨国, 祝海炳, 等. 经皮穿刺髓核成形术治疗腰椎间盘突出症初步临床报道. 骨与关节损伤杂志, 2002, 17(1):20-21.
9. 辛洪奎, 张超, 阮狄克. 骨形态发生蛋白-7及其对椎间盘退变修复作用的研究进展. 中国脊柱脊髓杂志, 2011, 21(5):416-418.
10. 张福勇, 吴小涛, 王运涛. 纤维环退变及其修复的研究现状. 中国脊柱脊髓杂志, 2008, 18(9):715-719.
11. 丁文元, 申勇, 郭金库, 等. 人工生物膜修复椎间盘纤维环的研究. 中华实验外科杂志, 2010, 27(11):1636-1638.
12. Bron JL, Helder MN, Meisel HJ, et al. Repair, regenerative and supportive therapies of the annulus fibrosus:achievements and challenges. Eur Spine J, 2009, 18(3):301-303.
13. Michalek AJ, Gardner-Morse MG, Iatridis JC. Large residual strains are present in the intervertebral disc annulus fibrosus in the unloaded state. J Biomech, 2012, 45(7):1227-1231.
14. Knell SC, Bürki A, Hurter K, et al. Biomechanical comparison after in vitro laminar vertebral stabilization and vertebral body plating of the first and second lumbar vertebrae in specimens obtained from canine cadavers. Am J Vet Res, 2011, 72(12):1681-1686.
15. Melrose J, Shu C, Young C, et al. Mechanical destabilization induced by controlled annular incision of the intervertebral disc dysregulates metalloproteinase expression and induces disc degeneration. Spine (Phlia Pa 1976), 2012, 37(1):18-25.
16. 单治, 范顺武, 赵凤东. 腰椎间盘纤维环的生物力学性能研究进展. 中华骨科杂志, 2014, 34(3):330-335.
17. 李晓龙, 孔清泉. 纤维环组织工程的发展及挑战. 中国修复重建外科杂志, 2015, 29(4):498-502.
18. Otani K, Arai I, Mao GP, et al. Nucleus pulposus-induced nerve root injury:relationship between blood flow and motor nerve conduction velocity. Neurosurgery, 1999, 45(3):614-619.
19. Kayama S, Konno S, Olmarker K, et al. Incision of the annulus fibrosus induces nerve root morphologic, vascular and functional changes. An experiment study. Spine (Phila Pa 1976), 1996, 21(22):2539-2543.
20. 黄卫国, 易军飞, 白瑞飞, 等. 阔筋膜修复腰椎间盘纤维环的组织学观察. 中国脊柱脊髓杂志, 2010, 20(11):902-906.
21. 周超, 田永昊, 郑燕平, 等. 腰椎椎间盘突出症术后症状复发原因分析. 脊柱外科杂志, 2015, 13(2):98-100.
22. 张寅, 朱辉, 周晓中. 去端肽胶原包埋骨髓基质干细胞修复兔椎间盘退变. 中华实验外科杂志, 2014, 31(4):837.
23. 刘铖祎, 田纪伟. 纤维环修复及其再生的研究进展. 中国矫形外科杂志, 2010, 18(17):1437-1439.

Chinese Journal of Reparative and Reconstructive Surgery

EXPERIMENTAL STUDY ON EFFECT OF THREE DIFFERENT OPERATIVE WAYS OF ANNULUS FIBROSUS INCISION ON INTERVERTEBRAL DISC BIOMECHANICAL STRENGTH

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