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, 李廣松, 曹赫基, 等. 經皮穿刺射頻熱凝術與后路椎管減壓突出髓核摘除術治療椎間孔型腰椎間盤突出癥臨床療效比較. 頸腰痛雜志, 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.	楊進, 孔清泉, 宋躍明. 三種經皮內鏡椎間盤髓核摘除術治療伴有高髂嵴的L₅~S₁椎間盤突出癥. 中國骨與關節雜志, 2014, 3(8):608-614.
4.	劉俊良, 鎮萬新, 高國勇, 等. 椎間孔鏡與椎板開窗治療腰椎間盤突出癥的前瞻性對照研究. 中國骨與關節雜志, 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.	劉元彬, 張智, 鄭佳狀, 等. 單純髓核摘除術與髓核摘除聯合動態穩定系統治療腰椎間盤突出癥的短期對比研究. 中國骨與關節雜志, 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, 龍亨國, 祝海炳, 等. 經皮穿刺髓核成形術治療腰椎間盤突出癥初步臨床報道. 骨與關節損傷雜志, 2002, 17(1):20-21.
9.	辛洪奎, 張超, 阮狄克. 骨形態發生蛋白-7及其對椎間盤退變修復作用的研究進展. 中國脊柱脊髓雜志, 2011, 21(5):416-418.
10.	張福勇, 吳小濤, 王運濤. 纖維環退變及其修復的研究現狀. 中國脊柱脊髓雜志, 2008, 18(9):715-719.
11.	丁文元, 申勇, 郭金庫, 等. 人工生物膜修復椎間盤纖維環的研究. 中華實驗外科雜志, 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.	單治, 范順武, 趙鳳東. 腰椎間盤纖維環的生物力學性能研究進展. 中華骨科雜志, 2014, 34(3):330-335.
17.	李曉龍, 孔清泉. 纖維環組織工程的發展及挑戰. 中國修復重建外科雜志, 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.	黃衛國, 易軍飛, 白瑞飛, 等. 闊筋膜修復腰椎間盤纖維環的組織學觀察. 中國脊柱脊髓雜志, 2010, 20(11):902-906.
21.	周超, 田永昊, 鄭燕平, 等. 腰椎椎間盤突出癥術后癥狀復發原因分析. 脊柱外科雜志, 2015, 13(2):98-100.
22.	張寅, 朱輝, 周曉中. 去端肽膠原包埋骨髓基質干細胞修復兔椎間盤退變. 中華實驗外科雜志, 2014, 31(4):837.
23.	劉鋮祎, 田紀偉. 纖維環修復及其再生的研究進展. 中國矯形外科雜志, 2010, 18(17):1437-1439.

1. ?汪巍, 李廣松, 曹赫基, 等. 經皮穿刺射頻熱凝術與后路椎管減壓突出髓核摘除術治療椎間孔型腰椎間盤突出癥臨床療效比較. 頸腰痛雜志, 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. 楊進, 孔清泉, 宋躍明. 三種經皮內鏡椎間盤髓核摘除術治療伴有高髂嵴的L₅~S₁椎間盤突出癥. 中國骨與關節雜志, 2014, 3(8):608-614.
4. 劉俊良, 鎮萬新, 高國勇, 等. 椎間孔鏡與椎板開窗治療腰椎間盤突出癥的前瞻性對照研究. 中國骨與關節雜志, 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. 劉元彬, 張智, 鄭佳狀, 等. 單純髓核摘除術與髓核摘除聯合動態穩定系統治療腰椎間盤突出癥的短期對比研究. 中國骨與關節雜志, 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, 龍亨國, 祝海炳, 等. 經皮穿刺髓核成形術治療腰椎間盤突出癥初步臨床報道. 骨與關節損傷雜志, 2002, 17(1):20-21.
9. 辛洪奎, 張超, 阮狄克. 骨形態發生蛋白-7及其對椎間盤退變修復作用的研究進展. 中國脊柱脊髓雜志, 2011, 21(5):416-418.
10. 張福勇, 吳小濤, 王運濤. 纖維環退變及其修復的研究現狀. 中國脊柱脊髓雜志, 2008, 18(9):715-719.
11. 丁文元, 申勇, 郭金庫, 等. 人工生物膜修復椎間盤纖維環的研究. 中華實驗外科雜志, 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. 單治, 范順武, 趙鳳東. 腰椎間盤纖維環的生物力學性能研究進展. 中華骨科雜志, 2014, 34(3):330-335.
17. 李曉龍, 孔清泉. 纖維環組織工程的發展及挑戰. 中國修復重建外科雜志, 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. 黃衛國, 易軍飛, 白瑞飛, 等. 闊筋膜修復腰椎間盤纖維環的組織學觀察. 中國脊柱脊髓雜志, 2010, 20(11):902-906.
21. 周超, 田永昊, 鄭燕平, 等. 腰椎椎間盤突出癥術后癥狀復發原因分析. 脊柱外科雜志, 2015, 13(2):98-100.
22. 張寅, 朱輝, 周曉中. 去端肽膠原包埋骨髓基質干細胞修復兔椎間盤退變. 中華實驗外科雜志, 2014, 31(4):837.
23. 劉鋮祎, 田紀偉. 纖維環修復及其再生的研究進展. 中國矯形外科雜志, 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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