椎間盤突出介紹

椎間盤突出癥脊柱解剖脊柱解剖結(jié)構(gòu)關(guān)系錐體的結(jié)構(gòu)關(guān)系脊柱運(yùn)動(dòng)單元ALLPLLILLFIDSEPIEPSEP=上終版ID=椎間盤IEP=下終板ALL=前縱韌帶PLL=后縱韌帶IF=椎間孔LF=黃韌帶IL=脊突間韌帶IF椎間孔椎間孔結(jié)構(gòu)關(guān)系Tanakaetal.,Spine1999頸椎間孔解剖椎間盤示意圖椎間盤的功能保持高度維持曲度保持椎間孔

聯(lián)結(jié)椎體保證活動(dòng)支撐身體力量傳導(dǎo)緩沖外力FunctionoftheMUShockabsorptionisNOTthemaintaskoftheintervertebraldisc!

LoadedUnloaded

Wislederetal.,Spine2001Shocks

aremainlyabsorbedbythebendingofthespine.FunctionoftheMUPressuredistribution

ontheadjacentendplatesEdwardsetal.,Spine2001FunctionoftheMUHomogenious

stressdistributioninthenormaldiscinaxial

compressionDolanandAdams.,Clin

Biomech2001FunctionoftheMUSittingStandingVaryingstressdistributionduetodifferentposturesDolanandAdams,Clin

Biomech2001纖維環(huán)的組織學(xué)90%膠原纖維

1型膠原纖維2型膠原纖維10%彈性纖維少量proteoglycans纖維環(huán)的解剖和組織學(xué)Collagenfibersoftheannulusarefixedintheepiphysisannularis膠原纖維的分層和排列方向NucleuspulposusTheeffectofageonthelateraldistensionofthenucleus0–20years40–60years

65+yearsThenucleuspulposusbecomesmorerigidwithage(Hall,1987)椎間盤突出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身體活動(dòng)和椎間盤突出AnnulusfibrosusRotationisresistedbythetensionofthecollagenfibersoftheannulusTaskDolanandAdams,Clin

Biomech2001Inhomogenious

stressdi