椎間盤突出介紹

椎間盤突出癥脊柱解剖脊柱解剖結構關系錐體的結構關系脊柱運動單元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椎間孔椎間孔結構關系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)結椎體保證活動支撐身體力量傳導緩沖外力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身體活動和椎間盤突出AnnulusfibrosusRotationisresistedbythetensionofthecollagenfibersoftheannulusTaskDolanandAdams,Clin

Biomech2001Inhomogenious

stressdi