椎间盘源性腰痛的病理生理学机制及组织工程学技术

Pathophysicological mechanism of discogenic low back pain and tissue engineering technique

背景:椎间盘源性腰痛的发病机制存在争议,认识其病理生理学机制,可为临床诊断和治疗提供重要的理论基础。目的:综述国内外关于椎间盘源性腰痛的病理生理学机制及组织工程学技术在其应用中的研究概况。方法:应用计算机检索PubMed1980-01/2009-08期间的相关文章,检索词为"椎间盘源性腰痛,下腰痛,Discogenic low back pain,low back pain,tissue engineering",并限定文章语言种类为English。同时计算机检索中国期刊全文数据库2000-01/2009-08期间的相关文章,检索词为"椎间盘源性腰痛",并限定文章语言种类为中文。此外还手工查阅相关专著数部。纳入椎间盘退变的病理生理机制、椎间盘突出致疼痛的病理生理学机制研究。结果与结论:慢性下腰痛部分是椎间盘本身内部结构病变导致的。自然退变和机械压力改变导致髓核和纤维环的破裂,神经纤维通过破裂的纤维环长入到椎间盘的内部,椎间盘内的髓核等组织破裂后能够刺激周围产生炎症因子,这些炎症因子刺激神经产生疼痛;腰部机械压力的改变,炎症因子进一步刺激神经导致疼痛加重。治疗盘源性下腰痛,传统手术治疗如椎间盘切除、腰椎融合、椎间盘内射频消融等会牺牲正常脊柱的高度和脊柱节段的活动,促进椎间盘的再生和椎间盘置换有可能解决这个问题,故组织工程方面治疗盘源性腰痛成为新的热门。

BACKGROUND： The pathogenesis of discogenic low back pain remains controversial. The understanding of pathophysicological mechanism provides important theoretical foundation for clinical diagnosis and treatment. OBJECTIVE： To review the pathophysicological mechanism of discogenic low back pain and application of tissue engineering at home and abroad. METHODS： A computer-based online search of Pubmed （1980-01/2009-08） and CNKI （2000-01/2009-08） was performed for articles in English and Chinese with the Keywords ＂discogenic low back pain, low back pain＂ in English and Chinese. In addition, manual search was performed. Studies regarding pathophysicological mechanism of intervertebral degeneration and pathophysicological mechanism of intervertebral disk hernia-induced pain were included. RESULTS AND CONCLUSION： Chronic low back pain is partially caused by intervertebral disk lesion. Natural degeneration and mechanical pressure changes lead to the breakdown of nucleus pulposus and annulus fibrosus. Through the breakdown of nerve fibers, nerve fibers grow into the disc. The nucleus of disc can stimulate surrounding tissue to produce inflammatory cytokines, which stimulate pain from nerves. The change of the waist mechanical stress can increase pain. Traditional surgical treatment, such as discectomy, lumbar fusion, intradiscal radiofrequency ablation, will reduce the height of normal spine and spine segment activities. The promotion of the regeneration of intervertebral disc and the disc replacement surgery may solve this problem. Therefore, treatment of discogenic low back pain with tissue engineering has become a new interesting topic.