应用生长分化因子-5和纤维蛋白凝胶复合物治疗兔腰椎间盘损伤

Complex of growth differentiation factor-5 and fibrin gel for repair of lumbar disc injury in rab- bits

目的研究应用生长分化因子-5（growthdifferentiationfactor-5，GDF-5）和纤维蛋白凝胶复合物局部注射治疗兔腰椎间盘损伤的效果。方法选用健康新西兰白兔40只，显露L3/4、L4/5L，5/6椎间盘，使用20号穿刺针进行椎间盘穿刺，L3／4椎间盘穿刺后注入GDF-5和纤维蛋白凝胶复合物（复合物组），L4／5椎间盘穿刺后注入纤维蛋白凝胶（纤维蛋白凝胶组），Ls／6椎间盘穿刺后不进行处理（空白对照组），分别于术后2周行腰椎计算机X线片检查、MRI检查、髓核内蛋白多糖含量测定、椎间盘组织学检查，了解各组椎间盘的退变情况。结果术后2，4，8，12周X线片示三组椎间盘高度指数（discheightindex，DHI）逐渐下降，但复合物组DHI下降速度低于其他两组（P〈0．05）。MRI显示三组椎间盘信号值均随时间推移进行性下降，但复合物组的信号值下降速度低于其他两组（P〈0．05）。术后4周复合物组、空白对照组和纤维蛋白凝胶组椎间盘髓核内蛋白多糖含量分别为6．3±0．4，5．9±0．4，5．8±0．3，复合物组含量高于其他两组（P〈0．05）。组织学检查显示，术后2周复合物组、空白对照组和纤维蛋白凝胶组的组织学评分分别为5．28±0．41，7．54±0．53，7．21±0．44，复合物组评分明显低于其他两组（P〈0．05）。结论应用GDF-5和纤维蛋白凝胶复合物局部注射能促进椎间盘的修复，延缓椎间盘的退变。

Objective To investigate the result of local injection of growth differentiation factor-5 （ GDF-5 ） and fibrin gel for treatment of lumbar disc injury in rabbits. Methods Lumbar puncture with a 20-gauge needle was performed at L3/4 , L4/5 , and Ls/6 discs of 40 New Zealand white rabbits. After nee- dle puncture, L3/4 discs were injected with GDF-5 and fibrin gel （compound group） ; L4/5 discs fibrin gel （fibrin gel group） ; L5/6 discs nothing （blank control group）. Two weeks later, intervertebral disc degen- eration in each group was observed via radiography, MRI and nucleus proteoglycan content detection and histological examination. Results At postoperative 2-, 4-, 8-, and 12-weeks, X-ray films revealed a gradual decrease in disc height index （DHI） among the three groups, but the decreasing velocity was low- er in compound group than in other two groups （ P 〈 0.05 ）. On MRI, the signal of intervebral discs a- mong the three groups diminished progressively with time, but a relatively lower decreasing was observed in compound group （P 〈 0.05）. At postoperative 4-week, proteoglycan content of the nucleus pulposus was （6.3 ± 0.4） in compound group, higher than （5.9 ± 0.4） in blank control group and （5.8 ±0.3 ） in fibrin gel group （P 〈 0.05）. At postoperative 2-week, histological evaluation showed （5.28 ±0.41 ） points in compound group, lower than （7.54 ±0.53 ） points in blank control group and （7.21 ±0.44） points in fibrin gel group （P 〈 0.05）. Conclusion Local injection of GDF-5 and fibrin gel facilitates the restoration of the injured discs and delays further disc degeneration.