腰椎间盘突出后髓核自发吸收现象的研究进展

Research progress on spontaneous absorption phenomena of lumbar disc nucleus

目的：探讨腰椎间盘突出后髓核自发吸收现象的研究进展。方法在 PubMed 和CNKI数据库，分别以“disc herniation resorption、regression、resolution、disappearance”和“腰椎间盘突出症、自发吸收、消退、溶解、消失”为关键词，限定语言种类为English和中文，检索1980年1月—2015年10月发表的有关腰椎间盘突出后髓核自发吸收的文章。对检索到的270余篇文献进行筛选，选择近期发表在较为权威期刊的论文26篇纳入分析。结果在腰椎间盘突出发病后的前6个月是髓核自发吸收的活跃期。脱出游离型椎间盘突出是最常见的自发吸收类型。后纵韧带完整与否是决定椎间盘突出能否自然吸收或缩小的关键因素之一。自发吸收现象的发生机制为突出的椎间盘组织穿破后纵韧带进入硬膜外腔接触血运，引起周边毛细血管爬行长入，并作为抗原异物引发机体的一系列免疫反应，使髓核自行溶解，即吸收的过程是一个对突出物进行免疫溶解的过程。结论髓核自发吸收与炎症反应、血管及解剖因素密切相关；发病后的前6个月是活跃期，游离型多发；尽管采取保守治疗后可出现髓核自发吸收，但并非必然；神经症状逐渐加重时，应积极考虑手术治疗。

Objective To explore the research progress on spontaneous absorption phenomena of lumbar disc nucleus. Methods A computer-based online search of PubMed was undertaken to identify the articles about spontaneous absorption phenomena of lumbar disc nucleus published in English from January 1980 to October 2015, with the key words of ＂ disc herniation resorption, regression, resolution, disappearance＂. And the computer-based online search of CNKI database was also undertaken to identify relevant articles published in Chinese from January 1980 to October 2015, with the key words of＂腰椎间盘突出症,自发吸收,消退,溶解,消失＂. More than 270 articles about the spontaneous absorption phenomena of lumbar disc nucleus were selected and 26 articles published in authorized journals in recent years were selected and analyzed. Results The onset of spontaneous absorption of lumbar disc nucleus always occurred in the first six months. Sequestered disc prolapse was the most common type of spontaneous absorption, the complete posterior longitudinal ligament was one of the key factors that decided whether natural absorption or reduced. The mechanism of spontaneous absorption of herniated disc tissue was the procedure as followed, the herniated disc contact with the epidural blood supply through posterior longitudinal ligament, then caused the surrounding capillary in growth crawl, and triggered a series of immune response as foreign antigens, resulted in self-dissolution of the nucleus. Conclusions Spontaneous absorption is closely related to inflammation, blood vessels and anatomical factors; the first 6 months after surgery is active, sequestered disc prolapse is the most common type; although conservative treatment is effective, yet not necessary;surgery should be recommended if neural symptoms worsened.