Ahlgren B D, Lui W, Herkowitz H N, Panjabi M M, Guiboux J P
Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan, USA.
Spine (Phila Pa 1976). 2000 Sep 1;25(17):2165-70. doi: 10.1097/00007632-200009010-00004.
The intervertebral disc, in a sheep model, was used to assess the effect of directly repairing three different anular incisions on the subsequent healing strength of the intervertebral disc.
To assess whether directly repairing an anular defect, made at the time of lumbar discectomy, could influence the healing rate and strength of the anulus fibrosus.
Twenty-four sheep underwent a retroperitoneal approach to five lumbar disc levels. An anular incision, followed by partial discectomy was done at each exposed level. Anular incisions used in this study consisted of 1) a straight transverse slit, 2) a cruciate incision, and 3) a window or box excision. Healing strength was measured at three time intervals: 2 weeks, 4 weeks, and 6 weeks. Each anular incision type was performed on 30 lumbar discs, 10 discs in each time interval. Five discs in each time interval underwent direct repair, and five discs were left unrepaired to heal as controls. The sheep were killed at 2, 4, and 6 weeks after surgery. The lumbar spines were removed en bloc, and the intervertebral discs were subjected to pressure-volume testing to assess the anular strength of repaired versus unrepaired disc injuries at each time interval.
Statistical analysis was performed to evaluate the effects of healing time, incision technique, and repair on the pressure-volume characteristics of the involved discs. Pressure-volume testing showed trends of stronger healing for repaired discs, but at no time interval was any significant difference found between repaired and nonrepaired anular strength. Of the nonrepaired discs, the box incision was only 40 to 50% as strong as the slit or cruciate incised discs during early healing.
Direct repair of anular incisions in the lumbar spine does not significantly alter the healing strength of the intervertebral disc after lumbar discectomy.
在绵羊模型中，使用椎间盘来评估直接修复三种不同的纤维环切口对椎间盘后续愈合强度的影响。
评估在腰椎间盘切除术时直接修复纤维环缺损是否会影响纤维环的愈合速度和强度。
24只绵羊接受经腹膜后途径暴露五个腰椎间盘节段。在每个暴露节段进行纤维环切口，随后行部分椎间盘切除术。本研究中使用的纤维环切口包括：1）直线横向切口；2）十字形切口；3）开窗或盒形切除。在三个时间点测量愈合强度：2周、4周和6周。每种纤维环切口类型在30个腰椎间盘上进行，每个时间点10个椎间盘。每个时间点的五个椎间盘进行直接修复，另外五个椎间盘不修复作为对照。术后2周、4周和6周处死绵羊。整块取出腰椎脊柱，对椎间盘进行压力-容积测试，以评估每个时间点修复与未修复的椎间盘损伤的纤维环强度。
进行统计分析以评估愈合时间、切口技术和修复对受累椎间盘压力-容积特征的影响。压力-容积测试显示修复后的椎间盘有更强愈合的趋势，但在任何时间点，修复和未修复的纤维环强度之间均未发现显著差异。在未修复的椎间盘中，盒形切口在早期愈合时的强度仅为直线切口或十字形切口椎间盘的40%至50%。
腰椎纤维环切口的直接修复不会显著改变腰椎间盘切除术后椎间盘的愈合强度。
