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计算机断层扫描引导下犬椎间盘退变制备的髓核活检:一项放射学与组织学研究

Computed tomography-guided nucleus pulposus biopsy for canine intervertebral disc degeneration preparation: a radiology and histology study.

作者信息

Shi Zhi-Yuan, Gu Tao, Zhang Chao, Wang De-Li, He Qing, Ruan Di-Ke

机构信息

Department of Orthopaedic Surgery, Institute of Orthopedics & Traumatology, Xijing Hospital, No 15, Changle Western Rd, Xi'an 710032, China; Department of Orthopaedic Surgery, Navy General Hospital, No 6, Fu-Cheng Rd, Beijing 100048, China.

Department of Orthopaedic Surgery, Navy General Hospital, No 6, Fu-Cheng Rd, Beijing 100048, China.

出版信息

Spine J. 2016 Feb;16(2):252-8. doi: 10.1016/j.spinee.2013.11.061. Epub 2014 May 17.

DOI:10.1016/j.spinee.2013.11.061
PMID:24845965
Abstract

BACKGROUND CONTEXT

Different animal models are being used in disc degenerative disease (DDD) research; most of these models are induced invasively rather than noninvasively. Computed tomography (CT)-guided percutaneous biopsy, widely used in clinical malignant pathology diagnosis, is a safe, useful, and highly accurate procedure. However, this process was not carried out in animal model preparation of intervertebral disc degeneration.

PURPOSE

To apply a minimally invasive method in DDD animal model preparation with a biopsy gun guided by CT scan and evaluate the accuracy and efficiency of this process with radiology and histology analyses. The relationship between the weight of removed nucleus pulposus (NP) and the degenerative process was also explored preliminarily.

METHODS

The canine intervertebral discs L1-L2, L3-L4, and L5-L6 were divided into three groups randomly: Group A: 18G biopsy gun; Group B: 20G biopsy gun; and Group C: 24G biopsy gun. After the lumbar spine was scanned with CT and the depth and angle of the centesis operation sites ascertained, biopsy gun was stabbed percutaneously through the annulus into the NP. A certain volume of NP tissue was removed by the biopsy gun. Radiology examination, including digital radiography (DR) and magnetic resonance imaging (MRI), was carried out preoperatively and at first and third months postoperatively. Each sample was harvested at the 3rd month postoperation for histology evaluation.

RESULTS

Computed tomography-guided percutaneous biopsy with 18G, 20G, and 24G biopsy guns was carried out for six discs, respectively. In the procedure, the weight of the NP tissue was removed: 3.0±0.53mg in Group A, 2.01±0.34 mg in Group B, and 0.99±0.12 mg in Group C. Significant differences of the weight of the removed NP tissue were calculated between groups (p<.05). During the observation period, although the disc height of Group A and B was reduced, no significant differences in the disc height comparison were found between groups at each time point and within groups at different time points in DR analysis. However, the signal intensity of MRI was reduced significantly (p<.05) in Group A when compared with Group C at third month, whereas the signal intensity was decrease mildly (p>.05) in Group B when compared with Group C at third month. The decreased content of NP, the number of NP cells, and the loose annulus fibrosus at the inner area was observed in both hematoxylin-eosin and Safranin-O staining in Group A at the 3rd month postoperation.

CONCLUSIONS

Computed tomography-guided percutaneous biopsy could be applied in intervertebral disc degeneration preparation of canine model, and the 20G biopsy gun would be the optimal choice in this procedure. The intervertebral disc degenerative process could be forecasted approximately on an account of the negative association between the degeneration process and the weight of the removed NP tissue.

摘要

背景

在椎间盘退变疾病(DDD)研究中使用了不同的动物模型;这些模型大多是通过侵入性而非非侵入性诱导产生的。计算机断层扫描(CT)引导下的经皮活检在临床恶性病理诊断中广泛应用,是一种安全、有用且高度准确的操作。然而,这一过程未在椎间盘退变的动物模型制备中进行。

目的

应用CT扫描引导活检枪的微创方法制备DDD动物模型,并通过放射学和组织学分析评估该过程的准确性和效率。还初步探讨了取出的髓核(NP)重量与退变过程之间的关系。

方法

将犬的L1-L2、L3-L4和L5-L6椎间盘随机分为三组:A组:18G活检枪;B组:20G活检枪;C组:24G活检枪。在对腰椎进行CT扫描并确定穿刺手术部位的深度和角度后,将活检枪经皮穿过纤维环刺入NP。用活检枪取出一定体积的NP组织。在术前以及术后第1个月和第3个月进行放射学检查,包括数字X线摄影(DR)和磁共振成像(MRI)。在术后第3个月采集每个样本进行组织学评估。

结果

分别用18G、20G和24G活检枪对6个椎间盘进行了CT引导下的经皮活检。在该过程中,取出的NP组织重量为:A组3.0±0.53mg,B组2.01±0.34mg,C组0.99±0.12mg。组间取出的NP组织重量差异有统计学意义(p<0.05)。在观察期内,虽然A组和B组的椎间盘高度降低,但在DR分析中,各时间点组间以及不同时间点组内的椎间盘高度比较均未发现显著差异。然而,在术后第3个月,A组与C组相比,MRI信号强度显著降低(p<0.05),而B组与C组相比,信号强度轻度降低(p>0.05)。术后第3个月,A组苏木精-伊红染色和番红O染色均观察到NP含量减少、NP细胞数量减少以及内部区域纤维环松弛。

结论

CT引导下的经皮活检可应用于犬模型的椎间盘退变制备,20G活检枪是该操作的最佳选择。根据退变过程与取出的NP组织重量之间的负相关关系,可大致预测椎间盘退变过程。

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