Huschak Gerald, Holzhausen Hans-Jürgen, Beier Andre, Meisel Hans Jörg, Hoell Thomas
Department of Anesthesiology and Intensive Care Medicine, Medical Faculty, University of Leipzig, Germany.
Department of Pathology, Martin Luther University, Medical Faculty, Halle, Germany.
Open Orthop J. 2014 Jul 11;8:242-9. doi: 10.2174/1874325001408010242. eCollection 2014.
The study investigated the impact of occupational workloads on disc surgery specimens. We report the relationship between workload and histological features.
Specimens were collected prospectively from patients suffering from lumbar disc prolapse (n=90) or spinal osteochondrosis (n=19). Histomorphology and occupational workload data and histomorphological features were evaluated. Occupational data were collected in a structured, standardized patient interview assessing lifting and carrying loads. In this way the exposure was assessed for each test subject's entire working life up to surgery.
There was no association between cumulative workload and histological patterns. In a subgroup of patients with a workload period of 12 months prior to surgery a relevant formation of chondrocyte clusters (p=0.055) was apparent. Chondrocyte cluster formation was found in 83% (n=74) of the prolapse patients and in 58% (n=11) of the osteochondrosis patients (p=0.02). Fibrocyte mediated scar formation was found in 55% of the prolapse patients and in 45% of the spinal stenosis patients. Chondrocyte clusters and their de novo collagen matrix did not integrate biomechanically sufficient with collagen fibers of the disc. Disintegration of clusters from disc matrix and formation of intra-discal sequesters were observed.
Matrix degeneration was common but displayed no relationship to occupational workload or other histological features. Scar formation was observed in every second specimen. Regenerative chondrocyte cluster proliferation was a common feature in disc specimens and tended to be associated in patients with a workload one year before surgery.
本研究调查了职业工作量对椎间盘手术标本的影响。我们报告了工作量与组织学特征之间的关系。
前瞻性收集腰椎间盘突出症患者（n = 90）或脊椎骨软骨病患者（n = 19）的标本。对组织形态学、职业工作量数据和组织形态学特征进行评估。通过结构化、标准化的患者访谈收集职业数据，评估搬运负荷情况。通过这种方式评估每个受试对象直至手术时的整个工作生涯中的暴露情况。
累积工作量与组织学模式之间无关联。在术前有12个月工作量期的患者亚组中，软骨细胞簇的相关形成（p = 0.055）明显。在83%（n = 74）的椎间盘突出症患者和58%（n = 11）的脊椎骨软骨病患者中发现软骨细胞簇形成（p = 0.02）。在55%的椎间盘突出症患者和45%的椎管狭窄患者中发现纤维细胞介导的瘢痕形成。软骨细胞簇及其新生胶原基质在生物力学上与椎间盘的胶原纤维整合不足。观察到簇从椎间盘基质中解体并形成椎间盘内游离体。
基质退变很常见，但与职业工作量或其他组织学特征无关。在每第二个标本中观察到瘢痕形成。再生性软骨细胞簇增殖是椎间盘标本中的常见特征，并且在术前一年有工作量的患者中更易出现。
