Bylski-Austrow Donita I, Glos David L, Wall Eric J, Crawford Alvin H
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
University of Cincinnati, Cincinnati, Ohio.
J Orthop Res. 2018 Sep;36(9):2450-2459. doi: 10.1002/jor.23900. Epub 2018 Apr 24.
Scoliosis progression in skeletally immature patients depends on remaining growth. Relationships between vertebral growth plate histomorphometry, growth rates, and mechanical stresses have been reported in several animal studies. Hypertrophic zone heights and chondrocyte heights have been used to assess treatments that aim to modulate growth. The purpose of this study was to determine whether human vertebral physeal hypertrophic zone and cell heights differed between two groups: Severe scoliosis and autopsy controls. Severity was defined at time of surgical planning by curve magnitude and curve stiffness. Physeal samples were obtained from the convex side apex, and from the concave side when feasible. Histologic sections were prepared, and digital images were used to measure hypertrophic zone height, cell height, and cell width. Thirteen spinal deformity patients were included, mean curve magnitude 67° (±23). Etiologies were juvenile and adolescent idiopathic, congenital, neurofibromatosis, neuromuscular, and Marfan syndrome. Five age-matched autopsy specimens without scoliosis served as controls. Results were presented by etiology, then all convex scoliosis specimens were combined and compared to controls. Zone heights for scoliosis, convex side, and controls were 152 µm (±34) and 180 µm (±42) (p = 0.21), cell heights 8.5 µm (±1.1) and 12.8 µm (±1.2) (p < 0.0005), and cell widths 14.9 µm (±1.5) and 15.0 µm (±2.5), respectively. Human values were compared to published animal models and to a quantitative theory of a stress ̶ growth curve. This quantification of vertebral physeal structures in scoliosis may be expected to help assess theories of progression and potential treatments using growth modulation. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2450-2459, 2018.
骨骼未成熟患者的脊柱侧弯进展取决于剩余生长情况。多项动物研究报告了椎体生长板组织形态计量学、生长速率和机械应力之间的关系。肥厚带高度和软骨细胞高度已被用于评估旨在调节生长的治疗方法。本研究的目的是确定两组之间人类椎体骺板肥厚带和细胞高度是否存在差异：严重脊柱侧弯组和尸检对照组。在手术规划时，根据侧弯程度和侧弯僵硬程度定义严重程度。从凸侧顶点获取骺板样本，可行时也从凹侧获取。制备组织学切片，并用数字图像测量肥厚带高度、细胞高度和细胞宽度。纳入了13例脊柱畸形患者，平均侧弯程度为67°（±23）。病因包括青少年特发性、先天性、神经纤维瘤病、神经肌肉性和马凡综合征。5例年龄匹配的无脊柱侧弯尸检标本作为对照。结果按病因呈现，然后将所有凸侧脊柱侧弯标本合并并与对照组进行比较。脊柱侧弯组、凸侧和对照组的带高度分别为152 µm（±34）和180 µm（±42）（p = 0.21），细胞高度分别为8.5 µm（±1.1）和12.8 µm（±1.2）（p < 0.0005），细胞宽度分别为14.9 µm（±1.5）和15.0 µm（±2.5）。将人类数据与已发表的动物模型以及应力 - 生长曲线的定量理论进行了比较。这种对脊柱侧弯中椎体骺板结构的量化有望有助于评估进展理论和使用生长调节的潜在治疗方法。© 2018年骨科研究协会。由威利期刊公司出版。《矫形外科学研究》36:2450 - 2459，2018年。
