Yasuma T, Makino E, Saito S, Inui M
J Bone Joint Surg Am. 1986 Sep;68(7):1066-72.
Sagittal and horizontal sections of 257 intervertebral discs obtained at autopsy and material obtained from 441 operations for herniation of a disc were examined histologically. In the material that was taken at autopsy, myxomatous degeneration of the annulus fibrosus increased in proportion to the age of the subject. The bundles in the internal layer of the annulus fibrosus reversed their usual direction and showed myxomatous degeneration, sometimes resulting in posterior and anterior convex bulging in the internal layer of the anterior and posterior parts of the annulus fibrosus, respectively. When material from a disc was surgically removed as a single free fragment (as in a complete extrusion or a sequestration type of herniation), annulus fibrosus with myxomatous degeneration was found in most material, while the nucleus pulposus rarely was. These results suggest that, from the standpoint of pathomechanism, a protrusion type of herniation of the annulus fibrosus exists in which only the annulus fibrosus is protruded due to reversal of the bundles of the annulus fibrosus, without involvement of the nucleus pulposus. This type of herniation would be a separate entity from the protrusion type of herniation of the nucleus pulposus that occurs when the nucleus pulposus is protruded through a fissure in the annulus fibrosus.
对257个经尸检获得的椎间盘矢状面和水平面切片以及441例椎间盘突出症手术所获材料进行了组织学检查。在尸检获取的材料中，纤维环的黏液样变性随受试者年龄增加而增多。纤维环内层的纤维束方向逆转并出现黏液样变性，有时分别导致纤维环前部和后部内层向后和向前凸出。当椎间盘材料作为单个游离碎片手术切除时（如在完全挤出或分离型突出中），大多数材料中都发现了有黏液样变性的纤维环，而髓核很少见。这些结果表明，从发病机制的角度来看，存在一种纤维环突出型的椎间盘突出症，即仅因纤维环纤维束方向逆转导致纤维环突出，而髓核未受累。这种类型的突出与髓核通过纤维环裂隙突出时发生的髓核突出型突出是不同的实体。
