Zaleske D J, Ehrlich M G, Huddleston J I
Clin Orthop Relat Res. 1977 Jul-Aug(126):121-6.
To attempt to understand the etiology of failures of chemonucleolysis, biochemical analyses were performed on intervertebral disk material to determine if the enzyme had actually digested the nucleus pulposus proteoglycans. This information was then correlated with the clinical laboratory data to see if a pattern evolved for the failures. Nine chymopapain treated disks, 6 untreated herniated disks and 6 lumbar disks from scoliotic patients were obtained at surgery. The results indicated that 6 out of 9 patients treated with chymopapain had a marked reduction in the proteoglycan (hexosamine) content of their disk compared to the untreated controls. There was a significant inverse correlation of intrinsic lysosomal enzymes and hexosamine content in those cases where the chymopapain failed to destroy the proteoglycan. The other 3 patients, however, had hexosamine levels virtually identical to those disks not treated with chymopapain. The clinical evaluation, consisting of preoperative myelograms, diskograms, the surgeon's observations at laminectomy and evaluation of the postoperative regimen did not explain the failures. This study suggests that the chymopapain failures are not the result of inactivity of the enzyme or failure to digest the nuclear material in at least 6 of the 9 cases. However, there were 3 patients where either the enzyme was not reaching the nuclear material or it was inactive.
为试图了解化学髓核溶解术失败的病因，对椎间盘组织进行了生化分析，以确定该酶是否真的消化了髓核蛋白聚糖。然后将这些信息与临床实验室数据相关联，看是否能找出失败的规律。手术中获取了9个经木瓜凝乳蛋白酶治疗的椎间盘、6个未经治疗的突出椎间盘以及6个脊柱侧凸患者的腰椎间盘。结果显示，与未治疗的对照组相比，9例接受木瓜凝乳蛋白酶治疗的患者中有6例其椎间盘的蛋白聚糖（己糖胺）含量显著降低。在木瓜凝乳蛋白酶未能破坏蛋白聚糖的那些病例中，内在溶酶体酶与己糖胺含量呈显著负相关。然而，另外3例患者的己糖胺水平与未用木瓜凝乳蛋白酶治疗的椎间盘几乎相同。包括术前脊髓造影、椎间盘造影、外科医生在椎板切除术中的观察以及术后治疗方案评估在内的临床评估，均无法解释这些失败情况。这项研究表明，在9例病例中的至少6例中，木瓜凝乳蛋白酶治疗失败并非酶无活性或未能消化核物质所致。然而，有3例患者，要么是酶未能到达核物质，要么是酶无活性。
