Boden S D, Schimandle J H, Hutton W C, Chen M I
Department of Orthopaedics, Emory University School of Medicine, Decatur, Georgia, USA.
Spine (Phila Pa 1976). 1995 Dec 15;20(24):2626-32. doi: 10.1097/00007632-199512150-00003.
The histology of lumbar intertransverse process spinal fusion was studied in an experimental model in rabbits.
To qualitatively and quantitatively analyze the sequential histology of spinal fusion using a previously validated animal model.
Few previous studies have described the sequential histology during the posterolateral spinal fusion healing process using autogenous bone, and a basic understanding of the biology of this repair process is lacking.
Fourteen adult New Zealand white rabbits underwent single-level posterolateral lumbar intertransverse process arthrodesis with autogenous iliac bone graft. Animals were killed 1-10 weeks after surgery, and the fusion masses were analyzed histologically and quantitated using a semiautomated image analysis system.
Three distinct phases of healing were identified (inflammatory, reparative, and remodeling) and occurred in sequence but in a delayed fashion in the central zone of the fusion mass compared with the outer transverse process zones. Membraneous bone formation, evident first at the ends of the fusion eminating from the decorticated transverse processes, was the predominant mechanism of healing. The central zone was somewhat different in that there was a period of endochondral bone formation during weeks 3 and 4 in this zone where cartilage formed and was converted to bone. Remodeling in the central zone had equilibrated with the transverse process zones by 10 weeks.
Lumbar intertransverse process spinal fusion is a complex process from a spatial and temporal standpoint. When autogenous bone is used as the graft material, this process critically depends on a variety of factors from the decorticated host bone and exposed marrow. The persistence of a central cartilage zone may be related to some types of nonunions and deserves future investigation. This enhanced understanding of the biology of spinal fusion with autogenous bone graft will provide a foundation for optimizing the use of osteoinductive bone growth factors in this healing process.
在兔实验模型中研究腰椎横突间脊柱融合的组织学。
使用先前验证的动物模型对脊柱融合的连续组织学进行定性和定量分析。
以往很少有研究描述自体骨在后外侧脊柱融合愈合过程中的连续组织学，且缺乏对该修复过程生物学的基本认识。
14只成年新西兰白兔接受单节段腰椎横突间后外侧关节融合术并植自体髂骨。术后1至10周处死动物，对融合块进行组织学分析并使用半自动图像分析系统进行定量分析。
确定了三个不同的愈合阶段（炎症期、修复期和重塑期），这些阶段按顺序发生，但与外侧横突区相比，融合块中央区的愈合过程有所延迟。膜性骨形成首先出现在去皮质横突发出的融合端，是主要的愈合机制。中央区有所不同，在第3周和第4周，该区域有一段时间的软骨内骨形成，软骨形成并转化为骨。到10周时，中央区的重塑与横突区达到平衡。
从空间和时间角度来看，腰椎横突间脊柱融合是一个复杂的过程。当使用自体骨作为移植材料时，这个过程严重依赖于来自去皮质宿主骨和暴露骨髓的多种因素。中央软骨区的持续存在可能与某些类型的不愈合有关，值得未来研究。对自体骨移植脊柱融合生物学的深入理解将为在这个愈合过程中优化骨诱导生长因子的使用提供基础。
