Adams M A, Dolan P
University of Bristol, Department of Anatomy, UK.
Lancet. 1997 Sep 6;350(9079):734-5. doi: 10.1016/S0140-6736(97)03021-3.
Epidemiological studies link high repetitive loading of the lower back with degeneration of intervertebral discs, and experiments on cadaver spines confirm that repetitive mechanical loading can disrupt the lumbar discs in a manner characteristic of "degeneration". But why do living discs not just strengthen in response to this stimulus, as other musculo-skeletal tissues do? Our hypothesis proposes that the low metabolic rate of lumbar discs (the largest avascular structures in the body) prevents them from keeping pace with adaptive remodelling changes in adjacent tissues, so that large and abrupt increases in a person's level of physical activity may leave the lumbar discs the weak link in a strengthening and heavily loaded spine. Recent laboratory investigations support the hypothesis, but clinical evidence is required to relate recent disc degeneration with recent increases in physical activity, and so test the hypothesis.
流行病学研究表明,下背部的高重复性负荷与椎间盘退变有关,对尸体脊柱进行的实验证实,重复性机械负荷能够以一种“退变”特征性的方式破坏腰椎间盘。但是,为什么活的椎间盘不像其他肌肉骨骼组织那样,对这种刺激做出强化反应呢?我们的假设是,腰椎间盘(身体中最大的无血管结构)的低代谢率使其无法跟上相邻组织适应性重塑变化的步伐,因此,一个人身体活动水平的大幅突然增加可能会使腰椎间盘成为正在强化且负荷沉重的脊柱中的薄弱环节。最近的实验室研究支持了这一假设,但需要临床证据来将近期的椎间盘退变与近期身体活动的增加联系起来,从而验证这一假设。