摘要
腰椎间盘突出症(lumbar disc herniation,LDH)是指由腰椎间盘退变、生物力学环境恶化、免疫炎症反应形成等因素,导致椎间盘内组织突出压迫神经引发的以腰腿痛为主要症状的综合征。巨大游离型腰椎间盘突出髓核脱出游离,常伴较重的临床症状,往往需要手术治疗。自腰椎间盘突出后重吸收的现象被发现并提出后,相关文献不断涌现,更有学者表明巨大游离型突出重吸收率更高,但其发生机制尚未完全明确,本文就近年来关于巨大游离型腰椎间盘突出后重吸收机制进行回顾总结,目前研究内容主要包括:免疫炎症反应、血管与淋巴管的形成、基质金属蛋白酶、脱水、细胞自噬与凋亡、张力施加等。基于重吸收的上述机制理论,笔者认为在巨大游离型LDH的治疗中应维持炎症反应,同时应以患者临床症状为主要手术评估标准,避免过度治疗所导致的不必要的社会经济与医疗负担。
Lumbar disc herniation refers to a syndrome mainly characterized by low back and leg pain caused by factors such as degeneration of the lumbar intervertebral disc,deterioration of the biomechanical environment,and formation of immune inflammatory reactions,which lead to the protrusion of intradiscal tissue and compression of nerves.In cases of massive migrated lumbar disc herniation,the nucleus pulposus is prolapsed and migrated,often accompanied by severe clinical symptoms and usually requiring surgical treatment.Since the phenomenon of resorption after lumbar disc herniation is discovered and proposed,relevant literature has continuously emerged.Some scholars have indicated that the resorption rate of massive migrated protrusions is higher,but its mechanism has not been fully clarified.This article reviews and summarizes the resorption mechanisms of massive migrated lumbar disc herniation in recent years.The current research contents mainly include immune inflammatory reactions,the formation of blood vessels and lymphatics,matrix metalloproteinases,dehydration,cell autophagy and apoptosis,and tension application.Based on the above mechanism theory of resorption,we believe that in the treatment of massive migrated LDH,inflammatory reactions should be maintained.At the same time,the patient's clinical symptoms should be used as the main surgical evaluation criterion to avoid unnecessary social,economic,and medical burdens caused by overtreatment.
作者
唐振宇
李子航
李亚浩
王宇铖
朱广晔
李超
姜宏
俞鹏飞
TANG Zhen-yu;LI Zi-hang;LI Ya-hao;WANG Yu-cheng;ZHU Guang-ye;LI Chao;JIANG Hong;YU Peng-fei(Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine,Suzhou 215009,Jiangsu,China)
出处
《中国骨伤》
2025年第11期1177-1181,共5页
China Journal of Orthopaedics and Traumatology
基金
国家自然科学基金项目(编号:82004393)
国家自然科学基金项目(编号:82474529)
国家自然科学基金项目(编号:82374220)
国家自然科学基金项目(编号:82405427)
苏州市科技发展计划项目(编号:SKY2023066)
苏州市姑苏卫生人才计划人才科研项目(编号:GSWS2021049)。
关键词
腰椎间盘突出症
巨大游离型
重吸收机制
综述
Lumbar disc herniation
Massive migrated
Reabsorption mechanism
Literature
