椎间盘镜辅助明胶海绵为载体自体骨髓间充质干细胞与富血小板血浆移植修复椎间盘纤维环缺损的实验研究

In recent years, lumbar disc herniation（LDH ）affects increasingly human life as a common and frequently-occurring disease. Microendoscopic discectomy（MED）has become an effective way to solve this disease as a minimally invasive surgery. But fiber ring defect coursed by the operation is one of the important factors of recurrent LDH with 5% to 11% rate. In order to improve the long-term effect of nucleus pulposus enucleation, reduce the recurrence rate forward, using tissue engineering repair fiber ring has become a research hotspot. Bone marrow stromal stem cell（BMSCs）has become the first choice of tissue engineering seed cells in sports system. because of its characteristics with proliferation quickly and multiplex differentiation, Gelatin sponge has long been considered a good scaffold materials in tissue engineering because of its good organization compatibility and loose porous structure. Rich platelet plasma （RPP）can stimulate cell to regenerate disc needed growth factors. Therefore, in this study, we will through the animal experiment and clinical research, choose autologous MSCs as seed cells, gelatin sponge as scaffold, autologous RPP as stimulating factor, build a tissue engineering disc to repair fiber ring defect. Through the histology, imaging, behavior to evaluate short-term and long-term outcome, explore a effective way to repair fiber ring defect.

近年来，腰椎间盘突出症正日益成为影响人类生活的常见病、多发病。内窥镜下髓核摘除术也成为解决这一疾病的行之有效的微创手术方式。但手术导致的纤维环缺损是腰椎间盘突出术后复发的重要因素之一, 其发生率可达5%到11%。因此，为了提高髓核摘除术远期疗效，降低远期复发率，利用组织工程修复纤维环已成为当今脊柱外科基础研究的热点之一。骨髓间充质干细胞（MSCs）因具有增殖快、多向分化等特征，成为组织工程的首选种子细胞。明胶海绵具有良好的组织相容性、可吸收性、疏松多孔的组织结构，一直被认为是组织工程的良好支架材料。富血小板血浆（RPP）能刺激细胞再生椎间盘所需的生长因子。因此，在本实验中，我们将通过动物实验及临床研究，选择自体MSCs作为种子细胞，明胶海绵作为支架，自体RPP作为刺激因子，来构建组织工程椎间盘修复纤维环缺损。通过组织学，影像学，行为学来评价近期疗效及远期疗效，探索一种修复纤维环缺损的途径。

腰椎间盘突出症正日益已成为影响人类生活的常见病、多发病。内窥镜下髓核摘除术已成为解决这一疾病行之有效的微创手术方式。而手术造成的纤维环缺损是术后复发主要危险因素。为了提高手术远期疗效，降低复发率，利用组织工程修复纤维环已成为当今脊柱外科的研究热点。本实验采用山羊作为实验动物，分离具有增殖快、多向分化潜能的山羊骨髓间充质干细胞（BMSCs）以及纤维环细胞（AFs），在体外建立非接触共培养体系，研究表明BMSCs有向纤维环样细胞诱导分化潜能。成功提取富血小板血浆（PRP）并证明了PRP可促进BMSCs增殖。这样在椎间盘镜下，自动神经牵引保护器辅助下，明胶海绵为载体，自体BMSCs作为种子细胞，PRP作为刺激因子，构建组织工程纤维环，移植入山羊纤维环缺损模型，分别于3周、6周、12周进行纤维环修复组织学检测，结果表明纤维环缺损可成功得以修复。该实验为修复纤维环缺损提供新的途径。自动神经牵引保护器的应用极大方便了BMSCs- PRP-明胶海绵移植入缺损纤维环处，可有效缩短实验时间，减少实验出血量，减少神经牵拉伤的发生率，有效防止硬脊膜破裂，在动物实验中反复使用，效果显著，并逐步推广并应用于椎间盘镜下腰椎间盘切除术（MED）临床实践中。