| Objective:1.Observe the cartilage endplates and pedicles through histology to understand the histological changes of cartilage endplates and pedicles in the apical vertebral region of patients with severe rigid spinal deformity,and to investigate the changes of vertebral disc wedge deformation in patients with severe rigid spine deformity.Correlation between the cartilage endplates.2.The expression of BMP,TGF,FGF,and IGF in cartilage endplates and pedicles was measured by immunohistochemistry.The expression differences of various growth factors in cartilage endplates and pedicles of the apical vertebra were compared.It further reveals the potential role of cartilage endplate growth factor expression in the development of severe rigid spinal deformities in patients with severe spinal deformities.Methods:Ten patients with severe rigid spinal deformity identified by imaging examination were enrolled.Among them,6 were female and 4 were female.The average age of visits was 17.6 years.The apical vertebra was located on the T6-T12 plane.The preoperative Cobb angle was 96°-158° with an average of 127.7°,and the combined kyphosis Cobb angle was 85°-150° with an average of 115°.The degree of stiffness of the deformity was routinely assessed before surgery(the degree of flexion of the main curve of the patient's kyphosis and scoliosis on the X-ray film was<10%).PVCR surgery was performed after the exclusion of surgical contraindications and informed consent of the patient.The top vertebral region was fully revealed during the operation.After ligation of the segmental arteries,the pedicle and cartilage endplate specimens were obtained by the surgeon.Hematoxylin-eosin staining was performed on the specimens to observe the histological changes of cartilage endplates and pedicles in the apical vertebral region of patients with severely rigid spinal deformities.At the same time,specimens were subjected to immunohistochemical studies to observe the apical vertebral regions.The pathological changes of the roots and cartilage endplates and the distribution of TGF,FGF,BMP,and IGF in the pedicle and cartilage endplates in the apical vertebral region of patients with severely rigid spinal deformities,the resulting immunohistochemical images were input to the image analysis system.A semi-quantitative analysis was performed and statistical analysis was performed on the corresponding sites on the convex side and concave side of the apical vertebra.The p<0.05 level was considered significant.Results:1.Observed significant wedge deformation of the vertebral body and intervertebral disc in patients with severe rigid spine deformity during surgery,accompanied by different degrees of rotation,bilateral pedicle development is not true,the concave side of the pedicle becomes shorter and thinner,cancellous The bone marrow cavity narrowed and even disappeared into the cortical bone,with the apical vertebral area being the most obvious,consistent with imaging observations.The appearance of cartilage endplates appeared white during surgery,and the cartilage endplates on the concave side were significantly thinner than those on the convex side.X-ray imaging showed that post-PVCR spinal deformity was significantly improved in patients with severe rigid spine deformity.2.The results of HEstaining showed that the cartilage layers of the apical cartilage of severely rigid spinal deformity all have varying degrees of thinning,the cells are arranged disorderly and are not parallel to the surface;the cartilage matrix is uneven,and the concave side is thin or not,within the cartilage matrix.Some appear to have multiple fissures,fibrosis in the matrix is aggravated,and focal calcification may be associated.Some of the chondrocyte aggregation phenomenon occurred,the line was irregular,and the concave side was more disordered.The top vertebral pedicle convex lateral bone porosity increased,the apical pedicle of the concave side of the bone density increased.3.Immunohistochemical staining showed that bFGF,BMP and TGF had similar expression characteristics.The specific expression status of the apical pedicle on the convex side(1.09±0.22,2.67±0.22,3.96±10.07)was higher than that on the concave side.(0.27±0.02,0.34±0.03,0.64±0.1)were statistically significant(P=0.03,t=5.92;P=0.002,t=20.73;P=0.0001,t=34.12);Apical vertebra cartilage endplate side The expression of the convex side(0.60±0.07,1.82±0.16,2.78±0.2)was significantly higher than that of the concave side(0.248±0.04,0.15±0.04,0.49±0.04)(P=0.03,t=5.55;P=0.004).,t = 15.19;P = 0.002,t = 24.85).However,there was no difference in the expression of the concave side and convex side of the apical cartilage endplate of TGF.The BMP and TGF apical vertebra cartilage end-plate convex side(4.14±0.19,7.54±0.51)expression was higher than the concave side(2.61 ±0.53,4.92±0.39)statistically significant(P=0.04,t=4.34;P= 0.04,t=5.09).The specific expression intensity of IGF expression in contrast to bFGF,BMP,and TGF was statistically significant(P=0.003,t=17.80),which was lower than that of the concave side(2.65±0.21)on the apical pedicle(0.28±0.04).The vertebral cartilage end-plate convex side(3.75±0.12)expression was significantly lower than the concave side(6.97±0.47)with statistical significance(P=0.01,t=9.61);the apical cartilage cartilage endplate convex side(0.02±)0.00)The expression was statistically significantly lower than the concave side(0.14 ± 0.03)(P=0.02,t = 6.39).Conclusion:1.Severe rigid spinal deformity patients are different degree of wedge discs,vertebral bodies asymmetric pedicle development.2.Severe rigid spinal deformity patients top vertebral pedicle and cartilage endplate the expression of growth factors vary.3.Growth factor in deformed spine is concave and convex side expressed the imbalance may be severe spinal deformity of vertebral wedge change,one of the main reasons for occurrence and development of spinal deformity. |
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