Nutrition of the intervertebral disc
Nutrition of the intervertebral disc
复制标题
椎间盘的营养
DOI：
10.1097/01.brs.0000146499.97948.52
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发表时间：
2004-12-01
期刊：
影响因子：
3
通讯作者：
Fairbank, JCT
中科院分区：
文献类型：
--
作者：
Urban, JPG;Smith, S;Fairbank, JCT
研究设计.椎间盘营养的文献回顾。总结椎间盘营养与椎间盘退变的关系。背景资料总结。椎间盘是无血管的，椎间盘细胞依赖于椎间盘边缘血管的扩散来提供细胞活性和生存力所必需的营养物质，并清除乳酸等代谢废物。由于血液供应的变化、软骨下骨的硬化或终板钙化，所有这些都可以阻止从血液供应到椎间盘的运输或由于细胞需求的变化，营养供应可能失败。综述了椎间盘血液供应、溶质转运、动物和体外人椎间盘溶质转运研究以及研究影响椎间盘营养因素的理论模型研究。少量营养物质，如氧气和葡萄糖，几乎完全通过扩散提供给椎间盘细胞;对流运输，由负荷引起的流体运动进出椎间盘，几乎没有直接影响这些营养物质的运输。因此，在椎间盘上氧、葡萄糖和乳酸的浓度梯度很陡;在乳酸浓度最高的核中心，氧和葡萄糖浓度最低。浓度的实际水平取决于扩散运输和细胞需求之间的平衡，如果终板钙化或营养需求增加，浓度可能会下降到临界水平。营养供应的丧失可导致细胞死亡、基质产生的丧失和基质降解的增加，从而导致椎间盘退变。
Study Design. A review of the literature on disc nutrition.Objectives. To summarize the information on disc nutrition in relation to disc degeneration.Summary of the Background Data. The disc is avascular, and the disc cells depend on diffusion from blood vessels at the disc's margins to supply the nutrients essential for cellular activity and viability and to remove metabolic wastes such as lactic acid. The nutrient supply can fail due to changes in blood supply, sclerosis of the subchondral bone or endplate calcification, all of which can block transport from blood supply to the disc or due to changes in cellular demand.Methods. A review of the studies on disc blood supply, solute transport, studies of solute transport in animal and human disc in vitro, and of theoretical modeling studies that have examined factors affecting disc nutrition.Results. Small nutrients such as oxygen and glucose are supplied to the disc's cells virtually entirely by diffusion; convective transport, arising from load-induced fluid movement in and out of the disc, has virtually no direct influence on transport of these nutrients. Consequently, there are steep concentration gradients of oxygen, glucose, and lactic acid across the disc; oxygen and glucose concentrations are lowest in the center of the nucleus where lactic acid concentrations are greatest. The actual levels of concentration depend on the balance between diffusive transport and cellular demand and can fall to critical levels if the endplate calcifies or nutritional demand increases.Conclusions. Loss of nutrient supply can lead to cell death, loss of matrix production, and increase in matrix degradation and hence to disc degeneration.