Research progress in pathogenesis of ossification of ligamentum flavum

doi:10.3969/j.issn.2095-4344.2016.33.015

Abstract

Abstract:

BACKGROUND: Current studies on the pathogenesis of ossification of the ligamentum flavum are still in a preliminary stage, and any single factor influencing incidence of ossification of ligamentum flavum cannot completely explain the pathogenesis of this disease.
OBJECTIVE: To summarize the pathogenesis of ossification of ligamentum flavum.
METHODS: A computer-based online search was conducted in PubMed, Wanfang, and CNKI databases from January 1990 to December 2015 to screen the relevant literatures regarding the pathogenesis of ossification of the ligamentum flavum using Chinese and English key words “ossification of ligamentum flavum, basic research, pathogenesis, gene, bone morphogenetic protein, osteopontin”. Consequently, 63 eligible literatures were included after the exclusion of the repetitive and old ones.
RESULTS AND CONCLUSION: Current studies have shown that ossification of the ligamentum flavum is a disease that results from multiple genetic and environmental causes and is one of the main causes of spinal stenosis. Tissue degeneration, local biomechanics, genetic factors, metabolic disorders, trace elements and vascular inflammation are all shown to be involved in the pathogenesis of ossification of ligamentum flavum.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: Ligamentum Flavum, Dissection, Heredity, Bone Morphogenetic Proteins

CLC Number:

R318

Dong Xing-cheng, Jia Lian-shun, Chen Xiong-sheng. Research progress in pathogenesis of ossification of ligamentum flavum[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(33): 4971-4978.

Figures/Tables 1

2.1 流行病学分析流行病学调查显示，黄韧带骨化的发病有家族倾向、种族差异及性别差异[9-10]。黄韧带骨化在黄种人群的发病率较高，主要分布于中日韩等亚洲国家，尤以日本为显著；而欧美及非洲的高加索人、加勒比人以及黑人发病率较低[11-13]。黄韧带骨化的种族差异表明可能与某种遗传因素相关。该病为中老年性疾病，Aizawa等[14]研究发现男性的高发年龄段在60岁左右，而女性其高发年龄段在50-70岁，随年龄增长呈增高趋势，男性发病较女性多，发病率之比为2-3∶1，平均发病年龄约为61岁。在年龄超过65岁的亚洲人中，韧带骨化的发病率可高达20%，而对于欧美人群的发病情况却罕见报道[15]。 2.2 解剖结构退变相关因素黄韧带骨化的发生与其解剖基础有着密切的联系。一些学者采用尸体做研究，Lirk等[16]研究者行尸体研究发现，下胸段双侧黄韧带的汇合连接，构成了解剖学的体积变小。黄韧带骨化多发于中老年人，以下胸段多见。Kobayashi等[17]认为黄韧带骨化的发生与解剖相关，因骨化常发生于韧带与骨连接处，C6/7节段以上的关节囊部黄韧带未与骨性部位相连，C6/7以下关节囊部与椎板间部分均与骨性部位相连，故颈椎黄韧带骨化少见，而胸椎黄韧带骨化常见。弹性纤维异常是黄韧带骨化的一个表现，颈椎的屈伸活动使动态压力反复作用而有利于弹性纤维的维持；胸椎和脊柱胸腰段由于长期静态张力致弹性纤维丢失，代之以胶原增生、成纤维细胞向软骨样细胞分化及韧带骨化的出现(图2)。Hadley- Miller等[18]国外学者研究发现编码原纤维的单基因在黄韧带骨化患者身上发生突变，该基因位于第15条染色体上，突变后会引起成纤维细胞所合成的原纤维无法结合胶原纤维，进而导致弹性纤维解剖学上的形成异常。但尚缺乏进一步研究证实黄韧带骨化的发生与此基因的相关性。黄韧带骨化的发生常伴有前纵韧带、后纵韧带等骨化，邻近关节突关节的增生肥大以及相应椎体的骨质增生骨赘形成，该病理变化与慢性退行性改变相一致。同样的结论也得到了Jayakumar等[19]学者的研究表明黄韧带骨化患者病理检测结果为黄韧带呈软骨样改变，内部胶原纤维大量增生，而起连接作用的弹性纤维明显减少，向骨化过度，为典型的慢性退行性变。"

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