下背痛是近年來常見的脊椎疾病之症狀，其中椎間盤退化是下背痛產生的主要因子之ㄧ。椎間盤在人體中除了扮演重要的力承載角色，亦為最大無血性組織，是由細胞外基質與內在流體組成的雙相材料，具有孔洞黏彈性質，使內在流體可攜帶養分通透至椎間盤，以維持椎間盤營養之供應與負載之傳遞。此外，椎間盤細胞外基質主要成分為膠原蛋白與蛋白多醣，過去相關研究提及，膠原蛋白交聯為提供椎間盤正常機械性質之重要機制。隨著年齡增長，膠原蛋白含量會隨之變化而影響交聯作用，使得椎間盤機械性質受到改變，導致椎間盤產生退化。
先前相關文獻發現，以交聯製劑梔子素對椎間盤作外源性交聯，可以改善因椎間盤退化所引發脊椎不穩定情形，並且增加椎間盤環狀纖維的機械強度。然而，交聯製劑對椎間盤孔洞黏彈性質產生之影響，至今仍無定論。因此，本研究目的在於以豬隻屍體腰椎椎間盤環狀纖進行體外實驗，探討外源性交聯對其孔洞黏彈性質之變化。
實驗中透過潛變與應力鬆弛兩種黏彈性試驗，根據線性雙相模型，以曲線擬合方法計算環狀纖維之通透性。實驗結果發現，外源性交聯會使環狀纖維勁度上升，潛變變形與應力鬆弛比例下降，代表膠原蛋白交聯增加，可以提升環狀纖維抵抗負載的能力，並且改變環狀纖維之黏彈性質。此外，在孔洞性與通透性也有下降的趨勢，說明經過外源性交聯後，會使得環狀纖維細胞外基質結構更為緊密，並改變其內在流體通透機制，進而影響雙相之拖曳作用，使流體於環狀纖維中不易流動，亦可作為其黏彈性質改變之印證。综合本研究之結果，可作為臨床醫師在使用外源性交聯治療退化性椎間盤病症之評估與參考。

Low back pain is a common symptom of spinal diseases in recent years, and the degeneration of the intervertebral disc (IVD) is a primary factor. The IVD plays an important load-bearing role in human body and it is the largest avascular tissue with biphasic material property that composed of extracellular matrix and interstitial fluid which provide the poroviscoelastic properties. The interstitial fluid carries nutrient that permeates through the IVD for maintaining nutrition supply and load transfer. On the other hand, the major components of extracellular matrix of IVD are collagen and proteoglycan. Previous studies suggested that the collagen crosslink can provide an important mechanism for normal mechanical nature of IVDs. When people grow older, collagen contents may be influenced by the crosslinking action, then the mechanical properties of IVDs may be affected and further IVD degeneration may be seen.
Previous literature suggested that by utilizing crosslinking reagent such as genipin for exogenous crosslinking to IVDs can improve spinal instability that induced by IVD degeneration, and increase the mechanical strength of annulus fibrosus. However, the effects of the crosslinking reagent on the poroviscoelastic properties of IVD are still unclear. Therefore, this study aims to investigate the effects of exogenous crosslinking on the poroviscoelastic properties of annulus fibrosus of lumbar IVD using in vitro experiments of porcine cadaver lumbar IVDs. Both the creep and stress-relaxation experiments were implemented. The curve-fitting method based on a linear biphasic model was used to calculate the permeability of annulus fibrosus of IVDs. From the result findings, the stiffness increased while the creep deformation and relaxation ratio decreased when exogenous crosslinking was applied to annulus fibrosus. This represents that increasing collagen crosslink can promote load resistance ability and change the viscoelastic properties of annulus fibrosus. Besides, the porosity and permeability were reduced. This result explains that when the structure of extracellular matrix becomes more compact, the permeability mechanism of interstitial fluid will be changed, and then the drag induced from biphasic interaction may cause fluid flowing difficulty in annulus fibrosus. This observation may be a further demonstration on the change of poroviscoelastic properties. In summary, this study can provide assessment and reference to clinicians when utilizing exogenous crosslinking treatment for intervertebral degenerative disc disease.

總目錄
摘要 I
Abstract III
謝誌 IV
總目錄 VI
表目錄 IX
圖目錄 X
第一章 緒論 1
1-1 前言 1
1-2 研究背景 3
1-3 研究目的 4
1-4 文獻回顧 5
1-4-1 利用力學測試探討流體通透性之相關研究 5
1-4-2 加入外源性因子改變椎間盤機械性質之相關研究 13
第二章 理論基礎 18
2-1 椎間盤生理結構 18
2-1-1 脊椎解剖構造 18
2-1-2 椎間盤解剖構造 18
2-1-3 椎間盤營養傳導與衰退 19
2-2 膠原蛋白交聯機制 23
2-3 交聯製劑梔子素概述 24
2-4 雙相孔洞黏彈性材料 27
2-4-1 孔洞性與通透性關係 27
2-4-2 黏彈性材料 29
2-4-2-1 潛變 29
2-4-2-2 應力鬆弛 30
第三章 材料與方法 31
3-1 材料製備 31
3-1-1 試片製備 31
3-1-2 交聯劑製備 31
3-2 實驗流程 34
3-3 孔洞性分析 35
3-4 力學測試 36
3-4-1 潛變試驗 37
3-4-2 應力鬆弛試驗 38
3-5 通透性分析之數學模型 41
3-6 統計分析 43
第四章 結果 44
4-1 孔洞性結果 44
4-2 黏彈性結果 46
4-2-1 潛變試驗結果 46
4-2-2 應力鬆弛試驗結果 51
4-3 通透性結果 54
第五章 討論 58
5-1 孔洞性討論 59
5-2 黏彈性討論 61
5-3 通透性討論 64
5-4 研究限制 68
第六章 結論 69
參考文獻 70

表目錄
表一 實驗組與控制組之孔洞性結果 44
表二 10N潛變下，實驗組與控制組之勁度與潛變變形結果 47
表三 20N潛變下，實驗組與控制組之勁度與潛變變形結果 47
表四 30N潛變下，實驗組與控制組之勁度與潛變變形結果 48
表五 10N應力鬆弛下，實驗組與控制組之應力鬆弛結果 52
表六 20N應力鬆弛下，實驗組與控制組之應力鬆弛結果 52
表七 30N應力鬆弛下，實驗組與控制組之應力鬆弛結果 52
表八 10N之通透性結果 54
表九 20N之通透性結果 55
表十 30N之通透性結果 55

圖目錄
圖1 脊椎：(A)前視(B)後視(C)側視 20
圖2 人體椎間盤與韌帶之側視 21
圖3 人體椎間盤與韌帶：(A)前視(B)上視 21
圖4 人體椎間盤構造 22
圖5 椎間盤組成方式：(A)細胞外基質(B)流體通透示意圖 22
圖6 (A)健康椎間盤(B)退化椎間盤 22
圖7 梔子素分子結構式 25
圖8 梔子花與其果實 25
圖9 梔子素於水中開環機制之示意圖 26
圖10 梔子素與甲胺基反應之示意圖 26
圖11 流體通透示意圖 28
圖12 (A)潛變時組織表現示意圖(B)潛變之力量與位移對照圖 29
圖13 (A)應力鬆弛時組織表現示意圖 30
圖14 豬隻腰椎 32
圖15 豬隻腰椎活動元 32
圖16 取樣之套管針 32
圖17 試片之幾何尺寸：(A)直徑3mm(B)厚度5mm 33
圖18 取樣區域示意圖 33
圖19 試片於離心管內進行浸泡 33
圖20 實驗流程圖 34
圖21 力學測試用夾治具 39
圖22 試片放置處：(A)拘束性金屬環(B)具孔洞金屬薄板 39
圖23 夾治具之底座 39
圖24 夾治具之探頭 39
圖25 力學測試示意圖 40
圖26 環狀纖維受力學測試裝置圖 40
圖27 實驗組與控制組之孔洞性比較 45
圖28 實驗組與控制組之勁度比較：(A)10N(B)20N(C)30N 49
圖29 實驗組與控制組之潛變變形比較：(A)10N(B)20N(C)30N 50
圖30 實驗組與控制組之應力鬆弛比例比較：(A)10N(B)20N(C)30N 53
圖31 潛變下，實驗組與控制組之通透性比較：(A)10N(B)20N(C)30N 56
圖32 應力鬆弛下，實驗組與控制組之通透性比較：(A)10N(B)20N(C)30N 57
圖33 控制組之各區域試片孔洞性與過去文獻比較 60
圖34 不同區域孔洞性比較 60
圖35 不同負載之勁度比較 63
圖36 使用線性雙相模型曲線擬合情形(A)潛變擬合(B)應力鬆弛擬合 67

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