退行性腰椎滑脱黄韧带病理组织学和免疫组化的观察

Pathological and immunohistochemical observation on the ligamentum flavum of degenerative lumbar spondylolisthesis

目的探讨退行性腰椎滑脱症患者黄韧带椎板间部组织学特征和新生成胶原的主要种类。方法对手术切除的退行性腰椎滑脱椎板间部黄韧带进行常规HE染色和Masson三色改良法胶原染色,同时用免疫组化的方法检测退变黄韧带中Ⅱ型胶原的表达情况,普通光镜观察。结果退行性腰椎滑脱组黄韧带弹力纤维减少,胶原成分显著增加,结构紊乱;免疫组化示基质染色明显深于对照组,其浅黄色至棕褐色阳性表达产物也见于成纤维细胞、成软骨细胞和软骨细胞的胞浆中,Ⅱ型胶原表达阳性率和表达强度与正常组之间差异均具有显著性(P<001或P<005)。结论退行性腰椎滑脱黄韧带退变增生肥厚,并有软骨化和骨化倾向,新生的胶原以Ⅱ型胶原为主。

Objective:To study the pathological features and the type of proliferative collagen of the interlaminar portion of the ligamentum flavum in degenerative lumbar spondylolisthesis(DLS).Methods:Pathological observation with HE staining and Masson trichrome staining and immunostaining for collagen type Ⅱ in DLS were done under optical microscope using surgical specimens of the interlaminar portion of ligamentum flavum from patients.Results:The degenerative ligamentum flavum showed decrease of the elastic fibers and significant increase of collagen fibers,with distorted fibrous structure.The immunostaining of collagen type Ⅱ was more marked in the extracellular matrix of ligamentum flavum in DLS group than that of the control group.Collagen type Ⅱ was also presented in the cytoplasm of fibroblasts,chondroblasts and chondrocytes.The positive expression rate and expression intensity of collagen type Ⅱ in the cell of ligamentum flavum were statistical significane between the DLS group and the control group(P<0.01 or P<0.05).Conclusion:The kind of proliferative collagen in the ligamentum flavum of degenerative lumbar spondylolisthesis is mainly collagen type Ⅱ.There is tendency of chondrogenesis and ossification of the ligamentum flavum in degenerative lumbar spondylolisthesis.