腰椎间盘突出症的超微结构病理研究

Ultrastructural Pathology Study on Lumbar Disc Herniation

目的:从超微结构病理角度研究破碎型腰椎间盘突出症和退变型腰椎间盘突出症的病理机制和病理过程。方法:选取40例腰椎间盘突出症患者的椎间盘手术标本,依术中所见分为破碎型腰椎间盘突出组(破碎组)和退变型腰椎间盘突出组(退变组)。椎间盘标本行光镜和透射电镜检查,对比研究两组形态学差异。结果:光镜检查见破碎组组织破坏,炎细胞浸润,血管化;退变组纤维环增厚,软骨基质增生。电镜检查破碎组见髓核基质溶解,胶原纤维断裂崩解,细胞破碎、坏死;退变组见相对完整纤维环、髓核结构,胶原纤维致密、增生,细胞合成活跃。结论:破碎型腰椎间盘突出症是以组织坏死、基质溶解为主的病理过程。退变型腰椎间盘突出是以增生反应为主反应的病理过程。

Objective： To discuss the pathological mechanism and process of ruptured lumbar disc herniation （RDH） and degenerative lumbar disc herniation （DDH） by ultrastructural study. Methods： Forty lumbar disc herniation cases were divided into RDH and DDH groups by the operational findings. Light microscopy and transmission electron microscopy study were performed for contrast morphology difference study in all specimens. Results：Tissue rupture, inflammation cells infiltration and vascularization were observed in RDH group, and fiber proliferation and cartilage proliferation were observed in DDH group by light microscopy. Marrow nuclear matrix dissolution, collagen fiber rupture, cell rupture and necrosis were observed in RDH, and the relative contact fiber ring and marrow nuclear structure, denseness and proliferation of collagen fiber and active cell synthesis were observed in DDH by transmission electron microscopy. Conclusion： The primary pathological processes are tissue rupture and inflammation cells infiltration in RDH, and the proliferation is the main reaction in DDH.