游离型腰椎间盘突出的组织学观察

Histopathological changes of sequestration-type lumbar herniated disc

目的观察游离型腰椎间盘突出组织的病理学改变,并探讨影响其自然吸收的相关因素。方法对经手术治疗的37例39个游离型腰椎间盘突出组织行HE染色及免疫组化研究。HE染色用于观察突出组织的病理来源;免疫组化研究包括CD68、CD34染色,分别用于观察突出组织巨噬细胞浸润程度及新生血管形成程度。按髓核组织含量将突出组织分为3组:髓核组、含髓核组及不含髓核组,分析巨噬细胞浸润程度、新生血管形成程度与年龄、病程、病理来源以及影像学各因素的相关性。所有资料采用单因素方差分析或直线相关分析。结果游离型突出组织以髓核为主的占62%,92%的游离型突出组织周围有新生肉芽组织形成。在新生肉芽组织内可见新生血管周围大量巨噬细胞浸润。3组间新生血管形成程度、巨噬细胞浸润程度差异均有统计学意义(F=5.663,P=0.008;F=3.604,P=0.038)。突出组织的巨噬细胞浸润程度、新生血管形成程度与年龄、病程无显著相关,与突出组织大小呈显著正相关关系(r=0.342,P=0.033;r=0.440,P=0.005);且当突出组织MRI相对信号强度为0.30～0.72时,其巨噬细胞浸润程度、新生血管形成程度最显著。结论多数游离型腰椎间盘突出组织以髓核组织为主要来源,并呈现不同程度的自然吸收现象。突出组织的自然吸收程度与年龄、病程无关,与突出组织的病理来源显著相关;当突出组织越大、突出组织相对信号强度为0.30～0.72时,自然吸收程度越显著。

Objective To demonstrate the histopathological changes of sequestration-type herniated disc, and investigate the related factors of its absorption. Methods 39 tissue samples were surgically removed from 37 patients with sequestration-type lumbar disc herniation. All the tissues were performed with HE stain and immunohistochemical study. In HE stain, the origin of tissue was identified; in immunohistochemical study, anti-CD34 antibody was used for detecting the vascular endothelial ceils, and anti-CD68 for macrophages. The sequestration-type lumbar disc was divided into 3 groups according to the content of nucleus pulposus： nucleus pulposus group, nucleus pulposus contained group and non-nucleus pulposus group. The correlation between the extent of angiogenesis and macrophage infiltration and the factor of age, disease duration, origin of sequestrated tissue and imaging features was studied. Results 62% （24/39） of the sequestrated tissues were mainly originated from nucleus pulposus. Granulation tissue with many macrophages around new blood vessels was found in 92%（36/39） of the sequestrated tissues. There was a significant difference of the extent of angiogenesis and macrophage infiltration among these 3 groups in terms of the content of nucleus pulposus group （F=5.663, P=0.008; F=3.604, P=0.038）. There was no significant correlation between the extent of angiogenesis and macrophage infiltration and age or disease duration, whereas, a positive significant correlation was found for the size of sequestrated tissue （r=0.342, P=0.033; r=0.440, P= 0.005）. Furthermore, the extent of angiogenesis and macrophage infiltration was significant when the relative signal intensity of sequestrated tissue on MRI was in 0.30-0.72. Conclusion The origin of sequestrationtype herniated disc is mainly from nucleus pulposus, and most of the sequestration tissue can be absorbed in different extent. The extent of spontaneous absorption was mainly depended on the origin of the sequestration tissue, but not the age or disease duration. Predominant absorption is found in bigger size of the sequestration tissue and their relative signal intensity on MRI being 0.30-0.72.