中耳胆脂瘤破坏听小骨的形态学研究

The morphological study of eroded auditory ossicles by cholesteatoma

目的:观察胆脂瘤破坏听小骨的形态学结构变化,探讨胆脂瘤的骨质破坏机制。方法:光镜观察8例胆脂瘤破坏听小骨和2例正常听小骨的形态学。透射电镜观察5例胆脂瘤破坏听小骨,2例正常外耳道对照骨的超微结构。结果:胆脂瘤破坏听小骨中有骨髓炎和活性破骨细胞存在,骨质破坏和骨质增生同时存在,膜内成骨和软骨内成骨2种成骨方式均可见。结论:破骨细胞参与的陷窝性骨吸收在胆脂瘤的骨质破坏中发挥一定的作用。胆脂瘤的破坏骨中有骨髓炎存在,窦性骨吸收在胆脂瘤的骨质破坏中发挥重要的作用。膜内成骨和软骨内成骨共同参与胆脂瘤骨质破坏后的重建,新骨生成也是胆脂瘤中的基本病理改变。

Objective：To observe the morphology of eroded auditory ossicles obtained in middle ear surgery for cholesteatoma and to investigate the mechanism of bone erosion in cholesteatoma. Method： The morphology of eroded auditory ossieles in 8 cholesteatoma eases and 2 normal eases were observed with light microscopy. The ultrastructure of eroded auditory ossieles in 5 cholesteatoma eases and the ultrastrueture of control bones in external ear canal of 2 eases were observed and compared with transmission electron microscopy. Result： Osteomyelitis and multinueleate osteoelasts with ruffled borders were observed in the eroded auditory ossieles of cholesteatoma. Intramembranous and endoehondral ossification were both observed. The obvious bone destruction and remodeling were observed coexistently. Conelusion：Osteoclasts and Osteomyelitis are both responsible for bone destruction in cholesteatoma. Intramembranous and endoehondral ossification may co-participate in hone remodeling. Osteogenesis is also a basic pathologic phenomena in cholesteatoma. The obvious bone destruction and remodeling can coexist in cholesteatoma cases.