青少年特发性脊柱侧凸患者终板软骨的组织形态学研究

Histomorphological study of the spinal endplate cartilages in adolescent idiopathic scoliosis

目的:观察青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者终板软骨的组织学形态,探讨其与AIS发生、发展的关系。方法:20例AIS患者,前路手术时分别获取20份顶椎及18份下端椎终板软骨,每份均包含凸侧与凹侧。切片行HE染色,光镜下观察终板软骨组织形态,采用病理图像分析系统测量终板软骨肥大区的厚度、细胞巢面积、巢内细胞数及增殖区细胞数(个/视野)。参照Enneking法设定曲度因子(factorof curve,FC),将顶椎标本分为FC≤6组(11例)和FC>6组(9例)。比较上述指标在不同部位、不同FC分组下的差异。结果:顶椎凸侧的上述指标均显著高于凹侧(P<0.05);下端椎仅凸侧肥大区细胞巢平均面积显著大于凹侧(P<0.05);顶椎与下端椎间同侧比较,仅下端椎凹侧肥大区的细胞数显著大于顶椎(P<0.05)。FC>6组的顶椎凸侧和凹侧终板软骨肥大区的巢内细胞数显著小于FC≤6组(P<0.05),FC>6组的凸侧增殖区细胞数也显著小于FC≤6组(P<0.05)。结论:AIS患者终板软骨的组织学变化特征更倾向于与脊柱不同部位、不同状态下机械应力差异有关的继发性改变;但组织学变化与机械应力变化之间不完全平行,AIS的发生、发展可能伴有生物力学以外的因素。

Objective：To investigate the histomorphology of endplate cartilages in apex and lower extreme vertebrae of patients with adolescent idiopathic scoliosis （AIS） and explore the correlation between the histomorphology and the genesis and progress of AIS.Method：Twenty cases with AIS were recruited in the study. 20 samples of endplate cartilages in apex vertebra and 18 ones in inferior extreme vertebra were obtained respectively through anterior approach operation.Each included the convex and concave side.Hematoxylin ＆ eosin （HE） staining was employed and the structure of endplate cartilage was observed under light microscope,then the pathological image analysis system was used for quantitative measurement of thickness of the hypertrophic zone in endplate cartilage,the average area of cell-nest,the average number of cells inside cell-nest or the proliferative zone of each visual field（piece/visual field）.Factor of curve（FC） was determined according to Enneking method,and samples from apex vertebra were divided into FC≤6 group （11 cases） and FC〉6 group（9 cases）.The above measurements between different parts or groups were compared.Result：In the apex vertebrae,the all measurements of the convex side were significantly higher than that of the concave side（P〈0.05）.In the extreme vertebrae,only the average area of cell-nest in the hypertrophic zone of the convex side was significantly higher than that of the concave side（P〈0.05）.On the comparison of ipsilateral side, only the average number of cells inside cell-nest in the concave side in the extreme vertebrae was significandy higher than that in the apex vertebrae （P〈0.05）.No matter whether in the convex or concave side of the apex vertebrae,the average number of cells inside cell-nest was significantly lower in FC〉6 group than in FC≤6 group （P〈0.05）.For the proliferative zone of convex side,the average number of cells for each visual field was significantly lower in FC〉6 group compared with that of FC≤6 group （P〈0.05）.Conclusion：The histomorphological changes of the endplate cartilage are likely to be the secondary changes associated with the difference of mechanical stress occuring in various parts of the spine under different state.There may exist the factors beyond biomechanics on the genesis and progress of AIS as the changes between histomorphology and mechanical stress were not totally paralleled.