先天性肌性斜颈病变组织中脂肪增生与纤维化

The fat tissue hyperplasia and fibrosis in congenital muscular torticollis

目的观察先天性肌性斜颈（congenital muscular torticollis，CMT）病变组织中脂肪增生现象及分布特点，分析脂肪增生程度与纤维化和年龄的关系。方法2009年7月至2011年8月CMT手术病例共i88例，其中男123例，女65例。年龄最小2个月24d，最大16岁，平均2．9岁，年龄分布是，＜7个月33例，7-12个月50例，1-3岁50例，＞3岁50例。对手术切除的病理组织常规石蜡包埋，并获取部分新鲜标本经液氮冰冻处理保存，石蜡标本行HE染色、Masson胶原染色，冰冻标本行苏丹III脂肪染色，对脂肪增生程度和间质纤维化程度进行判定。结果Masson胶原染色结果提示0-3岁纤维化与年龄负相关（r=-0．168，P=0．049），3岁后纤维化与年龄正相关（r=0．281，P=0．001）。苏丹Ⅲ脂肪染色可见橙红色阳性区域即脂肪组织。脂肪增生标本占总标本数的69．68％（131／188），脂肪增生随纤维化加重和年龄增长而加重，且与二者均正相关（P〈0．05）。结论传统的病理发现是胸锁乳突肌纤维化，本研究在常规病理观察中发现脂肪增生现象。增生的脂肪在CMT病变组织内呈团块或条索状堆积分布，其增生程度在不同的CMT标本中也存在差异。脂肪增生参与CMT的基本病理变化，随病变胸锁乳突肌纤维化进程和年龄增长而加重，并可能对肌纤维的病理改变与组织纤维化产生影响。

Objective To observe distribution of fat hyperplasia in tissue of congenital muscular torticollis, and investigate correlations between fat hyperplasia/fibrosis and age in children. Methods Specimens were embedded for HE and Masson staining, and some of them werer frozen using liquid nitrogen for Sudan III staining. Totally 188 CMT （M： 123; F： 65） patients aging from 2 months 24 days to 16 years were investigated, including 75 in left and 113 in right. Results HE staining showed that muscle fibers could be seen around atrophy tissue, hypertrophy and necrosis. Part of the fibers showed the vacuolar degeneration and nuclear suppressive. Masson staining indicated that differential extent of collagen hyperplasia were distributed in perimysium and endomysium, and surrounded by muscle fibers. Sudan III fat staining demonstrated that salmon pink positive area was correlated with distribution of fat hyperplasia in HE stain. Fat hyperplasia could be found in 131 cases of all specimens （69. 68%）. The severity of fat hyperplasia increased with fibrosis area and age. Conclusions Fibrosis is the basic pathologic changes in CMT. Our observation in this study described the phenomenon of fat hyperplasia in CMT. The proliferation of fat clump in the CMT lesions or rope-like stack, and hyper plasia severity varied in specimens. The fat hyperplasia severity will increase with fibrosis and age, and have potential to influent the pathologic change of muscle fibers and tissue fibrosis, and is also basic characteristics in CMT.