腰椎间盘突出症髓核组织的超微病理观察

Ultrapathological observation on nucleus pulposus with herniated lumbar intervertebral discs

目的 :观察腰椎间盘突出症中髓核组织的超微结构改变 ,探讨其发病机理。方法 :应用电镜技术 ,对 19例患者手术中取出的髓核组织进行详细的超微结构观察 ,并探讨其病变程度与临床表现的关系。结果 :1)软骨样细胞减少 ,多呈不同程度地退变、死亡 ,细胞外周致密颗粒增多 ,并与其退变程度成正相关。 2 )胶原原纤维发生不同程度的变性、融合、扭结或钙化 ,胶原纤维束间裂隙增大。斑块状扭结的数量与胶原原纤维的退变程度成正比。 3)弹力纤维数量减少 ,伴老化、变性。 4 )髓核退变程度与患者的年龄、病程成正相关 ,而与临床表现的严重程度无明显相关。结论 :胶原原纤维的扭结和致密颗粒的数量是判断髓核退变程度的重要指标。多种因素诱发髓核组织多种成份。

Objective: To investigate the pathogenesis of lumbar disc herniation by means of observing the ultrastructural changes of nucleus pulposus.Methods: Under electron microscope, 19 specimens obtained from lumbar discectomy were observed. and the relationship between the nucleus pulposus degradation and clinic manifestations was studied statistically.Results: 1) Most chondrocyte like cells were degenerated or necrotic and their number decreased markedly. The quantity of dense particles positively correlated to the degree of chondrocyte like cell degeneration. 2) Collagenous fibrils appeared various kinds of degeneration including fusion, twist and calcification. There were gaps between the collagen bundles. The number of twisting collagenous fibrils closely correlated with the degree of fibrous degeneration. 3) The density of elastic fiber apparently decreased and showed senile changes and degeneration. 4) The degree of nucleus pulposus degradation was significantly associated with the age and the course,but was not with the severity of clinic manifestation.Conclusion:The ultrastructural changes such as collagenous fibril twists and dense particles are reliable indicators to identify the degree of nucleus pulposus degeneration. There are multiple factors giving rise to the degeneration of nucleus pulposus , which includs the changes of cell and stroma elements, and varies in degrees of severity, and eventually causes lumbar intervertebral disc herniation.