儿童失神经支配马蹄内翻足腓肠肌病理组织学观察

Observation on pathological changes of gastrocnemius muscle in children with denervated talipes equinovarus

目的:观察特发性和继发于脊髓栓系综合征的儿童失神经支配马蹄内翻足腓肠肌病理形态的变化。方法:选取脊髓栓系综合征并行手术治疗的继发性马蹄内翻足23例患儿的29足为试验组,同期治疗的特发性马蹄内翻足12例患儿的17足为对照组。两组术中均取腓肠肌远端肌肉组织,通过光镜、扫描电镜及透射电镜对其形态结构进行观察。结果:光镜下试验组75.9%(22/29)出现肌纤维脂肪变性,对照组为35.3%(6/17),两者比较差异有统计学意义(P=0.007);扫描电镜下试验组44.8%(13/29)出现肌丝强直性收缩,对照组为11.8%(2/17),两者比较差异有统计学意义(P=0.021);透射电镜下试验组大量线粒体空泡化、萎缩、破裂,嵴溶解、断裂、缺失,糖原数量明显减少。结论:继发于脊髓栓系综合征的儿童失神经支配马蹄内翻足腓肠肌出现较严重的超微结构改变,这可能是其畸形较重、矫形困难的一个原因。

Aim:To observe and compare the pathological changes of gastrocnemius muscle in children with idiopathic and secondary talipes equinovarus.Methods:A total of 23 cases(29 feet)of talipes equinovarus were selected as trial group,which were secondary to tethered cord syndrome and were treated by operation.There were 12 cases(17 feet)of idiopathic talipes equinovarus treated at the same time as the control group.The muscle samples of distal gastrocnemius muscle was taken,and its ultrastructure was observed under light microscope,scanning electron microscope and transmission electron microscope.Results:Under light microscope,muscle fiber steatosis was found in 22 feet(22/29,75.9%)in the trial group and only 6 feet(6/17,35.3%)in the control group,and there was significant differences(P=0.007).Under scanning electron microscope,myofilament ankylosing contraction was found in 13 feet in the trial group(13/29,44.8%)and only 2 feet in the control group(2/17,11.8%),and there was significant differences(P=0.021).Under transmission electron microscope,a large number of mitochondria vacuolated,atrophied,ruptured,crest dissolved,broken and deleted,and the number of glycogen decreased significantly in the trial group.Conclusion:The severe ultrastructural pathological changes of gastrocnemius muscle of talipes equinovarus secondary to tethered cord syndrome may be one of the causes of severe deformity and difficulty in orthopaedic treatment.