脑-颈髓轴索损伤的解剖和取材新方法及其应用  

A new method of anatomy and sampling of brain-cervical spinal cord axonal injury and its application

作　　者：毛彦辉 于晓军 王海鹏 徐广涛[1,3] 赖小平 吕俊耀[1] Mao Yanhui;Yu Xiaojun;Wang Haipeng;Xu Guangtao;Lai Xiaoping;Lv Junyao(Medicolegal Department of Shantou University Medical College,Shantou,Guangdong 515041;Medical College of Beihua University,Jilin 132000;Medicine and Pathology Laboratory of Jiaxing University Medical College,Jiaxing,Zhejiang 314001;Medicolegal Department of Guangdong Medical University,Dongguan,Guangdong 523000)

机构地区：[1]汕头大学医学院法医学教研室,广东汕头515041 [2]北华大学医学院,吉林132000 [3]嘉兴学院医学院法医与病理学实验室,浙江嘉兴314001 [4]广东医科大学法医学教研室,广东东莞523000

出　　处：《中国法医学杂志》2020年第6期642-646,共5页Chinese Journal of Forensic Medicine

基　　金：1989年度吉林医学院科研自选题;1994年国家教委博士点基金(C1037);2007年国家自然基金(30772458);2012年“十二五”科技支撑计划项目子课题(2012BAK02B02)。

摘　　要：目的本文介绍一套提高脑干-脊髓轴索损伤观察效果及其检出率的解剖取材新方法。方法基于1989年至今980例大鼠脑震荡模型的大脑-脑干-颈髓-小脑联合解剖取材法,195例颅脑损伤人尸检案例,先常规开颅切断大脑脚上端,单独提取大脑,再翻转尸体呈俯卧位,锯开枕骨-颈椎,联合提取脑干-颈髓-小脑。常规固定后,正中联合切开脑干-颈髓-小脑,单侧或双侧切取中脑-桥脑中上部-上髓帆-小脑脚及周边小脑组织、桥脑中下部-下髓帆-小脑脚及其周边小脑组织-延脑-颈髓上部,共2或4个组织块。常规HE和嗜银染色,镜检。结果轴索损伤为最常见的脑损伤病变,大鼠760例、人144例,发生率分别约77.6%和73.8%。结论轴索损伤好发于活动度最大的延脑-颈髓、脑干-小脑和颅神经根等"交界区"。平行于脑干神经纤维长轴的解剖取材法,与传统的中脑、桥脑、延脑3段横断面的取材法比较,可获得完整连续的神经纤维组织结构及其成分,操作简单易行,显著提高了轴索损伤形态类型及其检出率,可常规推广应用于法医病理学尸检实践及相关科研。Objective To introduce a new method of forensic pathological anatomy and sampling to improve the detection rate and accuracy of brainstem-spinal cord axonal injury. Methods Tissue blocks were jointly extracted from brain stem, cervical spinal cord and cerebellum in 980 rat brain concussion models since 1989;195 autopsy cases of craniocerebral injury were performed by routine craniotomy to cut off the upper end of cerebral foot and extract the brain separately;then the cadavers were turned into prone position, and the occipital-cervical vertebra, the brainstem-cervical spinal cord-cerebellum were jointly extracted. After routine fixation, the brain stem-cervical spinal cord-cerebellum was cut along the midline, and a piece of 5 mm thick tissue was cut from the left and right sides respectively. Finally, four pieces of tissue were obtained by cutting the mesencephalon-superior pontine-superior medullary sail-cerebellar peduncle and its surrounding cerebellar tissue, and the middle and lower pontine-inferior medullary sail-cerebellar peduncle and its surrounding cerebellar tissue-medulla oblongata-upper cervical spinal cord. Routine HE, argyrophil staining and microscopic examination were performed. Results There were 760 rats and 144 people with axonal injury, with an incidence of about 77.6% and 73.8% respectively, which was the most common brain injury. Conclusion Axonal injury usually occurs in the junction areas with the maximum activity of medulla oblongata-cervical spinal cord, brainstemcerebellum and cranial nerve root with highest activity. Compared with the traditional three cross-sectional methods of mesencephalon, pons and medulla oblongata, the complete and continuous tissue samples of mesencephalonpons-medulla oblongata-cervical spinal cord can be obtained by using the anatomical and sampling method parallel to the long axis of brainstem nerve fibers. This method can detect more morphological types, has a higher detection rate, and can be routinely applied to forensic pathological autopsy practice and

关 键 词：法医病理学 轴索损伤 脑干-颈髓-小脑联合解剖法 平行轴索长轴取材法 

分 类 号：DF795.1[医药卫生—法医学]