微观角度下对脊髓栓系综合征终丝病理的综合分析  

Comprehensive analysis of the pathology of the filum terminale in tethered cord syndrome from a microscopic perspective

作　　者：李俞龙 杨记超 姬杉峰 谷浩源 马惠迪 娄永利 Li Yulong;Yang Jichao;Ji Shanfeng;Gu Haoyuan;Ma Huidi;Lou Yongli(Xinxiang Medical University,Xinxiang,Henan 453003,China;Department of Neurospinal Surgery,Zhengzhou Central Hospital Affiliated to Zhengzhou University,Zhengzhou,Henan 450000,China)

机构地区：[1]新乡医学院,河南新乡453003 [2]郑州大学附属郑州中心医院神经脊柱外科,河南郑州450000

出　　处：《中国微侵袭神经外科杂志》2025年第2期92-98,共7页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：郑州市科技攻关项目(编号:222102310652);先进医学研究中心分中心培育研究项目(编号:XJYXZX2021010)。

摘　　要：目的探讨脊髓栓系综合征(tethered cord syndrome,TCS)的病因及发病机制。方法回顾性分析20例TCS患者的临床资料,均采用手术治疗,对手术切除的终丝进行相关病理学处理,并在光镜和电镜下进行微观观察。结果苏木素-伊红染色可见TCS终丝胶原纤维不规则增粗,排列紊乱,走行无规律,同时可观察到神经组织及脂肪化。MASSON染色可见TCS终丝存在明显纤维化及小血管增多。网状纤维染色可见TCS终丝内网状纤维减少,排列稀疏。间苯二酚品红染色可见TCS终丝中弹性纤维数量减少。扫描电镜可观察到TCS终丝胶原纤维直径增粗、排列紊乱,发生异常黏连、融合等,并可见结晶样物质析出,弹性纤维平行胶原纤维排列其中,网状纤维作为支撑将二者连接。透射电镜可见TCS终丝横切面胶原纤维呈现为直径不同的光晕,纵切面可见胶原纤维周期性条纹消失,排列紊乱,以及可观察到血管内皮细胞、成纤维细胞等成分存在。结论造成TCS终丝弹性减退、张力增高的主要原因是胶原纤维、脂肪细胞等非弹性成分异常增生以及弹性纤维、网状纤维减少。Objective To investigate the etiology and pathogenesis of tethered cord syndrome(TCS).Methods The clinical data of 20 patients with TCS were analyzed retrospectively,all of whom were treated by surgery,and the relevant pathological treatment of the surgically resected filum terminal was performed,and microscopic observation was performed under light microscope and electron microscope.Results Hematoxylin-eosin staining showed that irregular thickening,disorganized arrangement,and disordered direction of collagen fibers in the filum terminale of TCS,along with the presence of neural tissue and fatty infiltration.MASSON staining demonstrated significant fibrosis of TCS filum terminale and an increase in small blood vessels.Reticular fiber staining showed a reduction and sparse arrangement of reticular fibers.Resorcin-fuchsin staining indicated a decrease in elastic fibers.Scanning electron microscopy(SEM)revealed thickened and disorganized collagen fibers with abnormal adhesion and fusion,as well as the deposition of crystalline substances.Elastic fibers were observed parallel to collagen fibers,with reticular fibers connecting the two.Transmission electron microscopy(TEM)showed collagen fibers in cross-section with halos of varying diameters,while longitudinal sections displayed the disappearance of periodic striations and disorganized arrangement.Additionally,vascular endothelial cells and fibroblasts were observed.Conclusion The primary causes of reduced elasticity and increased tension in the filum terminale of TCS patients are the abnormal proliferation of non-elastic components such as collagen fibers and adipocytes,as well as the reduction of elastic and reticular fibers.

关 键 词：脊髓栓系综合征 终丝 扫描电镜 透射电镜 

分 类 号：R651.2[医药卫生—外科学]