儿童扳机拇指增厚腱鞘组织病理的初步研究  

A preliminary study on the histopathology of thickened tendon sheath of the pediatric trigger thumb

作　　者：孙钰涵 袁泉文[1] 赵超晨 王晓东[1] Sun Yuhan;Yuan Quanwen;Zhao Chaochen;Wang Xiaodong(Department of Orthopedics,Children's Hospital of Soochow University,Suzhou 215000,China;Department of Pediatric Surgery,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]苏州大学附属儿童医院骨科,苏州215000 [2]上海交通大学医学院附属儿童医院小儿外科,上海200062

出　　处：《中华小儿外科杂志》2025年第3期244-249,共6页Chinese Journal of Pediatric Surgery

基　　金：学前儿童狭窄性腱鞘炎保守治疗临床研究与技术转化(P113100122)。

摘　　要：目的初步研究儿童扳机拇指(pediatric trigger thumb,PTT)增厚腱鞘组织病理,探讨保守治疗的病理基础。方法收集2022年3月至2022年10月于苏州大学附属儿童医院行手术治疗的患病拇指组织22例,记录患儿一般资料,术中取增厚的拇长屈肌腱鞘组织分别行电子显微镜检查、免疫组织化学染色、蛋白质印迹法(Western blotting,WB)、实时荧光定量聚合酶链式反应(real time quantitative polymerase chain reaction,RT-qPCR)。实验组16例,其中行电子显微镜检查10例(同时进行免疫组织化学染色),WB组3例,RT-qPCR组3例;对照组6例,其中WB对照组3例,RT-qPCR对照组3例。初步分析PTT病理结构,探索其与治疗方式之间的联系。结果10例进行电子显微镜观察的样本镜下可见典型的肌成纤维细胞,细胞中含有波形蛋白样中间丝,免疫组织化学染色可见杂乱无章的胶原纤维,Ⅲ型胶原蛋白未见,其中9例波形蛋白染色阳性,1例β-连环蛋白染色阳性。6例经WB的样本中β-连环蛋白表达在两组间的差异没有统计学意义(P>0.05),Ⅲ型胶原蛋白在两组样本中未表达。6例经RT-qPCR的样本中β-连环蛋白和Ⅲ型胶原蛋白基因表达在两组间差异无统计学意义(P>0.05)。结论儿童扳机拇指拇长屈肌腱鞘样本中呈现的肌成纤维细胞提示病理状况下挛缩的原因,波形蛋白可导致软组织释放后再次复发,两者可引起软组织挛缩。参考马蹄内翻足早期行手法矫正和石膏固定的保守治疗方式,儿童扳机拇指保守治疗的合理性有依据可循。可考虑将β-连环蛋白作为预测术后复发概率的指标,但β-连环蛋白介导的Wnt信号通路在调节与PTT病因相关蛋白形成的过程中变化不显著,还有待在病理学方面进一步详细研究。Objective To study the histopathology of the thickened tendon sheath of pediatric trigger thumb(PTT),and to explore the pathological basis of conservative treatment.Methods A total of 22 thumb tissues of PTT patients surgically treated in the Children's Hospital of Soochow University from March 2022 to October 2022 were collected.General data of PTT cases were recorded.The thickened tendon sheath tissues of flexor pollicis longus were intraoperatively collected for electron microscopy,immunohistochemical staining,Western blotting(WB)and real time quantitative polymerase chain reaction(RT-qPCR).Intraoperatively collected tissues were randomly divided into an experimental group(n=16),and control group(n=6).In the experimental group,10 tissue samples were examined by both the electron microscopy and immunohistochemical staining,3 were examined by WB,and 3 were examined by RT-qPCR.In the control group,3 cases of tissues were examined by WB,and the remaining were examined by RT-qPCR.The pathologic structure of PTT was analyzed and the relationship between PTT and treatment was explored.Results Typical myofibroblasts with vimentin like intermediate filaments were found in 10 thickened tendon sheath tissues of flexor pollicis longus intraoperatively collected from PTT cases by electron microscope.Disorganized collagen fibers were found by immunohistochemical staining,but no typeⅢcollagen was found.Among them,vimentin staining was positive in 9 cases andβ-catenin staining was positive in 1 case.WB showed no significant differences in the protein levels ofβ-catenin and typeⅢcollagen between the two groups(P>0.05).Similarly,there were no significant differences in the mRNA levels ofβ-catenin and type III collagen between the two groups in 6 RT-qPCR samples(P>0.05).Conclusions Myofibroblasts presented in the tendon sheath tissues of flexor pollicis longus from PTT cases suggest the cause of contracture in pathological conditions,and vimentin causes recurrence after soft tissue is released,both of which explain soft t

关 键 词：肌成纤维细胞 儿童扳机拇指 波形蛋白 马蹄内翻足 保守治疗 

分 类 号：R726.8[医药卫生—儿科]