CAJ | 학술논문

目的观察先天性肌性斜颈(congenital muscular torticollis,CMT)病变组织中脂肪增生现象及分布特点,分析脂肪增生程度与纤维化和年龄的关系.方法 2009年7月至2011年8月CMT手术病例共188例,其中男123例,女65例.年龄最小2个月24d,最大16岁,平均2.9岁,年龄分布是,＜7个月33例,7～12个月50例,1～3岁50例,＞3岁50例.对手术切除的病理组织常规石蜡包埋,并获取部分新鲜标本经液氮冰冻处理保存,石蜡标本行HE染色、Masson胶原染色,冰冻标本行苏丹Ⅲ脂肪染色,对脂肪增生程度和间质纤维化程度进行判定.结果 Masson胶原染色结果提示0～3岁纤维化与年龄负相关(r=-0.168,P=0.049),3岁后纤维化与年龄正相关(r=0.281,P=0.001).苏丹Ⅲ脂肪染色可见橙红色阳性区域即脂肪组织.脂肪增生标本占总标本数的69.68％(131/188),脂肪增生随纤维化加重和年龄增长而加重,且与二者均正相关(P＜0.05).结论传统的病理发现是胸锁乳突肌纤维化,本研究在常规病理观察中发现脂肪增生现象.增生的脂肪在CMT病变组织内呈团块或条索状堆积分布,其增生程度在不同的CMT标本中也存在差异.脂肪增生参与CMT的基本病理变化,随病变胸锁乳突肌纤维化进程和年龄增长而加重,并可能对肌纤维的病理改变与组织纤维化产生影响.
목적 관찰선천성기성사경(congenital muscular torticollis,CMT)병변조직중지방증생현상급분포특점,분석지방증생정도여섬유화화년령적관계.방법 2009년7월지2011년8월CMT수술병례공188례,기중남123례,녀65례.년령최소2개월24d,최대16세,평균2.9세,년령분포시,＜7개월33례,7～12개월50례,1～3세50례,＞3세50례.대수술절제적병리조직상규석사포매,병획취부분신선표본경액담빙동처리보존,석사표본행HE염색、Masson효원염색,빙동표본행소단Ⅲ지방염색,대지방증생정도화간질섬유화정도진행판정.결과 Masson효원염색결과제시0～3세섬유화여년령부상관(r=-0.168,P=0.049),3세후섬유화여년령정상관(r=0.281,P=0.001).소단Ⅲ지방염색가견등홍색양성구역즉지방조직.지방증생표본점총표본수적69.68％(131/188),지방증생수섬유화가중화년령증장이가중,차여이자균정상관(P＜0.05).결론 전통적병리발현시흉쇄유돌기섬유화,본연구재상규병리관찰중발현지방증생현상.증생적지방재CMT병변조직내정단괴혹조색상퇴적분포,기증생정도재불동적CMT표본중야존재차이.지방증생삼여CMT적기본병리변화,수병변흉쇄유돌기섬유화진정화년령증장이가중,병가능대기섬유적병리개변여조직섬유화산생영향.
Objective To observe distribution of fat hyperplasia in tissue of congenital muscular torticollis,and investigate correlations between fat hyperplasia/fibrosis and age in children.Methods Specimens were embedded for HE and Masson staining,and some of them werer frozen using liquid nitrogen for Sudan Ⅲ staining.Totally 188 CMT (M:123:F:65) patients aging from 2 months 24 days to 16 years were investigated,including 75 in left and 113 in right.Results HE staining showed that muscle fibers could be seen around atrophy tissue,hypertrophy and necrosis.Part of the fibers showed the vacuolar degeneration and nuclear suppressive.Masson staining indicated that differential extent of collagen hyperplasia were distributed in perimysium and endomysium,and surrounded by muscle fibers.Sudan Ⅲ fat staining demonstrated that salmon pink positive area was correlated with distribution of fat hyperplasia in HE stain.Fat hyperplasia could be found in 131 cases of all specimens (69.68％).The severity of fat hyperplasia increased with fibrosis area and age.Conclusions Fibrosis is the basic pathologic changes in CMT.Our observation in this study described the phenomenon of fat hyperplasia in CMT.The proliferation of fat clump in the CMT lesions or rope-like stack,and hyperplasia severity varied in specimens.The fat hyperplasia severity will increase with fibrosis and age,and have potential to influent the pathologic change of muscle fibers and tissue fibrosis,and is also basic characteristics in CMT.