【作者】 陆根华；

【导师】 王晓东；

【作者基本信息】 苏州大学 ， 儿科学， 2007， 硕士

【摘要】 目的:通过对发育性髋关节脱位患儿股骨头圆韧带进行大体形态学、组织学及免疫组织化学研究,探讨发育性髋关节脱位的病理改变及发病机制。材料和方法:收集我院2005年1月～2006年11月发育性髋关节脱位患儿手术治疗过程中完整切下的股骨头圆韧带标本,共29例36髋(其中2例2髋圆韧带退化),其余27例34髋,年龄9个月～48个月,平均19.8个月;其中<18个月有15例18髋,≥18个月有12例16髋;女性20例25髋,男性7例9髋;单侧脱位20髋,双侧脱位7例14髋;左侧22髋,右侧12髋。全部标本均进行大体形态学观察、常规组织学染色以及免疫组织化学染色研究,本组采用S-P免疫组化方法检测发育性髋关节脱位各年龄组股骨头圆韧带标本组织中Ⅰ、Ⅲ型胶原蛋白的表达,并结合计算机图像分析系统测定阳性染色面积占目标面积的百分比,半定量比较各组间Ⅰ、Ⅲ型胶原的含量变化。结果:大体形态学及组织学观察:显示股骨头圆韧带增生、肥大明显,但未见有圆韧带动脉的迹象。其长度为(27.56±4.84)mm,平均宽度为(12.41±2.69)mm,在不同年龄组间、男女不同性别间、左右侧间及单双侧间差别均无统计学意义(P>0.05)。免疫组化染色:显示Ⅰ型胶原增加明显,阳性面积约占(93.31±3.26)%,Ⅲ型胶原则减少,阳性面积约占(6.59±3.36)%,两者呈负相关关系(r=–0.3480 ,P<0.05),且在不同年龄组间、男女不同性别间差异具有统计学意义(P<0.01),但在左右侧及单双侧之间差异无统计学意义(P>0.05)。结论:1.发育性髋关节脱位患儿股骨头圆韧带明显增生、肥大,几乎占据整个髋臼,明显大于正常婴幼儿,接近成人的水平。2.增生、肥大的圆韧带内未见有圆韧带动脉的存在,只在近髋臼侧可见大量毛细血管增生,近股骨头侧未见有任何血管迹象。3.发育性髋关节脱位股骨头圆韧带中胶原分布及含量变化明显,胶原含量增多、分布不均、排列紊乱,其中以Ⅰ型胶原增多明显,Ⅲ型胶原则减少。以上胶原纤维的改变与组织器官纤维化、病理性瘢痕性纤维结缔组织增生的改变是一致的。4.发育性髋关节脱位股骨头圆韧带增生、肥大是一种继发性改变,早期有防止股骨头脱位的作用,晚期失代偿后增生纤维化,反过来阻碍了股骨头的复位或导致缺血性坏死。更多还原

【Abstract】 Objective: A morphologic, histological and immunohistochemical studies of Ligamentum Capitis Femoris (LCF) in Developmental Dislocation of the Hip (DDH) was designed to investigate the pathology and pathogenesis of formation in DDH.Materials and Methods: 36 LCF for specimens biopsy were taken during the surgery in 29 patients with 36 hips from January 2005 to November 2006. Two LCF discarded as its degeneration.Among 34 LCF in 27 patients with 34 hips, the mean age was 19.8 month (range from 9～48 month); 15 patients with 18 hips were younger than 18 month old and 12 patients with 16 hips were beyond; 20 patients with 25 hips were female and 7 patients with 9 hips were male; 20 cases were unilateral DDH and 7 were bilateral; 22 specimens came from left and 12 from right.All specimens were studied with morphologic observation, histological stain and immunohistochemistry. An immunohistochemical technique (S-P method) was applied to demonstrate the typeⅠ,Ⅲcollagen of the LCF and performed with computer imaging analysis and calculated the positive staining area, then compared the content of collagen change in semiquantitative.Results: Gross, Morphologic and histological observations: the LCF was hyperplastic, hypertrophia considerably. But there was no artery of ligamentum tere. The length was (27.56±4.84) mm, the average width was (12.41±2.69) mm, There were no statistical significant between the different age groups, different gender groups, left and right groups, unilateral and bilateral groups (P>0.05).Immunohistochemical stain: the content of collagen typeⅠincreased greatly. Positive staining area was about (93.31±3.26) %, collagen typeⅢdecreased, which was about (6.59±3.36) %, both showed negative correlation (r=–0.3480, P<0.05). There were distinctly statistical significant between the different age groups, different gender groups (P<0.01), but no statistical significant between the left and right groups, unilateral and bilateral groups (P>0.05).Conclusions:1. The LCF of patients with DDH was hyperplastic, hypertrophia; almost occupied the whole acetabular which sign was larger than the normal infant and similar to the adult.2. No artery of ligamentum tere existed in LCF. There were a large number of capillaries increasing in the LCF close to the acetabular, but no blood vessel eyeable in the LCF close to the head of femur which showed the partial hyline degeneration.3. The distribution and content of collagen of the LCF in DDH changed considerably. The collagen fiber deranged and distributed asymmetric. The content of collagen typeⅠincreased greatly, but collagen typeⅢdecreased. The above change was consistent with the tissue fibrosis and fibroelastosis.4. The hyperplastic, hypertrophia LCF in DDH was a secondary change. In earlier period it would prevent the dislocation of the femoral head, but late it started decompensation and fibrosis, which hindered the reduction of the head of femur or leaded to avascular necrosis.更多还原