胎儿胸锁乳突肌组织学与先天性肌性斜颈病理的比较研究

发布时间：2018-03-08 21:06

本文选题：胸锁乳突肌　切入点：斜方肌　出处：《遵义医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的:通过对比胎儿胸锁乳突肌(Sternocleidomastoid Muscle,SCM)、斜方肌、股直肌,探讨胎儿SCM大体和组织学特点,并与先天性肌性斜颈(Congenital Muscular Torticollis,CMT)病理变化作比较,以期进一步认识先天肌性斜颈的病因和发病机理。方法:收集引产或流产的胎儿标本58例,按胎龄分为五组:118-19周组4例;220-21周组15例;322-23周组10例;424-25周组22例;526-28周组7例。收集深圳市儿童医院经临床和病理确诊的小于1岁患儿的CMT病理标本58例。大体解剖胎儿的SCM、斜方肌和股直肌,对比观察其发育特点以及术中CMT的大体特点。通过HE染色和Masson染色观察以上肌肉的组织学特点,免疫组织化学Max Vision法观察以上肌肉中CD45的表达。结果:58例胎儿中,53例SCM双侧对比大小基本对称,5例双侧不对称,发育异常检出率为8.6%,其中1例双侧SCM整体发育不对称,1例右侧乳突头较左侧肿大,3例双侧乳突头发育不对称。58例斜方肌与股直肌大体标本未见明显发育异常。大体解剖发现大于18周的胎儿SCM肌纤维较密集,发育基本成形,肌鞘并不明显。术中见CMT中肌纤维被不同程度的白色纤维结缔组织取代。HE染色和Masson染色发现同一胎儿SCM发育较斜方肌、股直肌差,肌纤维稀疏、连续性差、排列紊乱,肌细胞核大、淡染,肌纤维间存在较多间质成分,Masson染色显示蓝色。随着胎龄增加,SCM、斜方肌及股直肌发育逐渐完善,但SCM发育较斜方肌、股直肌慢。CMT中发现大片纤维结缔组织增生,肌细胞大小不等,染色深浅不一,部分肌细胞出现萎缩、变性等多种改变,弥漫性间质纤维化,肌束正常结构遭到破坏。免疫组织化学CD45在各组中表达的平均光密度值有统计学差异,在同一胎儿右SCM中的阳性表达较左SCM明显,在同一胎儿,SCM阳性表达明显高于斜方肌、股直肌,具有明显统计学差异;在SCM与CMT中表达没有明显差异。结论:(1)胎儿期SCM出现大体上发育不对称,而斜方肌、股直肌没有出现发育异常现象,说明SCM自身发育有特殊性。(2)组织学上发现胎儿SCM较斜方肌、股直肌间质成分多,且肌纤维发育落后、不成熟。(3)CD45在胎儿SCM与CMT中表达较斜方肌、股直肌高,推测CMT的病理变化与胎儿SCM发育异常有关。
[Abstract]:Objective: To compare the fetal sternocleidomastoid muscle (Sternocleidomastoid, Muscle, SCM), trapezius muscle, rectus femoris, investigate fetal SCM gross and histologic features of congenital muscular torticollis, and with (Congenital Muscular, Torticollis, CMT) were compared to pathological changes, with a view to further understanding of the etiology and pathogenesis of congenital muscular torticollis. Methods: 58 cases of fetal abortion or abortion were collected, according to gestational age 118-19 weeks were divided into five groups: Group 4 cases; 220-21 week group 15 cases; 322-23 week group 10 cases; 424-25 week group 22 cases; 526-28 week group 7 cases. The collection of Shenzhen city children's Hospital by CMT pathology confirmed clinically and pathologically less than 1 years old children in 58 cases. The gross anatomy of fetal SCM, trapezius muscle and rectus femoris, compared to observe the growth characteristics and intraoperative CMT. General features features by HE staining and Masson staining than muscle tissue, immunohistochemistry Vision method to observe Max The expression of CD45 in muscle. Results: 58 cases of fetus, 53 cases of bilateral SCM scale symmetry, 5 cases of bilateral asymmetry, abnormal detection rate was 8.6%, including 1 cases of bilateral SCM overall developmental asymmetry, 1 cases of the right over the left mastoid head enlargement, 3 cases of bilateral mastoid hair was symmetrical.58 cases of trapezius the rectus femoris muscle and no obvious abnormalities. The gross anatomy found that fetal SCM muscle fibers greater than 18 weeks is intensive, the development of basic shape, muscle sheath is not obvious. Intraoperative muscular fiber CMT are white fibrous connective tissue with different degrees of substitution of.HE staining and Masson staining showed the same fetal SCM developed the trapezius muscle the rectus femoris muscle fiber, poor, sparse, poor continuity, arrangement disorder, muscle cells, light pollution, there are many stromal elements among the muscle fibers, Masson staining showed blue. With the increase of gestational age, SCM, trapezius muscle and rectus femoris development gradually improved, But the SCM development of the trapezius muscle, hyperplasia of connective tissue fibers found large rectus femoris slow.CMT, muscle cell sizes, dyeing shades, part of the muscle cell atrophy, degeneration and other changes, diffuse interstitial fibrosis, normal muscle structure is destroyed. The average optical density of CD45 immunohistochemical expression in each group of the value statistically, the positive expression in the same fetal right in SCM is left SCM significantly, in the same fetus, the positive expression of SCM was significantly higher than that of the trapezius muscle, rectus femoris, with statistically significant difference in the expression of CMT and SCM; there is no significant difference. Conclusion: (1) SCM in fetal development and asymmetry. The trapezius muscle, the rectus femoris did not appear abnormal development phenomenon, SCM development is special. (2) histological findings of fetal SCM with trapezius muscle, rectus femoris muscle stroma, and muscle fiber development lags behind, not mature. (3) in CD45 The expression of SCM and CMT in the fetus is higher than that of the trapezius muscle, and the rectus femoris is high. It is presumed that the pathological changes of CMT are related to the abnormal SCM development of the fetus.

【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R714.5

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