脊髓拴系综合征终丝超微结构的观察分析

目的 探讨脊髓拴系综合征（TCS）病人脊髓圆锥末端终丝的结构变化，为TCS的诊治提供客观依据。方法 选择2021年10月～2022年5月手术切除的16例TCS病人的终丝标本，进行病理染色，并在显微镜和电镜下观察。结果 HE染色显示TCS终丝波浪状的弹性纤维明显减少，胶原纤维明显增多，可见大量的脂肪细胞。天狼猩红染色显示TCS终丝以Ⅰ型胶原纤维为主，Ⅲ型则嵌入其中。间二苯酚染色显示TCS终丝几乎都是浅色的胶原纤维。网状纤维染色显示TCS终丝多见空泡状的脂肪细胞，偶见穿梭于胶原纤维中的黑色网状纤维。扫描电镜观察显示TCS终丝多见大量排列紊乱、方向性差的胶原纤维，部分可见散在的脂肪细胞；透射电镜观察显示TCS终丝内部多见密集交错的胶原纤维以及这些纤维的规律性的横纹，偶可见成纤维细胞、脂肪细胞等。16例Ⅰ型胶原纤维数量增多，占终丝的大部分；6例可见脂肪细胞，3例显示小血管。结论 多数TCS终丝的弹性纤维、网状胶原纤维明显减少，Ⅰ型胶原纤维异常增加。

Ultrastructure of filum terminale in patients with tethered cord syndrome

Objective To investigate the structural changes of filum terminale (FT) of patients with tethered cord syndrome (TCS) to provide objective evidence for the diagnosis and treatment of TCS. Methods The pathological staining was performed on the FT obtained from 16 patients with TCS who were surgically resected from October 2021 to May 2022 The structural changes were observed using a microscope and electron microscope. Results HE staining showed that the elastic fibers were significantly reduced, the collagen fibers were significantly increased, and many adipose cells could be seen within these fibers. Picro sirius red staining showed that the FT was mainly composed of type Ⅰ collagen fibers, with a few of type Ⅲ collagen fibers. M-diphenol staining showed that the FT was mainly composed of collagen fibers. Reticular fiber staining showed that many vacuolated adipose cells could be seen within the FT with a few black reticular fibers. Scanning electron microscopy showed that there were a lot of disordered collagen fibers with poor orientation in the FT, with some scattered adipocytes. Transmission electron microscopy showed that there were more dense interlacing collagen fibers and regular transverse lines of these fibers, and occasionally fibroblasts and adipocytes in the FT. The number of type Ⅰ collagen fibers increased in all 16 patients. Fat cells were seen in 6 patients and small blood vessels in 3 patients. Conclusions The elastic fibers and reticular collagen fibers of most FT in the patients with TCS are significantly reduced, while the type Ⅰ collagen fibers are abnormally increased.