黄韧带退变与腰椎管狭窄症椎管形态的变化

背景：目前研究发现Ⅰ型及Ⅱ型胶原在结缔组织的增殖与分化、软骨的形成和吸收等过程中起十分重要的作用。目的：探讨腰椎黄韧带退变与腰椎管狭窄症椎管形态变化的相关性。方法：收集中央型腰椎管狭窄症36例和外伤性腰椎骨折20例患者的黄韧带标本分别为实验组和对照组,采用酶联免疫吸附法测定Ⅰ型和Ⅱ型胶原;CT测量腰椎硬膜横截面积;黄韧带行苏木精-伊红和Masson染色,观察组织病理学变化。结果与结论：实验组黄韧带厚度、Ⅰ型及Ⅱ型胶原含量高于对照组,腰椎硬膜横截面积和Ⅰ型/Ⅱ型比值低于对照组（P〈0.05）;病理学显示实验组黄韧带弹性纤维排列紊乱,数量减少,胶原纤维增生。提示腰椎黄韧带Ⅰ型、Ⅱ型胶原含量及Ⅰ型/Ⅱ型比值发生改变,可能引起黄韧带厚度增加,导致椎管横截面积减小,参与腰椎管狭窄症的发生。

Relationship between the degeneration of the lumbar ligamentum flavum and the morphological changes of lumbar canal in the lumbar spinal stenosis

BACKGROUND：Studies have demonstrated that type Ⅰ and type Ⅱ collagen proteins play an important role in osteocytes proliferation and differentiation,sclerotic formation and absorption.OBJECTIVE：To study the relationship between the degeneration of the lumbar ligamentum flavum and the morphological change of lumbar canal in the lumbar spinal stenosis.METHODS：The ligament flavum specimens from 36 cases of the central lumbar spinal stenosis and 20 cases of the lumbar fracture as experimental group and control group respectively.The contents of type Ⅰ and type Ⅱ collagen were determined by ELISA.The morphological change of lumbar canal was measured by CT scanning.Histopathological changes of the ligamentum flavum were observed by hematoxylin-eosin staining and Masson staining.RESULTS AND CONCLUSION：The thickness of ligamentum flavum and content of type Ⅰ and type Ⅱ collagen in the experimental group were higher than those in the control group,the lumbar canal morphological area and the ratio of Ⅰ/Ⅱ type collagen in the experimental group were lower than those in the control group（P 0.05）.Pathological observation showed that the elastic fibers of ligamentum flavum were disorganized and decreased in experimental group,while collagen fibers proliferated.The change of the type Ⅰ and type Ⅱ collagen content in ligamentum flavum and the ratio of Ⅰ/Ⅱ type collagen may lead to the increasing hypertrophic ligamentum flavum thickness and decrease of lumbar canal cross-section which caused the lumbar spinal stenosis.