发育性髋关节脱位关节囊(胶原)组织偏光显微镜观察及临床病理意义

目的 观察发育性髋关节脱位(developmental dislocation of the hip,DDH)与正常儿童的髋关节囊的形态学特点,分析Ⅰ型和Ⅲ型胶原含量及二者比例(Ⅰ/Ⅲ)变化规律.方法 2005年6月～2006年8月第一次手术DDH患儿42例,男8例,女34例,排除胶原代谢疾病及其他畸形.对照组选择因其他疾病第一次行髋关节手术及尸检患儿共20例,男7例,女13例,1.5～14岁,平均7.4岁,无DDH病史,排除胶原代谢疾病及其他畸形.根据术前X线片,按Tonnis分类将DDH患儿分为四组,分别与正常对照组对比分析.关节囊取材于手术或尸检切除标本,行苦味酸-天狼猩红染色,分别在普通显微镜和偏振光显微镜下观察并测量Ⅰ型和Ⅲ型胶原含量及计算比例(Ⅰ/Ⅲ).结果 对照组与Tonnis各组分别进行t检验,差异有统计学意义(P=0.000<0.01);病例组间进行方差分析,差异无统计学意义(0.1250.05);但是其值病例组要明显低于对照组(P<0.05).结论 DDH患儿和对照组间关节囊Ⅰ和Ⅲ型胶原含量及比例(Ⅰ/Ⅲ)有较大差别,但是脱位高患儿并不一定会有明显形态学上改变.

Polarizing microscope evaluation and clinic pathologic study of the articular capsule in patients with DDH

Objective To describe the pathologic characters of hip capsule in patients with development dysplasia of the hip (DDH) by evaluating the amount of type Ⅰ and Ⅲ collagens of the capsule. Methods From Jun. of 2005 to Aug. of 2006, forty two patients with DDH were divided into four groups according to Tonnis standard by the preoperative X rays. Samples of the hip capsule from patients with DDH and from 20 patients without DDH were analyzed and compared for quantitative evaluation of the total and type Ⅰ and Ⅲ collagens. Picrosirius-polarization staining was used to evaluate the total collagen, and to distinguish type Ⅰ and Ⅲ collagens, all the samples were analyzed by light microscopy and Polarizing microscopy. Results The amount of total collagen and type Ⅰ collagen in patients with DDH were less than those in controls (P<0. 05). The amount of Type Ⅲ collagen in patients with DDH, however, was higher than that in controls (P<0. 05). The Ⅰ/Ⅲ collagen ratio in controls was significantly higher than that in DDH patients (P<0. 05). Conclusions The results of this study indicate that patients with DDH have less collagen Ⅰ while more collagen Ⅲ in the hip capsule.