本文選題：胸鎖乳突肌　切入點：斜方肌　出處：《遵義醫(yī)學院》2016年碩士論文　論文類型：學位論文

【摘要】：目的:通過對比胎兒胸鎖乳突肌(Sternocleidomastoid Muscle,SCM)、斜方肌、股直肌,探討胎兒SCM大體和組織學特點,并與先天性肌性斜頸(Congenital Muscular Torticollis,CMT)病理變化作比較,以期進一步認識先天肌性斜頸的病因和發(fā)病機理。方法:收集引產(chǎn)或流產(chǎn)的胎兒標本58例,按胎齡分為五組:118-19周組4例;220-21周組15例;322-23周組10例;424-25周組22例;526-28周組7例。收集深圳市兒童醫(yī)院經(jīng)臨床和病理確診的小于1歲患兒的CMT病理標本58例。大體解剖胎兒的SCM、斜方肌和股直肌,對比觀察其發(fā)育特點以及術(shù)中CMT的大體特點。通過HE染色和Masson染色觀察以上肌肉的組織學特點,免疫組織化學Max Vision法觀察以上肌肉中CD45的表達。結(jié)果:58例胎兒中,53例SCM雙側(cè)對比大小基本對稱,5例雙側(cè)不對稱,發(fā)育異常檢出率為8.6%,其中1例雙側(cè)SCM整體發(fā)育不對稱,1例右側(cè)乳突頭較左側(cè)腫大,3例雙側(cè)乳突頭發(fā)育不對稱。58例斜方肌與股直肌大體標本未見明顯發(fā)育異常。大體解剖發(fā)現(xiàn)大于18周的胎兒SCM肌纖維較密集,發(fā)育基本成形,肌鞘并不明顯。術(shù)中見CMT中肌纖維被不同程度的白色纖維結(jié)締組織取代。HE染色和Masson染色發(fā)現(xiàn)同一胎兒SCM發(fā)育較斜方肌、股直肌差,肌纖維稀疏、連續(xù)性差、排列紊亂,肌細胞核大、淡染,肌纖維間存在較多間質(zhì)成分,Masson染色顯示藍色。隨著胎齡增加,SCM、斜方肌及股直肌發(fā)育逐漸完善,但SCM發(fā)育較斜方肌、股直肌慢。CMT中發(fā)現(xiàn)大片纖維結(jié)締組織增生,肌細胞大小不等,染色深淺不一,部分肌細胞出現(xiàn)萎縮、變性等多種改變,彌漫性間質(zhì)纖維化,肌束正常結(jié)構(gòu)遭到破壞。免疫組織化學CD45在各組中表達的平均光密度值有統(tǒng)計學差異,在同一胎兒右SCM中的陽性表達較左SCM明顯,在同一胎兒,SCM陽性表達明顯高于斜方肌、股直肌,具有明顯統(tǒng)計學差異;在SCM與CMT中表達沒有明顯差異。結(jié)論:(1)胎兒期SCM出現(xiàn)大體上發(fā)育不對稱,而斜方肌、股直肌沒有出現(xiàn)發(fā)育異�，F(xiàn)象,說明SCM自身發(fā)育有特殊性。(2)組織學上發(fā)現(xiàn)胎兒SCM較斜方肌、股直肌間質(zhì)成分多,且肌纖維發(fā)育落后、不成熟。(3)CD45在胎兒SCM與CMT中表達較斜方肌、股直肌高,推測CMT的病理變化與胎兒SCM發(fā)育異常有關(guān)。
[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.

【學位授予單位】：遵義醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R714.5

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