Paulsen F, Kimpel M, Lockemann U, Tillmann B
Department of Anatomy, Christian Albrecht University of Kiel, Germany.
J Anat. 2000 Jan;196 ( Pt 1)(Pt 1):41-54. doi: 10.1046/j.1469-7580.2000.19610041.x.
The vocal ligaments insert at the anterior and posterior commissures of the larynx. These structures fulfil biomechanical functions, balancing the different elastic moduli of tendon, cartilage or bone and undergo age-related changes that may be responsible for voice changes with increasing age. The aim of this study was to analyse the insertion structures of the vocal ligaments by means of macroscopic, histological, immunohistochemical and electron-microscopic methods and to draw conclusions from age-related structural changes on a functional basis. Investigations were carried out on the larynges of 22 males and 15 females (aged 1-95 y). In adolescence, the insertion zone of the vocal ligament tendon, a dense network of connective tissue rich in sulphated glycosaminoglycans at the thyroid cartilage, is characterised by a layer between tendon and cartilage comparable to fibrocartilage. The insertion zone lacks a perichondrium. Collagen fibrils of the vocal ligament tendon penetrate directly into the thyroid cartilage. In the insertion area, the chondrocytes are surrounded by collagen fibrils, which show positive reactivity to antibodies against type I and type III collagen. Sulphated glycosaminoglycans are integrated between the collagen fibrils. In the area of the posterior glottis, elastic cartilage rests like a cap on the hyaline base of the arytenoid cartilage. There is no distinctive border between the structures. With increasing age, ossification of the laryngeal skeleton occurs, involving hyaline cartilage at the posterior glottis and hyaline and fibrocartilage at the anterior commissure. At the same time, a loss or sulphated glycosaminoglycans is observed inside the vocal ligament tendon. Advanced ossification of the laryngeal skeleton, particularly in the area of the commissures, an increasing loss of glycosaminoglycans in the vocal ligament tendon and changes in the elastic tissue reduce the elastic modulus between tendon, cartilage and bone, thus 'stiffening' the insertion zones, which could be one factor among others favouring voice changes with advancing age.
声带韧带附着于喉的前后连合处。这些结构发挥生物力学功能，平衡肌腱、软骨或骨的不同弹性模量，并经历与年龄相关的变化，这些变化可能是导致随着年龄增长声音改变的原因。本研究的目的是通过宏观、组织学、免疫组织化学和电子显微镜方法分析声带韧带的附着结构，并基于与年龄相关的结构变化得出功能方面的结论。对22名男性和15名女性（年龄1 - 95岁）的喉部进行了研究。在青春期，声带韧带肌腱的附着区，即甲状腺软骨处富含硫酸化糖胺聚糖的致密结缔组织网络，其特征是在肌腱和软骨之间有一层类似于纤维软骨的结构。附着区缺乏软骨膜。声带韧带肌腱的胶原纤维直接穿透甲状腺软骨。在附着区域，软骨细胞被胶原纤维包围，这些胶原纤维对I型和III型胶原抗体呈阳性反应。硫酸化糖胺聚糖整合在胶原纤维之间。在后声门区域，弹性软骨像帽子一样覆盖在杓状软骨的透明基底上。这些结构之间没有明显的边界。随着年龄的增长，喉骨架发生骨化，涉及后声门处的透明软骨以及前连合处的透明软骨和纤维软骨。同时，在声带韧带肌腱内观察到硫酸化糖胺聚糖的丢失。喉骨架的晚期骨化，特别是在连合处区域，声带韧带肌腱中糖胺聚糖的不断丢失以及弹性组织的变化降低了肌腱、软骨和骨之间的弹性模量，从而使附着区“变硬”，这可能是导致随着年龄增长声音改变的诸多因素之一。
