Department of Orthopaedics, University Hospital Galway, Newcastle Road, Galway, Ireland.
National University of Ireland, Galway, Newcastle Road, Galway, Ireland.
Ir J Med Sci. 2019 Aug;188(3):987-992. doi: 10.1007/s11845-018-1940-9. Epub 2018 Dec 15.
While first described in 1904, the characterisation of the peridural membrane, which is frequently encountered, yet usually unnoticed, during lumbar decompression surgery, remains inconclusive. This relatively little known membrane is continuous with the posterior longitudinal ligament and lines the epidural space. In this study, we are comparing the membrane and ligamentum flavum from patients to analyse the variations of the histological and ultrastructural compositions.
We took samples of the membrane and ligamentum flavum from five separate patients who were undergoing lumbar spine decompression surgery for herniated discs which were then analysed with transmission electron microscopy and stained with H&E (morphology), trichrome (collagen content), and Verhoeff-Van Gieson (elastin content).
Upon analysis of the peridural membrane, we observed tightly packed collagen fibres, interspaced with elastin fibres and very few fibroblasts. While the ligamentum flavum showed a significantly higher elastin to collagen ratio and looser arrangement of collagen fibres with a larger extracellular matrix. The peridural membrane was similar in appearance and constituent parts to the dura mater.
The peridural membrane is a distinctive and important membrane in the spinal canal, and given its high collagen to elastin ratio and it tightly packed nature, we conclude that it forms a protective layer around the spinal cord which may help in minimising the compressive nature of intervertebral disc herniation.
虽然硬脊膜外膜于 1904 年首次被描述，但在腰椎减压手术中经常遇到但通常未被注意到的这种膜的特征仍不确定。这种相对不太为人知的膜与后纵韧带连续，并沿着硬膜外腔排列。在这项研究中，我们比较了来自患者的膜和黄韧带，以分析组织学和超微结构成分的变化。
我们从五个接受腰椎减压手术治疗椎间盘突出症的患者身上采集了膜和黄韧带的样本，然后用透射电子显微镜进行分析，并进行 H&E（形态学）、三色（胶原含量）和 Verhoeff-Van Gieson（弹性蛋白含量）染色。
在对硬脊膜外膜进行分析时，我们观察到紧密堆积的胶原纤维，其间散布着弹性纤维和很少的成纤维细胞。而黄韧带则显示出明显更高的弹性蛋白与胶原比值，胶原纤维排列更疏松，细胞外基质更大。硬脊膜外膜在外观和组成部分上与硬脑膜相似。
硬脊膜外膜是椎管内一个独特而重要的膜，由于其高胶原与弹性蛋白比值以及紧密堆积的性质，我们得出结论，它在脊髓周围形成了一个保护层，有助于减轻椎间盘突出的压迫性。
