Furusawa N, Baba H, Maezawa Y, Uchida K, Wada M, Imura S, Fukuda M
Department of Orthopaedic Surgery, Fukui Medical School, Japan.
Clin Exp Rheumatol. 1997 Nov-Dec;15(6):641-7.
To investigate the histological and immunohistochemical properties of the lumbar ligamentum flavum with calcium crystal deposition.
We examined the histological characteristics of the ligamentum flavum of the lumbar spine containing calcium deposits, obtained from 16 surgical cases with symptomatic lumbar spinal stenosis. Sections of the ligaments were also immunostained for elastase, chymotrypsin and S-100 protein, and examined by energy dispensive X-ray microanalysis and scanning electron microscopy. The results were compared with those of ligaments without calcium deposits.
The elastic fibres of ligaments with calcium deposits showed marked degeneration (irregular arrangement and fragmentation of the fibre bundles) and nodular granulomatous lesions. Calcium crystal deposits were present in this area and in the nodular granulomatous areas. The calcified areas were surrounded by neutrophils and new small blood vessels. Immunostaining for elastase and chymotrypsin was positive in these areas, and S-100 protein-containing chondrocytes were detected around and within the calcified areas. Calcium pyrophosphate dihydrate crystals were identified in the calcified areas in all patients.
Nodular degeneration of the elastic fibres of the ligament is probably caused by the action of proteolytic enzymes. Degeneration results in small granulomatous areas that form the nidus for calcium crystal deposition. Accumulated neutrophils, and S-100 protein-containing chondrocytes appear to precipitate the deposition of calcium crystals in the granulomatous lesions of the degenerated lumbar ligamentum flavum.
研究伴有钙晶体沉积的腰椎黄韧带的组织学和免疫组化特性。
我们检查了从16例有症状的腰椎管狭窄症手术病例中获取的含有钙沉积物的腰椎黄韧带的组织学特征。对韧带切片进行弹性蛋白酶、糜蛋白酶和S-100蛋白免疫染色，并通过能量色散X射线微分析和扫描电子显微镜检查。将结果与无钙沉积物的韧带结果进行比较。
有钙沉积物的韧带弹性纤维显示出明显退变（纤维束排列不规则和断裂）及结节状肉芽肿性病变。钙晶体沉积物存在于该区域及结节状肉芽肿区域。钙化区域被中性粒细胞和新生小血管包围。这些区域弹性蛋白酶和糜蛋白酶免疫染色呈阳性，在钙化区域周围及内部检测到含S-100蛋白的软骨细胞。所有患者钙化区域均鉴定出二水焦磷酸钙晶体。
韧带弹性纤维的结节状退变可能是由蛋白水解酶的作用引起的。退变导致形成钙晶体沉积灶的小肉芽肿区域。积聚的中性粒细胞及含S-100蛋白的软骨细胞似乎促使钙晶体在退变的腰椎黄韧带肉芽肿性病变中沉积。
