POST-TRAUMATIC REGENERATION OF NERVE FIBRES INHUMAN SPINAL CORD AND ITS RELATION TO INTRAMEDULLARY NEUROMA
POST-TRAUMATIC REGENERATION OF NERVE FIBRES INHUMAN SPINAL CORD AND ITS RELATION TO INTRAMEDULLARY NEUROMA
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DOI：
10.1002/path.1700940116
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发表时间：
1967-01-01
期刊：
影响因子：
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通讯作者：
WOLMAN, L
中科院分区：
文献类型：
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作者：
WOLMAN, L
结果：12例脊髓损伤段内或损伤段附近有发达的轴突再生;后者存活12个月至32年，3例发生在颈椎，胸区5例，腰区4例，再生神经纤维的形态清晰可见。它们由细小的轴突组成，通常有很好的髓鞘（图1），并被雪旺细胞包裹（图2）。在大多数纤维中，髓鞘被LFB-PAS染成深蓝色，表明起源于外周（Feigin和Popoff，1966）;脊髓中的一些纤维染成蓝绿色，而在较小的束中，颜色差异不足以确定以允许区分。虽然大多数倾向于向吻侧或尾侧延伸，因此在横截面中可见，但许多倾斜，不规则甚至横向延伸（图2）。在3例病例中，有些神经束更大，由大量螺旋状和相互缠绕的细有髓纤维组成，类似于截肢神经瘤（图3）。再生纤维束在四种主要情况下可见。(1)在邻近后根进入区的脊髓后部或后外侧增厚的软脑膜蛛网膜中（图4）。当多时，它们在后表面延伸到中线或侧面到齿状韧带的附着处。(2)在前中裂增厚的软脑膜蛛网膜中，它们要么呈广泛分离的小束（图5），要么呈紧密排列的大束（图6）。偶尔可见于脊髓的前外侧，靠近前神经根的附着点，向内侧延伸至前正中裂（图7）。在一个病例中，在一个正常的前神经根中可见一个小的神经瘤形成（图8）。(3)在脊髓中，它被无数的束所取代
RESULTSThough minute bundles of sprouting nerve fibres are seen in the tissue at the site of injury in several spinal cords, there is well-developed axon regeneration in or near the damaged segments in 12 cases; the latter had survived from 12 mth to 32 yr, and the trauma occurred in the cervical spine in 3, in the thoracic region in 5 and the lumbar region in 4 cases.The appearance of the regenerated nerve fibres is readily recognised. They consist of small bundles of fine axons, usually well myelinated (fig. 1) and ensheathed with Schwann cells (fig. 2). In most of the fibres the myelin sheaths stain deep blue with LFB-PAS suggesting a peripheral origin (Feigin and Popoff, 1966); some fibres in the cord stain blue-green whereas in the smaller bundles the colour difference is not sufficiently definite to permit differentiation. Though the majority tend to extend rostrally or caudally and are therefore seen in cross-section in transverse sections, many run obliquely, irregularly or even transversely (fig. 2). In 3 cases some of the bundles are much larger and consist of a mass of whorled and intertwined fine myelinated fibres resembling an amputation neuroma (fig. 3). The bundles of regenerating fibres are seen in four main situations.(1) In the thickened pia-arachnoid on the posterior or posterolateral aspect of the cord adjacent to the posterior root entry zone (fig. 4). When numerous they extend on the posterior surface to the midline or laterally to the attachment of the ligamentum denticulatum.(2) In the thickened pia-arachnoid in the anteromedian fissure, where they appear either as widely separated small bundles (fig. 5) or as closely packed larger fascicles (fig. 6). Occasionally they are present on the anterolateral aspect of the cord near the site of attachment of the anterior nerve roots, extending medially into the anteromedian fissure (fig. 7). In one case a small neuroma formation is seen in an otherwise normal anterior nerve root (fig. 8).(3) In the spinal cord, which is replaced by numerous bundles