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目的:观察胆脂瘤破坏听小骨的形态学结构变化,探讨胆脂瘤的骨质破坏机制。方法:光镜观察8例胆脂瘤破坏听小骨和2例正常听小骨的形态学。透射电镜观察5例胆脂瘤破坏听小骨,2例正常外耳道对照骨的超微结构。结果:胆脂瘤破坏听小骨中有骨髓炎和活性破骨细胞存在,骨质破坏和骨质增生同时存在,膜内成骨和软骨内成骨2种成骨方式均可见。结论:破骨细胞参与的陷窝性骨吸收在胆脂瘤的骨质破坏中发挥一定的作用。胆脂瘤的破坏骨中有骨髓炎存在,窦性骨吸收在胆脂瘤的骨质破坏中发挥重要的作用。膜内成骨和软骨内成骨共同参与胆脂瘤骨质破坏后的重建,新骨生成也是胆脂瘤中的基本病理改变。
OBJECTIVE: To observe the morphological changes of cholesteatoma in the destruction of ossicles and explore the mechanism of bone destruction in cholesteatoma. Methods: The morphological changes of 8 cases of cholesteatoma were observed by light microscope. Transmission electron microscopy of 5 cases of cholesteatoma destruction of the ossicles, 2 cases of normal external auditory canal contrast bone ultrastructure. Results: Cholesteatoma had osteomyelitis and active osteoclasts in the ossicular bones. Osteoblasts and bone hyperplasia existed simultaneously in the cholesteatoma. Both osteogenic and intraosseous osteogenesis of cholesteatoma were visible. CONCLUSION: Osteoclasts involved in lacunar bone resorption play a role in the destruction of bone in cholesteatoma. Cholesteatoma destruction of bone in the presence of osteomyelitis, sinus bone resorption plays an important role in the destruction of bone in the cholesteatoma. Intramedullary and endochondral ossification are involved in the reconstruction of osteolysis after cholesteatoma. The new bone formation is also the basic pathological change in cholesteatoma.