髌内侧滑膜皱襞中表达P物质的神经分布与髌股关节痛的相关性  

The correlation between patellfemoral pain and substance P in the symptomatic medial plica

作　　者：何锐[1] 杨柳[1] 郭林[1] 陈光兴[1] 段小军[1] 戴刚[1] 杨滨[1] 

机构地区：[1]第三军医大学西南医院关节外科中心,重庆400038

出　　处：《中华骨科杂志》2009年第6期567-571,共5页Chinese Journal of Orthopaedics

基　　金：重庆市重大科技专项（CSTC,2007AA5023）;重庆市科技攻关项目（CSTC,2007AC5047）

摘　　要：目的 研究病理性髌内侧滑膜皱襞中神经解剖结构变化，证实表达P物质的神经纤维分布增多是病理性髌内侧滑膜皱襞引起髌股关节痛的结构基础。方法 通过膝关节镜获取滑膜皱襞标本，采用免疫组化半定量分析方法观察P物质在膝关节髌内侧滑膜皱襞中的分布规律、变化趋势，比较空白对照组（无症状的滑膜皱襞）、阳性对照组（有症状的滑膜皱襞合并其他损伤）、实验组（有症状的滑膜皱襞）共51例患者髌内侧滑膜皱襞中表达P物质的神经纤维分布密度。结果 空白对照组髌上滑膜皱襞P物质染色阳性神经纤维密度为（24．60±26．17）根／cm^2；阳性对照组为（117．36±73．62）根／cm^2，实验组为（59．06±44．06）根／cm^2。实验组髌内侧滑膜皱襞P物质染色阳性神经纤维密度为（255．44±87．91）根／cm^2，阳性对照组为（268．00±71．60）根／cm^2，空白对照组为（23．23±18．41）根／cm^2。髌内侧滑膜皱襞神经纤维密度高于髌上滑膜皱襞。实验组与阳性对照组髌内侧滑膜皱襞中P物质染色阳性神经纤维密度均高于空白对照组，阳性对照组高于实验组。P物质神经纤维分布密度与VAS疼痛评分呈正相关。结论 病理性髌内侧滑膜皱襞中表达P物质的神经纤维分布密度与患者疼痛程度呈正相关。病理性髌内侧滑膜皱襞中表达P物质的伤害性疼痛感觉神经纤维是疼痛发生的重要神经病理学基础，是髌内侧滑膜皱襞综合征发病机制中的重要环节。Objective To study the innervations of symptomatic medial plica, and to affirm that the innervations upgoing of nerve fibers expressed substance P in medial plicae responded for the patellofemoral pain. Methods The samples of medial plicae were obtained from 51 patients by knee arthroscope, and divided into three groups： negative control group （symptomless medial plicae）, positive control group （symptomatic medial plicae with other injury）, experimental group （symptomatic medial plica）. One indirect immunohistological techniques were employed for the semiquantitative analysis of substance P. Observe the regularity of the innervations in medial plicae, and compare the density of innervations between the three groups. Evaluate the correlation between the density of innervations and the scores of VAS. Results The density of never fibers in superior plica： negative control group （24.60±26.17）/cm^2, positive control group （117.36±73.62）/cm^2, experimental group （59.06±44.06）/cm^2. The density of never fibers in medial plica： negative control group （23.23±18.41）/cm^2, positive control group （268.00±71.60）/cm^2, experimental group （255.44±87.91）/cm^2. The density of nerve fibers in medial plicae was higher than superior pliea. There was significant correlation between the density of nerve fibers and pain level. Conclusion There is significant relationship between the innervations of substance P in medial plicae and the anterior knee pain. The nerve fibers expressed substance P in symptomatic medial plicae is an important reason for patellofemoral pain syndrome. Innervations upgoing and density of nerve fiber of substance P upgrade in medial pliea syndrome patients are significantly correlated with pain.

关 键 词：滑膜 髌股疼痛综合征 免疫组织化学 P物质 

分 类 号：R686[医药卫生—骨科学]