退变性腰椎疾病患者小关节囊中P物质的表达  

Substance P expression in lumbar facet joint capsule in degenerative lumbar disease patients

作　　者：左进步[1] 李家谋[2] 张春波[1] 林欣[2] 

机构地区：[1]武警北京总队医院骨科,北京市100027 [2]首都医科大学附属北京天坛医院骨科,北京市100050

出　　处：《中国组织工程研究与临床康复》2010年第30期5618-5621,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:以往基于动物实验或尸体的研究发现,腰椎小关节源性腰痛中退变的腰椎小关节软骨下骨和钙化软骨神经纤维中P物质增多。目的:观察退变性腰椎患者中小关节囊中P物质的表达变化。方法:采用术前诊断性封闭方法筛选出18例退变性慢性腰痛患者,行小关节囊切除,切除的小关节囊标本作为实验组,选取18例骨折前无腰痛的腰椎骨折患者的小关节囊标本为对照组,进行P物质免疫组化染色,观察P物质免疫组化染色阳性神经纤维的分布情况。结果与结论:实验组中15例可见P物质阳性神经纤维,3例未见阳性反应。P物质神经纤维在小关节囊内的定位与分布基本一致,关节囊上的P物质神经纤维大部分沿血管走行,血管周围阳性神经纤维密度较大,也有一些P物质神经不与血管伴行,独立走行于关节囊基质中,另外在小关节软骨下骨区亦有少量独立走行的P物质纤维。对照组腰椎小关节囊中5例可见少量P物质阳性神经纤维,13例为阴性。由此得出,腰椎小关节囊病理改变与退变性腰痛有明显关系,小关节囊中P物质阳性神经纤维可能参与了退变性腰痛疼痛的发生。小关节囊病理改变在小关节源性腰痛发生中起重要作用。BACKGROUND：Previous animal or corpse-based studies show that substance P is increased in degenerative lumbar facet joint bone below cartilage and calcified cartilage nerve fiber in lumbar facet joint-derived low back pain.OBJECTIVE：To investigate the substance P expression changes in facet joint capsule in patients with degenerative lumbar disease.METHODS：A total of 18 cases were selected by diagnostic block before operation in degenerative lumbar disease.The test group experienced resection of facet joint capsule,and the control group had no low back pain before fracture.Immunohistochemical method was used to observe the SP immunoreactive fibers in the degenerative facet joints capsule.RESULTS AND CONCLUSION：In the test group,substance P immunoreactive nerve fibers were observed in 15 cases,and 3 cases had no positive reaction.Substance P immunoreactive nerve fibers distributed in joint capsule and subchondral bone area,and most of them were located in facet capsule.The fibers were also detected in plical tissue of the capsule.They were not all associated with large blood vessels,but some of them ran freely in the stroma.In addition,a few substance P immunoreactive nerve fibers were observed in 5 cases of the control group,and 13 cases were negative.The degenerative change of facet joint capsule is one of the important causes of chronic low back pain.The observation provides morphological basis for low back pain,implying that the substance P immunoreactive fibers might involve in facet degeneration and might be an important source of the lower back pain.

关 键 词：慢性下腰痛 P物质 小关节囊 组织构建 骨组织工程 

分 类 号：R318[医药卫生—生物医学工程]