慢性小关节源性腰痛与小关节囊神经纤维数量及神经肽Y表达变化的病例对照研究  

Case control study on the relationship of chronic low back pain of facet joint origin with the distribution of nerve endings and neuropeptide:a quantitative histological analysis

作　　者：王磊[1] 李家谋[1] 刘宝戈[1] 崔维[1] 亢卫波[1] 

机构地区：[1]首都医科大学附属北京天坛医院骨科,北京100050

出　　处：《中国骨伤》2014年第8期663-667,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:通过研究临床症状、核磁共振小关节Fujiwara分级与末端神经纤维分布及神经肽Y表达的关系,探索慢性小关节源性腰痛的病理机制。方法:选取无腰痛的腰椎管占位需手术内固定患者为对照组(A组),共15例。慢性腰痛患者,术前封闭腰椎小关节,注射前后进行VAS测评。根据测评结果将其分为3组:疼痛完全无缓解患者,为慢性非小关节源性腰痛组(B组),共15例;腰痛基本消失的患者,为慢性小关节源性腰痛组(C组),共20例;腰痛有改善但不能完全消除的患者,为慢性混合性腰痛组(D组),共20例。取各组患者的小关节囊标本,分别用氯化金染色及免疫组化法研究小关节囊上的神经末梢及神经肽Y的分布及表达的变化。结果:与对照组相比,慢性小关节源性腰痛组和慢性混合性腰痛组腰椎小关节退变趋势明显,神经纤维分布明显增多,且慢性小关节源性腰痛组神经分布稠密。免疫组化结果表明,慢性小关节源性腰痛组神经肽Y阳性分布稠密。此外,小关节囊神经纤维数量分布及神经肽Y阳性分布具有一定的相关性,但二者与小关节MRI Fujiwara分级无相关性。结论:慢性小关节源性腰痛患者小关节囊中存在丰富的末端神经纤维;当关节囊受压、牵张,组织炎症或化学物质刺激时或者脊柱小关节病变及力学行为改变时,小关节囊神经末梢疼痛介质分布会发生改变,进而参与腰痛的发生发展。Objective：To investigate the density and distribution of nerve endings and neuropeptide Y （NPY） in lumbar facet joints of patients with low back pain.Methods：Fifteen patients without low back pain were selected as control group （group A）.Facet joint samples in group A were obtained during the operation or lumbar spinal canal tumor they suffered from.Those patients with low back pain were divided into three groups according to their different origins of pain,such as not from facet joint （group B,15 patients）,from facet joint only （group C,20 patients）,or from facet joint partially （group D,20 patients）.Different origins were determined by VAS after facet joint block.The density and distribution of nerve ending and neuropeptide in the capsular tissues were analyzed by a modified gold chloride staining and immunochemistry respectively.Results：Compared with the ones in group A and B,the fact joints in group C and D were more inclined to be degenerated and got more nerve endings.NPY was expressed mainly in the facet joint of patients with low back pain in group C and D.In addition,there was a significant relationship between the distribution of nerve endings and NPY expression,while none of them were related with MRI Fujiwara grade of facet joint.Conclusion：These results suggest that the number of mechanoreceptors,neural sprouting and secreted peptides in the facet joint capsules vary with the change of mechanical or nociceptive stimulation,which may promote the development of low back pain in return.

关 键 词：腰痛 神经肽Y 神经末梢 病例对照研究 

分 类 号：R681.55[医药卫生—骨科学]