退变性腰椎疾患小关节囊中P物质的表达及其意义

摘要] 目的 探讨退变性腰椎疾患中小关节囊病理变化及其疼痛机理。 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（Substance P,SP）免疫组化染色，观察SP免疫组化染色阳性神经纤维的分布情况。结果 实验组中13例可见SP阳性神经纤维，5例未见阳性反应。SP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SP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SP 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SP纤维。对照组腰椎小关节囊中3例可见少量SP阳性神经纤维，15例为阴性。结论 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SP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。

The Distribution of Substance P Immunoreactive Nerve Fibers in the Lumbar Facet Joint Capsule in Degenerative Lumbar Disease and Its Clinical Significance

Abstract] Objective To investigate the pathogenic role of facet joint capsule in chronic low back pain and its pathologic change in degenerative lumbar disease.Method 18 cases were selected by diagnositic block before operation in degenerative lumbar disease, the test group were experienced resection of facet joint capsule, The control group was the cases the fracture of lumbar vertebra who were no low back pain before fracture. Using immunohistochemical method to visualize nerve terminals with antibodys to Substance P to characterize sensory nerve terminals on sections from lumbar of resection the facet joint capsule. Observed the SP immunoreactive fibers in the degenerative facet joints capsule. Result In the test group, SP immunoreactive nerve fibers were found in 9 cases and 5 cases have no positive reaction. SP immunoreactive nerve fibers distributed in joint capsule and subchondral bone area ,most of them were located in facet capsule. The fibers were also found in plical tissueof the capsule . They were not all associated with large blood vessels , some of them run freely in the stroma. A little SP immunoreactive nerve fibers were found in 2 cases of the control group. 10 cases were negative. Conclusions The degenerative change of facet joint capsule is one of the important causes of chronic low back pain. The observation provided morphological basis for low back pain , implied that the SP immunoreactive fibers might involve in facet degeneration and might be an important source of the lower back pain.