颈椎小关节囊的神经支配及其临床意义

目的：研究颈椎小关节囊的神经支配来源及其通路，为阐明小关节损伤后弥漫性头颈肩部疼痛的机制及其治疗提供依据。方法：39只SD雄性大鼠，分为颈交感神经未切除组（A组，18只）、切除组（B组，18只）及对照组（C组．3只）．A、B组分别于Cl-2、C3—4或C5—6（各6只大鼠）小关节囊内注射5％双雀甲亚胺（Bb）0．6μl．C组注射等量生理盐水。8h后检查各组C1～C8脊神经节（DRG）和交感神经节（SG）的荧光标记细胞，片作统计学分析。结果：A组脊神经节和交感神经节内均可见到荧光标记细胞，其中，C1-2和C3—4关节囊内注射组的C1～C8DRG内有Bb（＋）细胞，C5—6关节囊内注射组的C3～C8DRG内可见Bb（＋）细胞；B组注射节段和相邻节段Bh（＋）细胞无明显减少，但远节段的Bh（＋）细胞明显减少；C组未见Bb（＋）细胞。结论：颈椎小关节囊神经支配来源于感觉和交感神经系统，脊神经节和交感神经节间有神经纤维联系，存临床上阻断脊神经和交感神经有可能缓解患者的头颈肩痛症状。

The fluorescent trace study of the dual innervation of cervical facet joint capsule

Objective:To investigate the innervation pattern of the cervical facet joint capsule and their pathways in order to clarify the causes of diffuse neck pain,headache and shoulder pain,and provide a basis for therapy after facet joint lesions.Method:39 male Sprague-Dawley rats were used.5% Bisbenzimide(Bb)were injected into the C1-2,C3-4 and C5-6 facet joints in sympathectomy and nonsympathectomy group,numbers of the labeled neurons in dorsal root ganglions(DRGs)from C1 to C8 and sympathetic ganglions(SG)were counted.Result:Neurons labeled with Bb were present in both DRGs and SG,in C1-2 and C3-4 group labeled neurons were present from C1-C8 DRGs while in C5-6 group that is from C3-C8.The number of Bb(+)neurons after sympathectomy was not significantly different in injected level from that in the groups without sympathetomy,but in the other levels Bb(+)neurons was significantly less than that without sympathetomy.Conclusion:The innervation of the cervical facet joint capsule is derived from the both sensory and sympathetic nervous system,DRGs are associated with SG through nerve fibers.Blockade of other spinal nerves or sympathetic ganglions is possibly effective for patients with facet disorders.