经腰椎关节突和椎板骨骼肌附着点的感受器通路

背景：经关节突滑膜和椎板骨骼肌附着点感受器通路给药及银质针导热治疗盘源性腰腿痛效果显著,但关节突滑膜和椎板骨骼肌附着点感受器通路尚不清楚。 目的：观察家兔经腰椎关节突和椎板骨骼肌附着点的感受器通路形态学特征。  方法：将8只家兔随机分为2组,在CT引导下经双侧腰椎关节突和椎板骨骼肌附着点分别注射荧光逆行神经追踪剂核黄进行逆行神经追踪,分别在注射后18,36 h取T₁₂~L₅脊神经节、颈、胸交感神经节、肠系膜下神经节、大脑、小脑、丘脑、脑干、脊髓、内脏、血管、皮、腰椎关节突滑膜、椎板骨骼肌附着点的肌腱、腰椎间盘、雄性的睾丸、雌性的卵巢等,连续冰冻切片,荧光显微镜及苏木精-伊红染色观察荧光标记的神经细胞及荧光标记密集的神经末梢部位,并记录曝光时间。 结果与结论：荧光素注射18 h,在下丘脑,颈、胸交感神经节,T₁₂~L₅脊神经节,胃黏膜下、小肠黏膜及黏膜下、肠系膜下神经节发现荧光标记细胞;在脊髓前、后角、大脑、小脑、腰椎间盘纤维环、腰椎间盘髓核、腰椎间关节滑膜、骨骼肌膜、气管内外膜、肺泡内膜、心肌的内外膜、肾小球、肾小管、胆囊壁、输卵管内外膜、卵巢、子宫内外膜、睾丸、皮内毛细血管袢及肠系膜动脉壁发现荧光密集区。苏木精-伊红染色可见脊神经节内淋巴细胞浸润,各荧光密集区与荧光显微镜下所见相同,但曝光时间显著减少(P < 0.01)。荧光素注射36 h,脊神经节标记细胞明显减少,曝光时间显著延长(P < 0.01),荧光密集区的部位相同,但有些部位曝光时间显著延长(P < 0.01),有些部位曝光时间显著减少(P < 0.01)。说明家兔腰椎关节突滑膜和椎板骨骼肌附着点感受器通路网络由交感神经节及节后神经元、小肠节细胞、脊神经节、外周副交感神经元、下丘脑部分神经元5大神经网络组成。     

人和大鼠腰椎关节突关节的SP能神经纤维的分布

目的：证实支配腰椎关节突关节的神经支配和化学性质，方法：用逆行荧光素标记结合免疫组化法，研究７只大鼠腰部脊神经节细胞的周围突分支投射到腰椎关节突关节及其递质性质以及３例人腰椎关节突关节囊上神经末梢的化学性质，结果：发现大鼠一侧Ｌ５和Ｌ６之间的关节突关节受同侧Ｌ２－５节段的脊神经节的部分细胞周围突分支支配，其中有３３．３９９％的中型和小型细胞为中ＳＰ能免疫反应阳性，人的关节突关节囊含有ＳＰ阳性的神经     

不同扭矩对腰椎融合后邻近上节段生物力学影响的实验研究

目的　探讨腰椎融合后不同扭矩对邻近上节段椎间盘内压、关节突关节压力的影响。 方法　选取12具猪腰椎,随机分成2组,比较融合（L4/5）前、后两种状态下三种不同扭矩加载邻近上节段（L3/4）椎间盘内压、关节突关节压力的差异。 结果 融合后随着扭矩的增加椎间盘内压增加,扭矩越大椎间盘内压变化越明显(P=0.023); 非融合组及融合组伴随着扭矩的增加关节突关节压力逐渐增加, 扭矩越大关节突关节压力越大。融合组较非融合组关节突关节压力变化明显（P=0.046）。 结论 腰椎融合后, 随着扭矩的增加邻近上节段腰椎间盘内压呈增高趋势; 关节突关节压力随着扭矩的增加关节突压力而增加。     

人工腰椎间盘置换术后上位关节突关节内应力变化的研究

目的　研究人工腰椎间盘置换术对上位相邻节段关节突关节内应力（FS）的影响,并与腰椎融合术进行比较,为人工腰椎间盘的临床应用提供理论依据。 方法　选取6具新鲜成人尸体的腰骶段（L2~S1）标本,将每具标本依次制作成L4/5椎间盘完整（对照组）、L4/5椎间盘置换和L4/5椎间融合模型,并依次进行生物力学实验,将压力传感器置入L3/4关节突关节,以400 N的恒定轴向载荷,±7.5 Nm的力矩模拟生理状态下轴向、后伸和左右侧弯4种运动,分别测量3种模型在各种运动下L3/4关节突关节内压力。 结果　在模拟生理载荷的各种运动下,人工椎间盘置换组与椎间盘完整组相比较,上位关节突关节内压力差异无统计学意义（P＞0.05）,而腰椎间融合组相对于椎间盘完整组和人工椎间盘置换组,上位关节突关节内压力均显著增加,差异具有统计学意义（P＜0.05）。 结论 人工腰椎间盘置换术后,上位相邻节段关节突关节内压力与正常腰椎相比无明显改变,而腰椎间融合术后,上位相邻节段关节突关节内压力则显著增加。     

下段腰椎小关节突角度及形态不对称与腰椎间盘突出的相关性探讨

目的：探讨下段腰椎小关节突的关节角度及其形态不对称与腰椎间盘突出的相关性。方法：在CT片上观察127例患者的小关节突关节形态、椎间盘是否突出,并测量小关节突关节角度,计算其差值。按年龄分为4组,每个每年龄组中依据两侧小关节突关节角度差值分为〈5°、≥5°、≥10°三个组,并将形态不对称纳入关节角度差≥10°组中。在每个年龄组中,对L3～M、L4～L5及L5～S1节段发生椎间盘突出的病例的不同小关节突角度差值的组间进行组间两两比较;同时,对不同小关节角度差值的各节段椎间盘突出病例的各个年龄组亦进行年龄组间的两两比较;以及不同关节角度差值中,各节段椎间盘突出的总数进行两两比较。结果：在每个年龄组中,各节段椎间盘突出与小关节突角度差值无统计学意义,在不同小关节角度差值的不同年龄组中,仅个别节段椎间盘有统计意义;而在不同小关节角度差值中L3～L4与L4-L5两节段椎间盘突出总数具有统计学意义。结论：下段腰椎椎间盘突出与小关节是否对称无相关性,大多数腰椎间盘突出的病例与年龄亦无明显相关性,而与发生的腰椎节段有相关性。     

单侧腰椎弓根螺钉及经椎板关节突螺钉固定与双侧固定的比较

背景：经椎板关节突关节螺钉固定、椎间植骨融合治疗脊柱疾患是一种独特的固定方法,可用于退变性腰椎的融合。 目的：比较采用微创经腰椎间孔椎体融合联合单侧椎弓根螺钉及经椎板关节突螺钉固定与常规开放后路腰椎体间融合术联合双侧椎弓根螺钉固定治疗下腰痛疾病的临床效果。 方法：纳入2010年6月至2012年6月于武警广东总队医院就诊的腰椎间盘突出伴腰椎轻度不稳患者49例,均采用后路减压椎间融合器植骨内固定治疗。其中24例采用微创经椎间孔椎体融合术联合单侧椎弓根螺钉及经椎板关节突螺钉固定,25例采用常规开放后路腰椎体间融合术联合双侧椎弓根螺钉固定,比较两种固定方法的临床疗效。 结果与结论：两种固定方法术后椎体融合率、日本矫形外科协会评分及疼痛目测类比评分改善率差异均无显著性意义(P > 0.05)。可见对无严重不稳的单节段退变性腰椎疾病患者,两种治疗方法的效果相当,均能有效提高椎间融合率,使小关节稳定,解除临床症状,门诊随访满意。但采用微创经椎间孔椎体融合术联合单侧椎弓根螺钉及经椎板关节突螺钉固定的患者手术切口长度、手术时间、术中出血量、术后切口引流液量明显减少(P < 0.05),说明该方法具有创伤小、操作简单的优势。     

腰椎间盘突出症力学特征的仿真计算方法

目的建立腰椎间盘突出症力学特征的数值计算分析模型,为腰椎间盘突出症的力学机理提供一种检测评估方法。方法利用健康成人L4～5腰椎运动节段CT影像,采用Mimics 10.01医学图像处理软件和Geomagic10.0逆向工程软件分别建立L4～5腰椎运动节段的椎骨和椎间盘,并在Ansys软件中附加腰椎相关韧带及通过改变椎间盘突出后对应的材料属性,建立腰椎L4～5运动节段有限元模型,构建正常模型和腰椎间盘突出模型;运用有限元方法模拟正常椎间盘和突出椎间盘在轴向压力、前弯、侧弯、旋转和后伸5种载荷下的生物力学特征参数。结果椎间盘突出后,椎间盘的应力分布及传递载荷的能力改变,应力集中于纤维环后外侧;在相同的载荷情况下,突出的椎间盘的最大形变量比正常椎间盘的大;椎间盘突出模型的小关节突接触力比正常模型的小关节突接触力大。结论椎间盘突出后,椎间盘的承载功能下降,关节突的应力水平升高,小关节的负荷增加,从而导致腰椎稳度下降。     

有限元模拟全内镜下精准椎板开窗减压术及生物力学分析

文题释义： 全内镜下精准椎板开窗：在内镜可视下及术中影像学实时监测下,对椎板开窗切除范围精准可控。 有限元分析：是一种采用较简单的小问题来替代较复杂的大问题,从而只需对简单的小问题进行求解的分析方法,可对脊柱的形状、材料属性及边界条件等进行描述,是一种研究人体力学的有效科学手段。 背景：目前内镜微创减压手术已应用于腰椎管狭窄症的治疗,但对镜下精准椎板开窗范围的研究较少。 目的：利用退变腰椎有限元模型,评估分析全内镜下不同分区精准椎板开窗减压手术对腰椎活动度及应力分布的影响。 方法：随机选取1名腰椎管狭窄症患者,采集CT数据,使用相关生物力学软件建立腰椎L_4-5节段有限元模型(M1),并进行有效性验证。继而有限元模拟内镜可视下精准椎板开窗减压手术,结合腰椎管狭窄症临床病理分型,建立椎板开窗减压相应范围L_4-5节段手术模型,分别为L₄椎板下缘+L_4-5关节突关节部分切除模型(M2)、L_4-5部分关节突关节+L₅椎板上缘切除模型(M3)、L₄椎板下缘+L_4-5部分关节突关节+L₅椎板上缘切除模型(M4)、L₄椎板下缘+L_4-5部分关节突关节+L₅椎板上缘+ Over-the-Top对侧部分关节突切除模型(M5)及L₄椎体下缘+L_4-5关节突关节1/2以上+L₅椎板上缘切除模型(M6)(以上椎体均保留峡部,除M6外,关节突关节均保留50%以上的关节面)。分别对完整脊柱(M1)及5种模拟手术模型(M2、M3、M4、M5、M6)施加相同载荷边界条件,进行前屈、后伸、左/右侧弯、左/右旋转6种工况下腰椎活动度及椎间盘等效应力的对比分析。 结果与结论：①与完整脊柱M1模型比较,M2、M3、M4及M5模型在各工况下活动度值相近,但M6模型的活动度值较M1明显增大,为M1活动度的151%-264%,特别是后伸和旋转工况为甚;②在椎间盘等效应力方面,M2、M3、M4及M5模型在椎间盘前区、左/右区工况下等效应力上升趋势不明显,在椎间盘后区、中区等效应力有所增加,最大增加幅度达53%,但未出现较大应力集中的情况;而M6模型椎间盘各区域等效应力均出现较大程度上升趋势,特别在前屈工况下最大达完整退变模型(M1)的3倍;③结果表明,过大椎板开窗明显影响腰椎稳定性,同时相应节段椎间盘应力增加,易加速椎间关节退变。内镜微创减压手术精准可控,针对不同类型腰椎管狭窄症采用个性化治疗方案,保证减压效果的同时,可有效维持手术节段的生物力学特性。 ORCID: 0000-0001-8935-3117(蒋强) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

腰椎间融合后路非对称与对称固定螺钉应力的有限元比较

背景：经椎间孔腰椎间融合非对称固定的生物力学稳定性研究,发现固定效果与双侧椎弓根螺钉接近,可满足临床应用所需生物力学要求。经关节突椎弓根螺钉参与经椎间孔腰椎间融合非对称固定的螺钉力学安全性又会怎样呢？ 目的：建立L₄-₅功能节段左侧经椎间孔腰椎间融合后,分别予以同侧椎弓根螺钉+对侧经关节突椎弓根螺钉、同侧椎弓根螺钉+对侧经椎板关节突螺钉及双侧椎弓根螺钉固定的三维有限元模型,施加相同的载荷,分析不同运动状态下螺钉应力分布特点,比较3种螺钉应力状况。 方法：对一成人正常L₄-₅椎节段标本、椎间融合器、椎弓根螺钉和皮质骨螺钉进行64排螺旋CT 扫描,通过Mimics11.1建立左侧经椎间孔腰椎间融合后3种内固定组合(同侧椎弓根螺钉+ 对侧经椎板关节突螺钉、同侧椎弓根螺钉+对侧经关节突椎弓根螺钉及双侧椎弓根螺钉固定)的几何模型,利用Simpleware3.1软件分别建立三维有限元模型,模拟500 N\6 Nm载荷下前屈、后伸、左\右侧弯、左\右侧旋等6种运动状态,用Abaqus6.8软件进行螺钉应力变化和分布特点分析。 结果与结论：由于经椎间孔腰椎间融合入路切除了左侧关节突,造成内植物应力分布不对称,对弹性模量大的内固定器械—椎弓根螺钉应力影响最大,尤其是在左旋运动时。在不对称组合内固定中,由于关节突关节螺钉的使用,使对侧椎弓根螺钉应力相应增加,以左旋运动时尤为明显,但关节突关节螺钉断裂的危险性增高不明显。提示为降低螺钉断裂的风险,经椎间孔腰椎间融合后路3种组合内固定均应严格限制旋转运动,尤其是关节突切除侧的旋转运动。     

经颈上节传递心脏痛感觉信息的迷走神经传入通路

目的　观察经颈上节至结状节传递心脏感觉信息的迷走神经传入通路。　方法　逆行追踪及逆行追踪结合免疫组织化学方法。　结果　HRP注射入颈上节后 ,逆行标记的一小团细胞恒定地出现在结状节上段 ,其数量较少且分布局限。将荧光金 (fluorogold ,FG)注射入颈上节后并结合免疫荧光组织化学染色 ,观察到结状节内约 18 5 %的SP阳性标记细胞同时呈阳性FG逆行标记。　结论　结合以往文献 ,研究结果提示 ,心脏的感觉信息向中枢传递存在着经颈上节至结状节的含SP神经活性物质的迷走神经传入通路     

Receptor binding sites for cholecystokinin, galanin, somatostatin, substance P and vasoactive intestinal polypeptide in sympathetic ganglia.

Sympathetic ganglia are innervated by neuropeptide-containing fibers originating from pre- and postganglionic sympathetic neurons, dorsal root ganglion neurons, and in some cases, myenteric neurons. In the present report receptor autoradiography was used to determine whether sympathetic ganglia express receptor binding sites for several of these neuropeptides including bombesin, calcitonin gene-related peptide-alpha, cholecystokinin, galanin, neurokinin A, somatostatin, substance P, and vasoactive intestinal polypeptide. The sympathetic ganglia examined included the rat and rabbit superior cervical ganglia and the rabbit superior mesenteric ganglion. High levels of receptor binding sites for cholecystokinin, galanin, somatostatin, substance P, and vasoactive intestinal polypeptide were observed in all sympathetic ganglia examined, although only discrete neuronal populations within each ganglion appeared to express receptor binding sites for any particular neuropeptide. These data suggest that discrete populations of postganglionic sympathetic neurons may be regulated by neuropeptides released from pre- and postganglionic sympathetic neurons, dorsal root ganglion neurons, and myenteric neurons.     

The sympathetic postganglionic and sensory innervation of oviducal magnum in hen: a choleratoxin subunit B-conjugated horseradish peroxidase study

The anatomy of the extrinsic innervation of the avian magnum has not been accurately demonstrated previously. In the present study, choleratoxin subunit B-conjugated horseradish peroxidase (CB-HRP) was used as a retrograde tracer to determine the sympathetic postganglionic and sensory innervation of the magnum of hens. With regard to the sympathetic postganglionic innervation, following CB-HRP injections under the serosa of the magnum, CB-HRP-positive neurons were found bilaterally in the C12-LS13 ganglia of the sympathetic chain, splanchnic ganglia and adrenal ganglia. The number of labelled neurons in the left ganglia of the sympathetic chain and splanchnic ganglia was approximately 2.1 times that in the right ganglia. This suggests that the unilateral magnum is bilaterally innervated with sympathetic postganglionic nerves, the left nerves being predominant. With regard to the sensory innervation, following tracer injections, CB-HRP-positive neurons were found bilaterally in the spinal ganglia C13-LS12, jugular ganglia and nodose ganglia. The number of positive cells in the left ganglia was about 2.2 times that in the right ganglia. In the spinal ganglia, 85.6% of the labelled neurons were in the T5-LS2 and LS8-LS11 ganglia. These results suggest that the sensory nerve fibres of the magnum reach the central nervous system principally via two groups of spinal ganglia and vagus nerves, and that the innervation is bilateral although the left-hand route predominates. Moreover, 45.7% of all the CB-HRP-labelled neurons were found in the rectal region of the intestinal nerve of Remak (INR), which suggests that the INR plays a very important role in the functional regulation of the magnum.     

猫胰腺交感节后神经元的定位研究

本文采用胰腺实质内注HRP逆行标记神经元的方法,研究猫胰腺交感节后神经元的位置,结果如下:1.猫胰腺交感节后神经元位于腹腔节和双侧T_5-L_2节段椎旁节内,并以腹腔节为主,二者之比约为8.52∶1。标记细胞在腹腔节内的分布具有局部定位关系;2.标记细胞在双侧椎旁节中的分布数量相等,集中分布于T_(12)-T_(13)两个节段;3.标记细胞形态多样,其中腹腔节中的细胞多呈椭圆形和圆形,而椎旁节内的细胞则多为梭形和长椭圆形。     

Pre and postganglionic innervation of rat adrenal gland by fluorescent tract tracer – Fast blue

IntroductionTo search for pre and postganglionic neurons innervating the adrenal gland by injecting retrograde tract tracer fast blue in the adrenal medulla.MethodsThe motor innervation of rat adrenal gland was studied by a fluorescent tract tracer fast blue. 5 μl of 2% aqueous suspension of fast blue was injected into left adrenal gland. After a survival period of 4–5 days, spinal cord, sympathetic ganglia, suprarenal ganglion, coeliac ganglion and left adrenal gland were dissected out and 15 μm thick plastic sections (JB4 Polysciences) were examined under a fluorescent microscope.ResultsRetrogradely labeled preganglionic neurons were observed in the ipsilateral intermediolateral column of spinal cord from T3 to L2 spinal segments with maximum concentration of labeled neurons from T6 to T11. The labeled neurons were multipolar, spherical or fusiform in shape with transverse diameter 10–20 μm and vertical diameter varying from 12 to 30 μm. Postganglionic labeled neurons were also observed in the left suprarenal ganglion and left sympathetic ganglia (T5 –L2) with maximum concentration from T6 to L1. Labeled neurons varied from 12 to 30 μm in diameter and were randomly distributed throughout the ganglion.DiscussionThe preganglionic neurons from T3 to L2 spinal segments and postganglionic nerve fibers from ipsilateral sympathetic ganglia (T5 –L2) and suprarenal ganglion supplying the adrenal gland might be responsible for the hormone release by regulating blood flow and also by directly innervating the parenchymal cells.     

Calcitonin gene-related peptide (CGRP)-immunoreactive neurons in the human cervico-thoracic paravertebral ganglia

The occurrence of CGRP-immunoreactive neurons in human paravertebral sympathetic ganglia was investigated and CGRP-immunoreactive perikarya correlated with the distribution of structures which were immunoreactive to other peptides and tyrosine hydroxylase, the key enzyme of catecholamine-synthesis. CGRP-immunoreactive neurons were present in all investigated ganglia (superior cervical ganglion, stellate ganglion, thoracic ganglia IV and VII). Most of the CGRP-immunolabelled cell bodies contained also vasoactive intestinal polypeptide-as well as somatostatin-immunoreactivity. Approximately 40 per cent of the CGRP-immunoreactive neurons were weakly tyrosine hydroxylase-immunolabelled. CGRP-immunoreactive cell bodies appear to be neither identical with the large population of neuropeptide Y-labelled perikarya nor with the large group of cell bodies which were surrounded by leuenkephalin-immunoreactive nerve fibres. Colocalization of CGRP- with vasoactive intestinal polypeptide- and somatostatin-immunoreactivity in postganglionic sympathetic neurons substantiates the suggestion of sympathetic origin of respective peptidergic nerve fibres in sweat glands.     

Confocal imaging of autonomic preganglionic neurons in the spinal cord of the caecilian Typhlonectes natans (Amphibia: Gymnophiona)

Little is known about the spinal sympathetic organization in the caecilian amphibians. We examined for the first time the location of sympathetic preganglionic neurons (SPNs) in the spinal cord using a panel of specific markers expressed in SPNs. The SPNs of anuran amphibians form two cell columns segregated mainly in the lateral and medial marginal areas of the central gray matter. In the caecilian Typhlonectes natans immunoreactivity for galanin and ChAT is found in most laterally arranged neurons lying in spinal segments 2–7. They are encircled by TH- and nNOS-immunoreactive nerve fibers. These neurons might project specifically to a population of adrenergic sympathetic postganglionic neurons in paravertebral ganglia and/or non-adrenergic sympathetic postganglionic neurons in the celiac ganglia. However the segmental restriction and target specificity of the neurons of the species studied are not known. As mucous and granular glands in the dermis may represent one of the peripheral targets of the adrenergic ganglion cells and reflect the prominent preganglionic cell columns, an immunohistochemical study was done also on these glands. Retrograde-tracing studies are, however, needed to study the segmental localization of the preganglionic neurons and their projections to the postganglionic neurons in sympathetic ganglia.     

肾脏的交感神经支配

采用大体解剖学方法和肾内注射HRP逆行标记神经元的方法,研究了猫肾脏的交感神经支配。发现了下述的待点。1.猫左、右侧腹腔神经节相互融合,呈半环状包绕在肠系膜上(前)动脉的起始处,于其融合部,各发出左、右肾支。肠系膜上神经节与右侧腹腔神经节融合。2.肾交感神经节后神经元,分别位于腹腔神轻节,同侧主动脉肾神经节和T_(12)～L~4节段的交感干神经节内,並具有局部定位分布的关系。3.肾交感神经节后纤维主要来自腹腔神经节(82.08％),其次是主动脉肾神经节(12.76％),交感干神经节最少(5.16％)。4.肾交感神经节后神经元,多呈圆形或椭圆形,交感干神经节中有少量呈梭形。5.支配肾周腹膜的交感神经节后神经元与肾交感神经节后神经元存在部位、数量和在各种神经节内分布形式均不相同。     

Distributions of neuropeptide Y, vasoactive intestinal peptide and somatostatin in populations of postganglionic neurons innervating the rat kidney, spleen and intestine.

Some peripheral peptidergic nerves selectively innervate different types of tissue in abdominal organs. Neuropeptide Y- and vasoactive intestinal peptide-immunoreactive nerve terminals have been identified in the kidney, spleen and intestine and these peptides may have important physiological actions. Somatostatin has been found in sympathetic ganglia, and nerve terminals containing this peptide have been identified in the intestine. We have used fluorescent retrograde tracers to identify renal, splenic and mesenteric postganglionic neurons in rat sympathetic ganglia and then used immunocytochemistry to determine the proportions of these three identified groups of neurons displaying immunoreactivity for neuropeptide Y, vasoactive intestinal peptide and somatostatin. Most renal, splenic and mesenteric neurons were immunoreactive for neuropeptide Y and less than 1% of cells innervating these organs were immunoreactive for vasoactive intestinal peptide. Somatostatin immunoreactivity was present only in a small percentage of mesenteric neurons and not in renal or splenic neurons. The present study demonstrates that (i) the rat kidney, spleen and intestine do not differ in the proportion of innervation by neuropeptide Y-immunoreactive neurons, (ii) the solar plexus, splanchnic ganglion and chain ganglia (T12 and T13) provide very little vasoactive intestinal peptide-immunoreactive inputs to these organs, and (iii) somatostatin-immunoreactive neurons innervate the intestine but not the kidney or spleen.