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18,36h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18h,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36h,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。

Receptor pathway of lumbar facet joint and lamina muscle attachment points

BACKGROUND：Drug administration and silver needle heat conductive treatment through receptor pathway of lumbar facet joint and lamina muscle attachment points can achieve good effect in the treatment of discogenic low back pain,but the pathway remains unclear.OBJECTIVE：To observe the receptor pathway of lumbar facet joint and lamina muscle attachment points morphologically in the rabbits.METHODS：A total of eight rabbits were randomly divided into 2 groups.Fluorescent riboflavin was injected into the bilateral lumbar facet and lamina muscle attachment points under CT guidance.At 18 and 36 hours after injection,consecutive frozen sections were made in T1-L5 spinal ganglia,cervical,thoracic sympathetic ganglion,inferior mesenteric ganglion,brain,cerebellum,thalamus,brain stem,spinal cord,internal organs,blood vessels,skin,synovial membrane of lumbar facet joint,tendon of lamina muscle attachment,disc,testes and ovaries,etc.Nerve cells and nerve endings labeled by fluorescence were observed under fluorescence microscope and hematoxylin-eosin staining.The exposure time was recorded.RESULTS AND CONCLUSION：Nerve cells labeled by fluorescence were observed in hypothalamus,neck,thoracic sympathetic ganglion,T12-L5 spinal ganglia,gastric mucosa,the intestinal mucosa and submucosa and the inferior mesenteric ganglion 18 hours after injection.Fluorescent-intensive area was observed in frontal horn and posterior horn of spinal cord,brain,cerebellum,annulus fibrosus disci intervertebralis,nucleus pulposus of lumbar intervertebral disc,lumbar synovial membrane between the skeletal muscle membrane,inside and outside membrane of trachea,inside membrane of lung,internal and external membrane of cardiac muscle,glomeruli,tubules,wall of gallbladder,inside and outside membrane of fallopian tube,ovary,inside and outside membrane of uterus,testis,capillary loops of skin and wall of mesenteric artery.Lots of lymphocyte were seen in the spinal ganglia under hematoxylin-eosin staining,fluorescent-intensive areas were similar to fluorescence microscope,but the exposure time was significantly reduced （P0.01）.At 36 hours after injection,labeled cells in spinal ganglion were significantly reduced,and exposure time was significantly lengthened （P0.01）.Fluorescence-intensive areas were the same,but the exposure time in some sites was significantly lengthened （P0.01）,significantly decreased at some sites （P0.01）.Receptor pathway network of lumbar facet joint and lamina muscle attachment points in the rabbit were composed by sympathetic ganglia and postganglionic neurons,intestinal ganglion cells,spinal ganglia,parasympathetic neuron in peripheral and part neurons in the hypothalamus.