腰椎小关节退变致腰腿痛机制的实验研究

An experimental study of relation between degenerative lumbar facet joint and low back pain

目的:探讨退变腰椎小关节病变和腰腿疼的关系及其可能的作用机制。方法:收集我院骨科临床手术中切除的腰椎小关节标本,利用组织病理学和影像学检查对比研究正常和退变腰椎小关节的病变特点,免疫组织化学方法观察P物质(substanceP,SP)、降钙素基因相关肽(calcitoningene-relatedpeptide,CGRP)能神经纤维在小关节中的分布,酶联免疫吸附剂测定法(enzyme-linkedimmunosobnentassay,ELISA)测定腰椎小关节中细胞因子IL-1β的含量。结果:退变腰椎小关节的X线和CT表现为关节间隙有不同程度的变窄或消失、关节面骨质增生、硬化,HE染色软骨表面不平整、细胞排列紊乱;白介素-1β(interleukin-1β,IL-1β)水平升高。在两组小关节中都发现了SP、CGRP能神经纤维的存在。结论:腰椎小关节退变后发生了不同程度的病理变化,机械摩擦和细胞因子刺激小关节中的神经纤维可能是小关节病变引起腰腿疼的原因之一。

Objective：To investigate the relation between the pathological and biochemical features of the degenerative lumbar facet joints and low back pain and the possible underlying mechanism.Method：The lumbar facet joints were harvested from the patients during surgery,the pathological features and the distributions of nerve fibers were studied by the means of pathological examination contrasted to the medical imaging characteristics,using ELISA method to measure the contents of IL-1β in the lumbar facet joints.Result：According to the features of pathological and the medical imaging characteristics some degenerative changes could be recognized in the degenerative lumbar facet jionts,this degenerative changes were demonstrated by the medical imaging included ： asymmetry of articular surface,calcification of articular capsule ,joint interspace narrowing, the main abnormality was demonstrated by pathological study included：chondrocyte proliferation ,unsmooth of articular surface,higher content of IL-1β in the degenerative lumbar facet joints than in the normal,substance P （SP） immunoreactive and calcitonin gene-related peptide（CGRP） immunoreactive nerve fibers could be found in the degenerative and normal lumbar facet joints by immunohistochemical method.Conclusion：Some pathological and biochemical changes occure in the degenerative lumbar facet jionts.The mechanical stimulation and cytokine excitation to the nerver fibers are the possible underlying mechanism of low back pain caused by degenerative lumbar facet joints.