退变性腰小关节疼痛的发病机制

Pathogenesis of degenerative lumbar facet joint pain

腰椎小关节关节囊及关节组织中有大量神经末梢分布,这些神经纤维来自脊神经后支的内侧分支,解剖学上每个小关节至少接受两个脊柱节段的神经支配。但是患有腰椎小关节损伤的患者有时会有下腰部、大腿前方、腹股沟等部位疼痛,说明腰小关节的神经支配分的复杂性,腰椎小关节的这种支配方式形成了十分复杂的腰腿痛发病机制。腰小关节骨性关节炎同其他关节的骨性关节炎一样,表现为软骨面的病损,软骨下骨的硬化及骨赘形成,关节腔狭窄,关节囊增厚及滑膜增生等改变。细胞因子及其受体的高表达是退行性骨关节炎形成的重要诱因,基中最重要的是白细胞介素1β和肿瘤坏死因子α。

Each lumbar facet joint is innervated by the medial branches of the primary dorsal rami from posterior rami of spinal nerves. The capsule of the facet joints is richly innervated with nociceptive and autonomic nerve fibers. It is often difficult to define the source of pain for most patients have referred somatic pain, in which neurological symptoms and signs are not so apparent. These indicate that the mechanism of degenerative lumbar facet joints cause low back pain was complicated. Osteoarthritis of the facet joints is similar to that of all diarthrodial joints, which displayed many changes such as cartilaginous surface defects, subchondral bone sclerosis, osteophyte formation, narrow capsule, apophyseal misalignment, and synovial hyperplasia. High expression of cytokine and its receptor, especially interleukin-1β and tumor necrosis factor -α was an important triggering factor for degenerative osteoarthritis.