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目的探讨颈椎关节突关节疼痛综合征并发上臂痛的神经解剖学机制。方法以抗降钙素基因相关肽(CGRP)抗体对SD大鼠C4~T1关节突关节囊作免疫组织化学染色。将荧光标记物快蓝(FB)和核黄(NY)分别注射到SD大鼠右侧桡神经和C1~T1颈椎关节突关节囊。显微镜下观察颈脊神经背根节(DRG)内被逆行荧光标记的神经元,再用抗CGRP抗体行免疫组织化学染色,观察DRG内的CGRP免疫阳性神经元。最后比较荧光照片和免疫组织化学照片上的神经元。结果C4~T1关节突关节囊上分布着丰富的CGRP免疫阳性神经纤维,它们或独立走行或交织成网。在C5~T1各节段的DRG中均可观测到被FB单标(76%)、NY单标(16%)和FB/NY双标(8%)的神经元。约40%的荧光逆行标记神经元在免疫组织化学染色的切片上呈CGRP免疫反应阳性。结论大鼠颈部DRG内一部分含GRP的感觉神经元的周围突分两支,一支支配颈椎关节突关节囊,另一支随桡神经分布到前(上)肢。提示,颈椎关节突关节疼痛综合征并发上臂牵涉痛的神经形态学基础之一可能发生在DRG水平。
Objective To investigate the neuroanatomical mechanism of upper cervical pain associated with cervical joint pain syndrome. Methods Anti-CGRP antibodies were used to detect the immunohistochemical staining of C4 ~ T1 articular synovial capsule in SD rats. Fluorescent markers fast blue (FB) and nuclear yellow (NY) were injected into the right radial nerve and C1 ~ T1 cervical synovial capsule of SD rats respectively. The retrograde fluorescence-labeled neurons in the DRG of the cervical dorsal root ganglion (DRG) were observed under a microscope. Immunohistochemical staining with anti-CGRP antibody was used to observe the CGRP immunoreactive neurons in the DRG. Final comparison of neurons on fluorescence and immunohistochemical pictures. Results CGRP-positive nerve fibers were abundantly distributed on the C4 ~ T1 articular surface of articular capsule. They either traveled independently or interlaced into the network. Neurons that were single-labeled with FB (76%), single-NY (16%) and double-labeled with FB / NY (8%) were observed in the DRG of each segment of C5 ~ Approximately 40% of fluorescent retrogradely labeled neurons are CGRP immunoreactive on immunohistochemical sections. Conclusion There are two branches of sensory neurons in the DRG of the DRG, one locating the facet joint capsule of the cervical spine and the other with the radial nerve distributing to the front (upper) limb. It is suggested that one of the neuromorphological bases of upper cervical involvement pain may be at DRG level.