CAJ | 학술논문

目的从新鲜尸体和踝关节不稳患者手术中所切取的韧带周围组织入手,分析踝关节周围本体感受器的性质和分布,并进一步与临床病例的生物力学、本体感觉功能检验结果相比较,判断和分析本体感受器受损在功能性踝关节不稳定中的作用.方法18例踝关节不稳患者行韧带重建手术.术前、术后分别行功能评分[美国骨科足踝医师协会(AOFAS)评分],平衡系统评价其本体感觉功能.从2例新鲜冰冻尸体踝关节韧带组织和手术中获取韧带组织标本,应用组织学方法和免疫组化染色观察分析感觉小体的结构特征和分布特点.结果 (1)标本发现Ⅰ型小体、Ⅱ型小体和Ⅳ型游离无神经鞘的神经末梢;这些感受器主要分布于韧带的浅层和近骨附着部.(2)患者重心摆动距离术前、术后睁眼与闭眼检测差异均有统计学意义;患者AOFAS评分手术前后差异有统计学意义.结论(1)踝关节不稳患者本体感觉功能受损,病史越长,症状越严重,功能评分越低,其本体感受受损越严重.(2)韧带感受器受损,与踝关节不稳症状相关联,韧带重建是避免感受器反复损伤的有效方法.
목적 종신선시체화과관절불은환자수술중소절취적인대주위조직입수,분석과관절주위본체감수기적성질화분포,병진일보여림상병례적생물역학、본체감각공능검험결과상비교,판단화분석본체감수기수손재공능성과관절불은정중적작용.방법18례과관절불은환자행인대중건수술.술전、술후분별행공능평분[미국골과족과의사협회(AOFAS)평분],평형계통평개기본체감각공능.종2례신선빙동시체과관절인대조직화수술중획취인대조직표본,응용조직학방법화면역조화염색관찰분석감각소체적결구특정화분포특점.결과 (1)표본발현Ⅰ형소체、Ⅱ형소체화Ⅳ형유리무신경초적신경말소;저사감수기주요분포우인대적천층화근골부착부.(2)환자중심파동거리술전、술후정안여폐안검측차이균유통계학의의;환자AOFAS평분수술전후차이유통계학의의.결론(1)과관절불은환자본체감각공능수손,병사월장,증상월엄중,공능평분월저,기본체감수수손월엄중.(2)인대감수기수손,여과관절불은증상상관련,인대중건시피면감수기반복손상적유효방법.
Objective To analyze the effect of ankle joint proprioceptor injury on the functional ankle instability. Methods The study enrolled 18 ( 13 males) with chronic ankle instability treated with ligament reconstruction operation. The American Orthopaedic Foot and Ankle Surgeons (AOFAS)score was used for evaluation of the function before and after operation and the balance system evaluate the proprioception function. The two ankle ligament specimens from fresh frozen body and the tissue samples from operation were used for investigation of the structure and distribution of the sensory corpuscles by using histology and immunohistoehemical staining. Results The sections were evaluated with a microscope and an image analyzer. Labeled nerve endings were mapped, measured and categorized. Type Ⅰ ( Ruffini-like ending) , type Ⅱ ( Pacinin-like corpuscle ) and type Ⅳ- (noncorpuscular) nerve endings could be identified in all the lateral ankle ligaments, with majority of types Ⅰ and Ⅱ nerve endings.These receptors were distributed primarily over the superficial ligament and near the bony attachments.There was statistical difference between preoperative and postoperative sway distance as well as between preoperative and postoperative AOFAS score. Conclusions This study suggests that the longer history,severer symptoms and lower AOFAS score may lead to the severer injury of the mechanical proprioceptors.The proprioceptor injury is correlated with ankle joint instability and the ligament reconstruction is effective to avoid the repeated injury of the proprioceptor.