CAJ | 학술논문

目的对髌骨周围软组织的神经末梢分布情况进行组织形态学观察,为人工全膝关节置换手术中行髌骨周围烧灼提供理论依据.方法取自4具新鲜截肢的髌骨标本(2例糖尿病足截肢、1例下肢动脉闭塞截肢和1例车祸伤截肢),采集髌骨周围0.5 cm以内软组织,长0.5 cm×宽0.5 cm×纵向全层的三维立体标本,通过HE染色、甘氨酸银染色,在同一视野下对髌周软组织标本紧贴髌骨内侧截面的神经末梢分布进行组织形态学观察.结果大体解剖发现来源于皮肤的血管网直接进入髌骨滋养孔区域参与构成髌骨滋养孔区域的血管网络并在2、4、7和10点位发现有血管进入髌骨；组织学观察发现髌骨周围软组织内存在大量的神经纤维,但4个髌骨标本周围软组织内神经纤维的区域分布没有明显区别.髌骨周围软组织内侧滑膜层有神经入髌的通道,主要存在于7、11和13点位,髌骨外侧没有发现神经进入髌骨的通道.神经纤维呈“区域性集中分布”现象,以5、6、7点位及10、11、12、1、2点位分布数目最多,其中又以股四头肌肌腱和髌腱两极居多,在髌骨滋养孔区域的筋膜及骨膜中也发现了大量的神经纤维.神经纤维分层分布,主要集中在滑膜层、脂肪垫、肌腱结缔组织间层的近髌骨端.结论髌骨周围软组织内神经纤维分布多,神经进入髌骨的通道主要存在于髌骨内侧和滋养孔区域,神经纤维分布呈分层且区域性集中现象,“中央较多,下多于上,内多于外,两极多于其他”.髌周烧灼去神经化操作,通过减少外周伤害感受器的数目实现“减敏”在临床上具有可行性.
목적 대빈골주위연조직적신경말소분포정황진행조직형태학관찰,위인공전슬관절치환수술중행빈골주위소작제공이론의거.방법 취자4구신선절지적빈골표본(2례당뇨병족절지、1례하지동맥폐새절지화1례차화상절지),채집빈골주위0.5 cm이내연조직,장0.5 cm×관0.5 cm×종향전층적삼유입체표본,통과HE염색、감안산은염색,재동일시야하대빈주연조직표본긴첩빈골내측절면적신경말소분포진행조직형태학관찰.결과 대체해부발현래원우피부적혈관망직접진입빈골자양공구역삼여구성빈골자양공구역적혈관망락병재2、4、7화10점위발현유혈관진입빈골；조직학관찰발현빈골주위연조직내존재대량적신경섬유,단4개빈골표본주위연조직내신경섬유적구역분포몰유명현구별.빈골주위연조직내측활막층유신경입빈적통도,주요존재우7、11화13점위,빈골외측몰유발현신경진입빈골적통도.신경섬유정“구역성집중분포”현상,이5、6、7점위급10、11、12、1、2점위분포수목최다,기중우이고사두기기건화빈건량겁거다,재빈골자양공구역적근막급골막중야발현료대량적신경섬유.신경섬유분층분포,주요집중재활막층、지방점、기건결체조직간층적근빈골단.결론 빈골주위연조직내신경섬유분포다,신경진입빈골적통도주요존재우빈골내측화자양공구역,신경섬유분포정분층차구역성집중현상,“중앙교다,하다우상,내다우외,량겁다우기타”.빈주소작거신경화조작,통과감소외주상해감수기적수목실현“감민”재림상상구유가행성.
Objective To observe the distribution of circum-patella nerve fibers in the soft tissue to provide experimental evidence,which is significant in denervation for Total Knee Arthroplasty (TKA).Methods Patella specimens were collected from 4 cadavers (2 cases of diabetic foot,lcase of lower extremity arterial occlusive,and 1case of car accident),all 4 of which were resected soft tissue with a dimension of 0.5cm × 0.5cm and full depth thickness around patella more than 0.5cm for histology and morphology observation.The nerve fibers histology and morphology were observed in all resected specimens with HE staining and silver-gilt glycine staining in the same field of microscopic vision.Results Anatomy found that the vascular network form skins directly involved in the patella nourish hole area and in the 10,2,4,7 clock point have found that blood vessels into the patella.There have a large number of nerve fibers near to the patella under the microscope,but there were no significant difference in the nerve fibers region distribution of all specimens.There were some into patella nerve fiber paths in side of patella soft tissue,which lied in 7,11 and 13 clock point,but outside no this phenomenon.The distribution of circum-patellar nerve fibers were described as" distribution of regional concentration",which lied in much more 5,6,7 clock points and 10,11,12,1,2,clock points,in which the quadriceps tendon and patellar tendon have more than the others.In the 13 clock point,the fascia and periosteum of nourish hole area were also found in a large number of nerve fibers,and there were laminar distribution in different soft tissue layers,which were collected much more in synovial layer,fat pad,tendon near to patella.Conclusion There are much more nerve fibers near to the patella and some into patella nerve fiber paths in the medial side and nourish hole area.Nerve fibers distribution of circum-patella can be described as "laminar distribution and regional concentration ",which is "more in the centre,bottom more than top,outside more than inside,the bipolar more than the others".The patella denervation operation by reducing the number of peripheral nociceptors to achieve "desensitization" is feasible in TKA.