交感神经在腰椎间盘源性疼痛中作用的研究进展

doi:10.3969/j.issn.1006-7795.2014.01.010

摘要/Abstract

摘要：

椎间盘病变是引起临床疼痛症状的常见原因。近年来，交感神经在退变腰椎间盘的分布逐步被阐明，腰椎间盘病变累及交感神经在腰椎间盘源性疼痛的发病机制中的作用越来越受到重视。椎间盘退变，髓核外漏会导致神经张入腰椎间盘内及神经炎性反应的发生，这种变化也构成了腰椎间盘源性疼痛的基础。本文就交感神经在退变腰椎间盘的分布及腰椎间盘源性疼痛的发病机制进行综述。

关键词: 腰椎间盘源性, 交感神经, 疼痛

Abstract:

Intervertebral disc disorder is a common cause for pain syndroms. Disc degeneration, annular tear, leakage of nucleus pulposus and the nerve ingrowth into the disc dominate the primary reason for discogenic pain. Recent studies on discogenic pain have provided new knowledge about this condition. The lumbar intervertebral disk may be innervated non-segmentally through the paravertebral sympathetic nerves. The exposure of the nucleus pulposus to the outer annulus fibrosus may induce nerve inflammation and ingrowth into the disc. Thus, sympathetic nerves irritation resulting from disc disorder has attached increasing attention to discogenic pain. This review focused on the sympathetic innervations into degenerated disc and the mechanisms of discogenic pain.

Key words: lumbar discogenic, sympathetic nerve, pain

中图分类号:

R441

唐元章, 卞晶晶, 倪家骧. 交感神经在腰椎间盘源性疼痛中作用的研究进展[J]. 首都医科大学学报, 2014, 35(1): 41-44.

Tang Yuanzhang, Bian Jingjing, Ni Jiaxiang. Recent advances in studies on the role of sympathetic nerve in lumbar discogenic pain[J]. Journal of Capital Medical University, 2014, 35(1): 41-44.

参考文献

[1] Peng B. Issues concerning the biological repair of intervertebral disc degeneration[J]. Nat Clin Pract Rheumatol, 2008, 4(5):226 227.

[2] Gupta G, Radhakrishna M, Chankowsky J, et al. Methylene blue in the treatment of discogenic low back pain[J]. Pain Physician, 2012, 15(4):333 338.

[3] Freemont A J, Peacock T E, Goupille P, et al. Nerve ingrowth into diseased intervertebral disc in chronic back pain[J]. Lancet, 1997, 350(9072):178-181.

[4] 王永刚, 周海宇, 王栓科, 等. 神经肽Y/降钙素基因相关肽在腰椎间盘中的分布与共表达[J]. 中国组织工程研究, 2012(48):9039 9043.

[5] 王永刚, 王栓科, 时培晟, 等. 神经肽Y在突出腰椎间盘组织中的表达及意义[J]. 中国疼痛医学杂志, 2012, 18(11):663 666.

[6] Gillette R G, Kramis R C, Roberts W J. Sympathetic activation of cat spinal neurons responsive to noxious stimulation of deep tissues in the low back[J]. Pain, 1994, 56(1):31 42.

[7] Peng B, Wu W, Hou S, et al. The pathogenesis of discogenic low back pain[J]. J Bone Joint Surg Br, 2005, 87(1):62-67.

[8] Tang Y Z, Shannon M L, Lai G H, et al. Anterior herniation of lumbar disc induces persistent visceral pain: discogenic visceral pain: discogenic visceral pain[J]. Chin Med J (Engl), 2013, 126(24):4691-4695.

[9] Ahmed M, Bjurholm A, Kreicbergs A, et al. Neuropeptide Y, tyrosine hydroxylase and vasoactive intestinal polypeptide-immunoreactive nerve fibers in the vertebral bodies, discs, dura mater, and spinal ligaments of the rat lumbar spine[J]. Spine (Phila Pa 1976), 1993, 18(2):268 273.

[10] 苏彩风, 邵增务. 腰椎间盘内神经侵润生长[J]. 国际骨科学杂志, 2007, 28(1):41-43.

[11] Palmgren T, Grnblad M, Virri J, et al. An immunohistochemical study of nerve structures in the anulus fibrosus of human normal lumbar intervertebral discs[J]. Spine (Phila Pa 1976), 1999, 24(20):2075 2079.

[12] 石作为, 姚猛, 王岩松, 等. 间盘源性下腰痛发生机制的探讨[J]. 中国疼痛医学杂志, 2007, 13(1):32 35.

[13] Nakamura S, Takahashi K, Takahashi Y, et al. Origin of nerves supplying the posterior portion of lumbar intervertebral discs in rats[J]. Spine (Phila Pa 1976), 1996, 21(8):917 924.

[14] Takahashi Y, Ohtori S, Takahashi K. Peripheral nerve pathways of afferent fibers innervating the lumbar spine in rats[J]. J Pain, 2009, 10(4):416 425.

[15] Raoul S, Faure A, Robert R, et al. Role of the sinu-vertebral nerve in low back pain and anatomical basis of therapeutic implications[J]. Surg Radiol Anat, 2003, 24(6):366 371.

[16] Groen G J, Baljet B, Drukker J. Nerves and nerve plexuses of the human vertebral column[J]. Am J Anat, 1990, 188(3):282 296.

[17] 陈金栋, 侯树勋, 彭宝淦, 等. 人腰椎交感神经解剖学研究[J]. 中华医学杂志, 2007, 87(9):602 605.

[18] Morinaga T, Takahashi K, Yamagata M, et al. Sensory innervation to the anterior portion of lumbar intervertebral disc[J]. Spine (Phila Pa 1976), 1996, 21(16):1848 1851.

[19] Ohtori S, Inoue G, Koshi T, et al. Sensory innervation of lumbar vertebral bodies in rats[J]. Spine (Phila Pa 1976), 2007, 32(14):1498 1502.

[20] 宋敏, 罗晓. 腰椎间盘突出症的分型及临床意义[J]. 颈腰痛杂志, 2008, 29(6):575-578.

[21] de Souza Grave A L, Ferrari L F, Defino H L. Cytokine inhibition and time-related influence of inflammatory stimuli on the hyperalgesia induced by the nucleus pulposus[J]. Eur Spine J, 2012, 21(3):537 545.

[22] Nakamura S I, Takahashi K, Takahashi Y, et al. The afferent pathways of discogenic low-back pain. Evaluation of L2 spinal nerve infiltration[J]. J Bone Joint Surg Br, 1996, 78(4):606 612.

[23] Chen J, Hou S, Peng B, et al. Effect of the L2 ramus communicans on the nociceptive pathway in lumbar intervertebral discs in rats[J]. Eur J Pain, 2008, 12(6):798 803.

[24] 李茂, 高春华, 庞晓东, 等. 椎间盘源性腰痛神经传入通路的实验研究[J]. 脊柱外科杂志, 2012, 10(5):299 303.

[25] 亢卫波, 艾依热提·买买提, 曾峥. 显微镜下手术治疗腰椎间盘突出症的临床观察[J]. 首都医科大学学报, 2012, 33(1):121-125.

[26] 康南, 海涌, 苏庆军. 多节段腰椎间盘突出症的治疗[J]. 首都医科大学学报, 2012, 33(4):503-507.

[27] 刘昊楠, 林欣, 潘海涛, 等. 应用椎间孔镜TESSYS技术治疗腰椎间盘突出症[J]. 首都医科大学学报, 2012, 33(6):827-832.

[28] 邵翔绪, 卢思奇. 胶原酶注射治疗腰椎间盘突出症32例随访报告[J]. 首都医科大学学报, 1999, 20(2):121-122.

[29] 任道禄, 高紫红. 腰椎间盘前突的CT诊断及其临床意义[J]. 放射学实践, 2003, 18(8):590 591.

[30] 杨辉, 仝超, 孔德明, 等. 伴腹痛腹胀的腰椎间盘突出症1例报告[J]. 中国脊柱脊髓杂志, 2005, 15(12):765.

[31] 曹家树, 刘乐, 易志坚, 等. 腰椎间盘突出症与下腹痛的关系4例分析[J]. 中国矫形外科杂志, 2010, 18(17):1496.

[32] 陈建明, 张成程, 庄颖, 等.军人腰椎间盘突出症258例临床分析[J].解放军医药杂志, 2012, 24(9):26-28.

[33] 袁建华, 龚灏.腰椎间盘突出症诊断治疗的几个问题及对策[J].临床误诊误治, 2010, 26(S1):62-63.