Immunohistochemical Mapping of Sensory Nerve Endings in the Human Triangular Fibrocartilage Complex
Immunohistochemical Mapping of Sensory Nerve Endings in the Human Triangular Fibrocartilage Complex
复制标题
DOI：
10.1007/s11999-015-4357-z
复制
发表时间：
2015-10-01
影响因子：
4.2
通讯作者：
Hagert, Elisabet
中科院分区：
文献类型：
--
作者：
Rein, Susanne;Semisch, Manuel;Hagert, Elisabet
三角纤维软骨复合体是桡尺远侧关节的主要稳定器。虽然静态关节稳定性由骨和韧带完整性构成，但关节稳定性的动态方面主要涉及作用于关节的压缩和定向肌肉力的本体感受控制。本研究旨在（1）分析桡尺远侧关节感觉神经末梢和血管的一般分布，（2）观察感觉神经末梢和血管在结构间的分布，（3）比较各部位机械感受器的数量和类型，（4）观察感觉神经末梢和血管在结构间的分布，（5）观察感觉神经末梢和血管在结构间的分布，（6）观察感觉神经末梢和血管在结构间的分布，（7）观察感觉神经末梢和血管在结构间的分布，（8）观察感觉神经末梢和血管在结构间的分布，（9）观察感觉神经末梢和血管在结构间的分布，（10）观察感觉神经末梢和血管在结构间的分布。（4）解剖了11例成人尸体腕部标本的尺侧腕伸肌腱鞘下鞘、尺腕关节突、关节盘、桡尺背侧韧带、尺月韧带、尺三角韧带、桡尺背侧韧带、桡尺掌侧韧带、尺月韧带、尺三角韧带。在用低亲和力神经营养因子受体p75、蛋白基因产物9.5和S-100蛋白染色后，对每个标本的感觉神经末梢进行5个水平的计数，以总细胞量/cm（2）计，然后根据Freeman和怀克进行分类。它只含有高尔基体样末梢、游离神经末梢和无法分类的小体。关节盘仅有游离神经末梢。游离神经末梢是主要的感觉神经末梢（中位数，72.6/cm（2）;范围，0-469.4/cm（2）），比所有其他类型的机械感受器更普遍：Ruffini（中位数，0;范围，0-5.6/cm（2）;中位数差异，72.6; p < 0.001），Pacini（中位数，0;范围，0-3.8/cm（2）;中位数差异，72.6; p < 0.001），高尔基体样（中位数，0;范围，0-2.1/cm（2）;中位数差异，72.6; p < 0.001）和不可分类的小体（中位数，0;范围，0-2.5/cm（2）;中位数差异，72.6; p < 0.001）。与除尺月韧带外的三角纤维软骨复合体的所有其他结构相比，关节盘含有较少的游离神经末梢（中位数，1.8;范围，0-17.8/cm（2））和较少的血管（中位数，29.8;范围，0-112.2/cm（2）;中位数差：255.9）（p分别为千分之0.001）。桡尺掌侧韧带血管较多（中位数，363.62;范围，117.8-871.8/cm 2）与尺月韧带相比（中位数，107.7;范围，15.9-410.3/cm（2）;中位数差异：255.91; p = 0.002）和桡尺背侧韧带（中位数，116.2;范围，53.9-185.1/cm（2）;中位数差异：247.47; p = 0.001）。在每种结构中获得的游离神经末梢比所有其他类型的感觉神经末梢更常见（分别为p < 0.001）。intrastructural分析显示，在所有调查的标本中，机械感受器的分布与可用的数字没有差异，表现出一个均匀的分布在所有七个部分的三角纤维软骨complex.Nociception的本体感受素质有一个主要的本体感受的作用，远端桡尺关节的神经肌肉的稳定性。关节盘和尺月韧带很少受神经支配，这意味着主要是机械功能，而所有其他结构都具有明显的本体感受质量，这是动态关节稳定性的先决条件。掌侧和背侧桡尺韧带的损伤不仅对远端桡尺关节的机械稳定性而且对远端桡尺关节的动态稳定性具有巨大的影响，在桡尺韧带损伤的情况下，手术重建是重要的。
The triangular fibrocartilage complex is the main stabilizer of the distal radioulnar joint. While static joint stability is constituted by osseous and ligamentous integrity, the dynamic aspects of joint stability chiefly concern proprioceptive control of the compressive and directional muscular forces acting on the joint. Therefore, an investigation of the pattern and types of sensory nerve endings gives more insight in dynamic distal radioulnar joint stability.We aimed to (1) analyze the general distribution of sensory nerve endings and blood vessels; (2) examine interstructural distribution of sensory nerve endings and blood vessels; (3) compare the number and types of mechanoreceptors in each part; and (4) analyze intrastructural distribution of nerve endings at different tissue depth.The subsheath of the extensor carpi ulnaris tendon sheath, the ulnocarpal meniscoid, the articular disc, the dorsal and volar radioulnar ligaments, and the ulnolunate and ulnotriquetral ligaments were dissected from 11 human cadaver wrists. Sensory nerve endings were counted in five levels per specimen as total cell amount/cm(2) after staining with low-affinity neurotrophin receptor p75, protein gene product 9.5, and S-100 protein and thereafter classified according to Freeman and Wyke.All types of sensory corpuscles were found in the various structures of the triangular fibrocartilage complex with the exception of the ulnolunate ligament, which contained only Golgi-like endings, free nerve endings, and unclassifiable corpuscles. The articular disc had only free nerve endings. Furthermore, free nerve endings were the predominant sensory nerve ending (median, 72.6/cm(2); range, 0-469.4/cm(2)) and more prevalent than all other types of mechanoreceptors: Ruffini (median, 0; range, 0-5.6/cm(2); difference of medians, 72.6; p < 0.001), Pacini (median, 0; range, 0-3.8/cm(2); difference of medians, 72.6; p < 0.001), Golgi-like (median, 0; range, 0-2.1/cm(2); difference of medians, 72.6; p < 0.001), and unclassifiable corpuscles (median, 0; range, 0-2.5/cm(2); difference of medians, 72.6; p < 0.001). The articular disc contained fewer free nerve endings (median, 1.8; range, 0-17.8/cm(2)) and fewer blood vessels (median, 29.8; range, 0-112.2/cm(2); difference of medians: 255.9) than all other structures of the triangular fibrocartilage complex (p a parts per thousand currency sign 0.001, respectively) except the ulnolunate ligament. More blood vessels were seen in the volar radioulnar ligament (median, 363.62; range, 117.8-871.8/cm(2)) compared with the ulnolunate ligament (median, 107.7; range, 15.9-410.3/cm(2); difference of medians: 255.91; p = 0.002) and the dorsal radioulnar ligament (median, 116.2; range, 53.9-185.1/cm(2); difference of medians: 247.47; p = 0.001). Free nerve endings were obtained in each structure more often than all other types of sensory nerve endings (p < 0.001, respectively). The intrastructural analysis revealed no differences in mechanoreceptor distribution in all investigated specimens with the numbers available, showing a homogenous distribution of proprioceptive qualities in all seven parts of the triangular fibrocartilage complex.Nociception has a primary proprioceptive role in the neuromuscular stability of the distal radioulnar joint. The articular disc and ulnolunate ligament rarely are innervated, which implies mainly mechanical functions, whereas all other structures have pronounced proprioceptive qualities, prerequisite for dynamic joint stability.Lesions of the volar and dorsal radioulnar ligaments have immense consequences not only for mechanical but also for dynamic stability of the distal radioulnar joint, and surgical reconstruction in instances of radioulnar ligament injury is important.