Fascia and soft tissues innervation in the human hip and their possible role in post-surgical pain
Fascia and soft tissues innervation in the human hip and their possible role in post-surgical pain
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DOI：
10.1002/jor.24665
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发表时间：
2020-03-22
影响因子：
2.8
通讯作者：
Stecco, Carla
中科院分区：
文献类型：
--
作者：
Fede, Caterina;Porzionato, Andrea;Stecco, Carla
持续的症状，最常见的疼痛，可能在其他成功的髋关节置换手术后仍然存在。筋膜和软组织的神经支配在疼痛的发病机制中已变得越来越重要，但髋部各种解剖结构的相对重要性仍不清楚。对11例患者和2具身体髋部皮肤、浅脂肪组织、浅筋膜、深层脂肪组织、深筋膜、肌肉、关节囊、关节囊韧带、圆韧带和肌腱的神经支配进行了髓鞘形成雪旺细胞的抗S100抗体染色，以获得抗体阳性百分率、神经纤维密度和平均直径。皮肤受神经支配程度最高(0.73%±0.37%；身体为0.80%±0.28%)，肌腱最少(0.07%±0.01%，身体0.07%+/-0.007%)。其次是臀中肌和外侧肌(活人0.31%+/-0.13%，身体0.30%+/-0.07%)，但神经少，直径大(平均36.4±13.4微米)。活体和身体浅筋膜的阳性面积分别为0.22%+/-0.06%和0.26%+/-0.05%。筋膜被细小的神经纤维网络侵犯，揭示了在疼痛中可能起到的作用。浅筋膜是仅次于皮肤的第二大神经支配组织，其密度为33.0+/-2.5/cm(2)，平均神经长度为19.1+/-7.2微米。最后，包膜神经支配不良(0.09%)，表明摘除包膜不一定会导致疼痛后果。临床意义陈述：更深入地了解人类髋关节软组织的神经支配将加强对髋关节置换术中减少术后疼痛的最佳手术程序的研究和理解。
Persistent symptoms, most commonly pain, may remain after otherwise successful hip replacement surgery. Innervation of fascia and soft tissues has become increasingly important in etiopathogenesis of pain, but the relative importance of the various anatomical structures in the hip region is still not known. Innervation of skin, superficial adipose tissue, superficial fascia, deep adipose tissue, deep fascia, muscles, capsule, capsule ligament, ligamentum teres, and tendon in the human hip from 11 patients and 2 cadavers were quantified by staining with anti-S100 antibody for myelin-forming Schwann cells, to obtain the percentage of antibody positivity, density and mean diameter of the nerve fibers. The skin was the most highly innervated (0.73% +/- 0.37% of positive area in patients; 0.80% +/- 0.28% in cadavers); the tendon was the least innervated (0.07% +/- 0.01% in patients, 0.07% +/- 0.007% in cadavers). The muscles (vasto-lateral and gluteus medius) were the second most innervated structure according the percentage (0.31% +/- 0.13% in living humans, 0.30% +/- 0.07% in cadavers), but with only a few nerves, with large diameters (mean diameter 36.4 +/- 13.4 mu m). Instead, the superficial fasciae showed 0.22% +/- 0.06% and 0.26% +/- 0.05% of positive areas in living humans and cadavers, respectively. Fasciae were invaded by networks of small nerve fibers, revealing a possible role in pain. The superficial fascia was the second most highly innervated tissue after the skin, with a density of 33.0 +/- 2.5/cm(2), and a mean nerve sizes of 19.1 +/- 7.2 mu m. Lastly, the capsule turned out to be poorly innervated (0.09%), showing that its removal does not necessarily lead to painful consequences. Statement of clinical significance: Deeper knowledge about the innervation of the soft tissue in the human hip joint will enhance study and understanding of the best surgical procedures to follow during hip arthroplasty to reduce post-operative pain.