Nerve-related characteristics of ventral paratendinous tissue in chronic Achilles tendinosis
Nerve-related characteristics of ventral paratendinous tissue in chronic Achilles tendinosis
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DOI：
10.1007/s00167-007-0364-2
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发表时间：
2007-10-01
影响因子：
3.8
通讯作者：
Forsgren, Sture
中科院分区：
文献类型：
--
作者：
Andersson, Gustav;Danielson, Patrik;Forsgren, Sture
超声和多普勒检查显示慢性疼痛性肌腱病患者的腹侧跟腱内外有高血流量新生血管形成，但在无痛的正常跟腱中没有。在跟腱病患者中，针对血流增加的区域注射硬化物质聚多卡醇已被证明可以缓解疼痛。在解释这些发现时的一个缺点是，目标区域（即肌腱的腹侧区域）的神经供应模式迄今为止尚不清楚。因此，在这项研究中，从该地区的组织标本，在手术治疗慢性疼痛的中部跟腱病患者，进行了检查。在检查区域，含有疏松结缔组织，一般发现是存在大小动脉和神经束。在针对泛神经标记蛋白基因产物9.5处理的切片中区分神经束。神经束含有感觉神经纤维，如通过对感觉标记物P物质（SP）和降钙素基因相关肽染色所示，以及交感神经纤维，如通过对酪氨酸羟化酶的处理所见。此外，在血管壁和神经束中存在SP优选受体，神经激肽-1受体的免疫反应。一些血管由广泛的血管周围神经支配提供，交感神经纤维是这种神经支配的独特组成部分。在动脉壁和神经束中也有明显的α（1）-肾上腺素受体免疫反应。总而言之，这些发现表明，研究的区域受到神经系统的显著影响，包括交感神经和感觉成分。因此，交感神经/感觉影响可能涉及该区域的疼痛机制。总之，这里首次显示了阿喀琉斯肌腱病的聚羟基烷醇注射治疗靶向区域的神经相关特征。
Ultrasound and Doppler examination has shown high blood flow-neovascularisation inside and outside the ventral Achilles tendon in chronic painful tendinosis, but not in pain-free normal Achilles tendons. In patients with Achilles tendinosis, injections with the sclerosing substance polidocanol, targeting the areas with increased blood flow, have been demonstrated to give pain relief. A drawback when interpreting these findings is the fact that the pattern of nerve supply in the target area, i.e. the ventral area of the tendon, is so far unknown. In this study, therefore, tissue specimens from this area, obtained during surgical treatment of patients with chronic painful midportion Achilles tendinosis, were examined. In the examined area, containing loose connective tissue, the general finding was a presence of large and small arteries and nerve fascicles. The nerve fascicles were distinguished in sections processed for the pan-neural marker protein gene-product 9.5. The nerve fascicles contain sensory nerve fibers, as shown via staining for the sensory markers substance P (SP) and calcitonin gene-related peptide, and sympathetic nerve fibers as seen via processing for tyrosine hydroxylase. In addition, there were immunoreactions for the SP-preferred receptor, the neurokinin-1 receptor, in blood vessel walls and nerve fascicles. Some of the blood vessels were supplied by an extensive peri-vascular innervation, sympathetic nerve fibers being a distinct component of this innervation. There was also a marked occurrence of immunoreactions for the alpha(1)-adrenoreceptor in arterial walls as well as in the nerve fascicles. Altogether, these findings suggest that the area investigated is under marked influence by the nervous system, including sympathetic and sensory components. Thus, sympathetic/sensory influences may be involved in the pain mechanisms from this area. In conclusion, the nerve-related characteristics of the area targeted by the polidicanol injection treatment for Achilles tendinosis, are shown here for the first time.