Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis?
Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis?
复制标题
血管神经向内生长是慢性跟腱炎疼痛的原因吗？
DOI：
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
S. Forsgren
中科院分区：
文献类型：
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作者：
H. Alfredson;L. Öhberg;S. Forsgren
本研究的目的是通过超声、彩色多普勒、免疫组织化学和诊断性注射来研究慢性跟腱中段病的疼痛来源。采用超声和彩色多普勒对24例临床诊断为疼痛性慢性跟腱中段病的患者（平均年龄47岁）的25根肌腱和14例无疼痛性跟腱的对照组（平均年龄48岁）的20根肌腱进行了超声和彩色多普勒检查。对于25条疼痛的肌腱，在肌腱腹侧以外有新生血管的区域注射局部麻醉剂。6例患者肌腱病组织活检采用PGP 9.5免疫组化。在所有疼痛性腱鞘病肌腱中，在肌腱改变区域的腹侧部分内外均可见新生血管，但在任何无痛对照肌腱中均未见。对肌腱腹外侧新生血管注射局部麻醉剂后，所有患者在肌腱负荷活动时的疼痛均得到暂时治愈。跟高的vas平均评分从75毫米显著下降到6毫米。活检中PGP 9.5免疫组化显示血管附近有神经结构。总之，我们的研究结果支持新生血管和伴随的神经可能是慢性中部跟腱炎疼痛的来源。
The purpose of this study was to investigate where the pain comes from in chronic mid-portion Achilles tendinosis, by using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Twenty-five tendons in 24 patients (mean age 47 years) with the clinical diagnosis of painful chronic mid-portion Achilles tendinosis, and 20 tendons in 14 controls (mean age 48 years) with pain-free Achilles tendons were examined with ultrasonography and colour Doppler. For the 25 painful tendons, a local anaesthetic was injected in the area with neovascularisation outside the ventral part of the tendon. Biopsies taken from tendinosis tissue in six patients were used for PGP 9.5 immunohistochemistry. A neovascularisation, inside and outside the ventral part of the area with tendon changes, was demonstrated in all painful tendinosis tendons, but not in any of the pain-free control tendons. After injection of the local anaesthetic towards the neovessels outside the ventral part of the tendon, the pain during tendon-loading activity was temporarily cured in all patients. The mean VAS-score for heel-raises decreased significantly from 75 mm to 6 mm. In biopsies, PGP 9.5 immunohistochemistry showed nerve structures in the vicinity of blood vessels. In conclusion, we demonstrate findings which support neovessels and accompanying nerves being the possible source of pain in chronic mid-portion Achilles tendinosis.