Saito T, Koshino T
Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Japan.
Clin Orthop Relat Res. 2000 Jul(376):172-82. doi: 10.1097/00003086-200007000-00024.
Synovial tissue was obtained from medial, lateral, and suprapatellar sites of 21 knees (15 patients) with medial compartmental osteoarthritis at surgery. All patients reported pain around the medial joint of their knees while walking and climbing stairs. For investigation of the synovial innervation, six samples were stained with modified gold chloride and the others with an immunohistochemical method using antisera against neuropeptides. The extent of synovitis in each part was scored using a new 10-point scale. The results showed that the synovium had an extensive neural network in the somatic and autonomic nervous systems. Neuropeptides were most abundant, with an especially large number of substance P and calcitonin gene related peptide immunoreactive free nerve endings. Some of the substance P positive nerve endings were surrounded by monocytes. Substance P and calcitonin gene related peptide were found more frequently in the medial than in the lateral or suprapatellar areas. Substance P positive free nerve endings showed more dendritic morphologic features in the medial region than did those in the lateral and suprapatellar regions, and small nerves were accompanied by newly developed vessels in synovial villi. In the medial region, the synovitis was more remarkable than in the lateral region. These findings suggest that free nerve endings containing substance P may modulate inflammation and the pain pathway in osteoarthritis.
在手术中，从21个膝关节（15名患者）的内侧、外侧和髌上部位获取滑膜组织，这些患者均患有内侧间室骨关节炎。所有患者均报告在行走和爬楼梯时膝关节内侧周围疼痛。为了研究滑膜神经支配情况，六个样本用改良氯化金染色，其他样本采用抗神经肽抗血清的免疫组织化学方法染色。使用新的10分制对各部位滑膜炎的程度进行评分。结果表明，滑膜在躯体和自主神经系统中具有广泛的神经网络。神经肽最为丰富，尤其是有大量P物质和降钙素基因相关肽免疫反应性游离神经末梢。一些P物质阳性神经末梢被单核细胞包围。在内侧区域发现P物质和降钙素基因相关肽的频率高于外侧或髌上区域。内侧区域的P物质阳性游离神经末梢比外侧和髌上区域的呈现出更多的树突状形态特征，并且小神经伴随着滑膜绒毛中新形成的血管。在内侧区域，滑膜炎比外侧区域更显著。这些发现表明，含有P物质的游离神经末梢可能调节骨关节炎中的炎症和疼痛通路。
