Barton R Shane, Ostrowski Mary L, Anderson Terrence D, Ilahi Omer A, Heggeness Michael H
Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas 77030, USA.
Am J Sports Med. 2007 Feb;35(2):307-11. doi: 10.1177/0363546506297968. Epub 2007 Jan 4.
The soft tissue structures surrounding the human knee joint have been the subject of extensive anatomic study. The detailed histologic findings within the bone of the human patella, however, have not been systematically studied. While the nerves supplied to the periarticular soft tissues have been very well documented, the nerves supplied to the interior of the bony patella have never been described.
This study tests the hypothesis that the patella contains an intraosseous nerve network. Further, the authors investigate the anatomic location of these intraosseous nerves to better understand their possible clinical relevance.
Descriptive laboratory study.
Ten matched pairs of cadaveric patellae (left and right patellae from the same individual; 20 total) were prepared for evaluation by hematoxylin and eosin staining using a technique that allows the creation of complete, large histologic sections of individual patellae. The matched specimens were dissected free of soft tissue and then sectioned using a diamond-wafering saw into 3-mm sagittal (left patella) and transverse (right patella) sections. Sections were then decalcified and whole-mounted into paraffin blocks for further sectioning using a large-format microtome. All 20 specimens were prepared for evaluation. Age at death averaged 80 years (range, 64-91). All specimens demonstrated at least grade II chondromalacia.
Nineteen of 20 (95%) specimens demonstrated intraosseous nerves. Of 248 sections studied, 116 (47%) demonstrated intraosseous nerves, with 227 individual nerves identified. The density of intraosseous nerves was greatest in the medial and central portions of the patella, with a significant paucity identified laterally.
The primary intraosseous innervation of the patella derives from a medially based neurovascular bundle.
A better understanding of the nerves within the human bony patella may improve understanding the patho-physiology of anterior knee pain syndromes.
人体膝关节周围的软组织结构一直是广泛解剖学研究的主题。然而，人类髌骨内详细的组织学发现尚未得到系统研究。虽然供应关节周围软组织的神经已有详尽记录，但供应髌骨内部的神经从未被描述过。
本研究检验髌骨包含骨内神经网络的假设。此外，作者研究这些骨内神经的解剖位置，以更好地理解它们可能的临床相关性。
描述性实验室研究。
准备10对匹配的尸体髌骨（来自同一个体的左、右髌骨，共20个），采用一种能制作单个髌骨完整、大组织学切片的技术，用苏木精和伊红染色进行评估。将匹配的标本软组织剥离，然后用金刚石切片锯切成3毫米的矢状（左髌骨）和横断（右髌骨）切片。切片随后脱钙并整体包埋入石蜡块，以便用大型切片机进一步切片。所有20个标本均准备好进行评估。平均死亡年龄为80岁（范围64 - 91岁）。所有标本均显示至少为II级软骨软化。
20个标本中有19个（95%）显示有骨内神经。在研究的248个切片中，116个（47%）显示有骨内神经，共识别出227条单条神经。骨内神经密度在髌骨内侧和中央部分最大，外侧明显稀少。
髌骨的主要骨内神经支配源自内侧的神经血管束。
更好地了解人类髌骨内的神经可能有助于增进对膝前疼痛综合征病理生理学的理解。
