Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy.
Department of Surgery, Oncology and Gastroenterology, Orthopedic Clinic, University of Padova, Padova, Italy.
J Orthop Res. 2020 Jul;38(7):1646-1654. doi: 10.1002/jor.24665. Epub 2020 Mar 22.
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 µm). 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 , and a mean nerve sizes of 19.1 ± 7.2 µm. 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.
髋关节置换术后，即使手术成功，一些患者仍会持续出现疼痛等症状。筋膜和软组织的神经支配在疼痛的发病机制中的作用越来越受到重视，但髋关节区域各种解剖结构的相对重要性尚不清楚。为了确定人体髋关节皮肤、浅层脂肪组织、浅层筋膜、深层脂肪组织、深层筋膜、肌肉、关节囊、囊韧带、圆韧带和肌腱的神经支配，我们对 11 名患者和 2 具尸体进行了 S100 抗体染色，以检测髓鞘形成施万细胞，从而获得抗体阳性百分比、神经纤维密度和平均直径。皮肤的神经支配最为丰富（患者中为 0.73%±0.37%的阳性面积，尸体中为 0.80%±0.28%）；肌腱的神经支配最少（患者中为 0.07%±0.01%，尸体中为 0.07%±0.007%）。根据阳性百分比，阔筋膜张肌和臀中肌是第二大神经支配结构（活体中为 0.31%±0.13%，尸体中为 0.30%±0.07%），但神经数量少，直径较大（平均直径 36.4±13.4μm）。相比之下，活体和尸体中的浅层筋膜分别显示出 0.22%±0.06%和 0.26%±0.05%的阳性面积。筋膜被小神经纤维网络侵袭，这可能在疼痛中发挥作用。浅层筋膜是继皮肤之后第二大神经支配组织，神经密度为 33.0±2.5/cm，平均神经直径为 19.1±7.2μm。最后，关节囊的神经支配较差（0.09%），表明其切除不一定会导致疼痛后果。临床意义：更深入地了解髋关节软组织的神经支配，将有助于研究和理解髋关节置换术中应遵循的最佳手术程序，以减少术后疼痛。
