目前,肌筋膜疼痛已成为医疗保健系统中的主要问题之一。研究其原因和与之相关的结构可能有助于改善其管理。直到几年前,所有的研究都集中在肌肉改变上,作为触发点,但是最近,筋膜开始被认为是一种新的,疼痛的可能来源。进行了此系统综述,目的是从组织学和/或免疫组织化学角度分析肌肉/深层筋膜神经支配的当前证据。在PubMed和GoogleScholar上进行了2000年至2021年之间的文献检索。搜索词包括筋膜的组合,神经支配,免疫组织化学,和不同的免疫组织化学标记。在纳入审查的23项研究中,在大鼠中进行了五项研究,四只老鼠,两个马,人类十个,人类和老鼠都有两个。有各种各样的免疫组织化学标记用于检测筋膜的神经支配;最常用的是蛋白基因标记9.5(在12项研究中使用),降钙素基因相关肽(十项研究),S100(十项研究),P物质(七项研究),和酪氨酸羟化酶(六项研究)。已经研究了各个领域,胸腰椎筋膜是观察最多的。此外,论文强调了各种筋膜神经支配的密度和类型的多样性,从自由神经末梢到帕西尼和鲁菲尼小体。最后,已观察到病理性筋膜的神经支配增加。从这篇评论来看,很明显,筋膜有很好的内在联系,它们的神经支配具有特定的分布和精确的定位,特别是由本体感受器和伤害感受器组成,后者在病理情况下更多。这可能有助于更好地理解和管理疼痛。
Currently, myofascial pain has become one of the main problems in healthcare systems. Research into its causes and the structures related to it may help to improve its management. Until some years ago, all the studies were focused on muscle alterations, as trigger points, but recently, fasciae are starting to be considered a new, possible source of pain. This systematic
review has been conducted for the purpose of analyze the current evidence of the muscular/deep fasciae innervation from a histological and/or immunohistochemical point of view. A literature search published between 2000 and 2021 was made in PubMed and Google Scholar. Search terms included a combination of fascia, innervation, immunohistochemical, and different immunohistochemical markers. Of the 23 total studies included in the
review, five studies were performed in rats, four in mice, two in horses, ten in humans, and two in both humans and rats. There were a great variety of immunohistochemical markers used to detect the innervation of the fasciae; the most used were Protein Gene Marker 9.5 (used in twelve studies), Calcitonin Gene-Related Peptide (ten studies), S100 (ten studies), substance P (seven studies), and tyrosine hydroxylase (six studies). Various areas have been studied, with the thoracolumbar fascia being the most observed. Besides, the papers highlighted diversity in the density and type of innervation in the various fasciae, going from free nerve endings to Pacini and Ruffini corpuscles. Finally, it has been observed that the innervation is increased in the pathological fasciae. From this
review, it is evident that fasciae are well innerved, their innervation have a particular distribution and precise localization and is composed especially by proprioceptors and nociceptors, the latter being more numerous in pathological situations. This could contribute to a better comprehension and management of pain.