微创牵张技术对山羊膝骨关节炎关节软骨的影响及初步临床观察

发布时间：2018-07-04 10:43

本文选题：微创牵张技术 + 骨关节炎　；参考：《福建中医药大学》2012年硕士论文

【摘要】：目的：第一部分：通过在体实验,建立山羊膝骨关节炎模型,观察微创牵张技术对滑膜及关节软骨的组织形态及关节液中MMP-1、CTX-Ⅱ浓度等指标的影响,探讨微创牵张技术有效治疗骨关节炎的机制,为微创牵张技术临床治疗骨关节炎提供理论依据。第二部分：通过临床初步观察,应用微创牵张技术配合骨关节炎Ⅰ号方治疗马蹄内翻畸形继发踝关节的骨关节炎,通过观察患者治疗前后Baird-Jackson评分,VSA疼痛评分及AOFAS评分情况,对微创牵张技术结合中药治疗骨关节炎的效果进行客观评价,为临床进一步应用,提供依据。方法：第一部分： 1、膝骨关节炎动物病理模型建立及动物分组：将32只山羊,随机分成造模组25只与假手术组7只,将造模组采用膝关节腔注射木瓜蛋白酶的方法建立实验动物的膝骨关节炎模型。行造模术6周后,造模组和假手术组各随机抽取1只山羊处死,取山羊关节软骨和滑膜进行组织形态学观察及关节液炎症因子的改变以确定造模是否成功,模型成功后,将造模组24只山羊随机分模型对照组、F1牵张力组、F2牵张力组、F3牵张力组,每组各6只。F1牵张力组、F2牵张力组、F3牵张力组分别给予F1、F2、F3的牵张力,安装外固定支架并锁定铰链连杆。假手术组、模型对照组均不予配戴外固定支具架。山羊外固定支架佩戴完毕后,每个动物分住在单独笼内,自由活动,肌注水剂青霉素3d(40万单位每天),由专人管理 2、取材、标本预处理及指标检测：30只山羊在相同条件下正常饲养,于安装支架8周后,观察实验动物的一般情况后处死,打开左膝关节后,肉眼观察关节滑膜组织、软骨一般表现。剥取左膝关节胫骨平台、股骨髁部及髌股关节处软骨,切除滑膜,固定于4%多聚甲醛固定,EDTA脱钙,制作HE切片。 3、统计处理：实验数据以x±S表示,用SPSS16.0软件进行分析。第二部分： 1、病例的选择：选择于福建省人民医院骨伤科住院治疗,马蹄内翻足畸形继发踝骨关节炎患者。 2、观察方法：术前对患者踝关节VSA疼痛评分,Baird-Jackson评分,AOFAS评分等,予行微创牵张技术矫正踝关节畸形,减轻踝关节软骨受力不均。术后第1天口服“骨关节炎Ⅰ号方”,分别于术后2周,1月,2月,4月对患者进行随访,进行包括VSA疼痛评分,Baird-Jackson评分,AOFAS评分等。 3、统计处理：实验数据以x±S表示,用SPSS16.0软件进行分析。结果：第一部分 1、手术8周后,假手术组行走步态均正常,模型对照组山羊跛行严重,膝关节屈曲、伸直活动受限,外支架固定3组行走跛行及膝关节屈曲、伸直活动受限与模型对照组相比有所的改善,其中,F1牵张力组改善较为明显。 2、手术8周后,模型对照组膝关节滑膜炎性变及关节软骨退变明显,5组组织形态观察外支架固定3组膝关节滑膜炎性变及关节软骨退变明显轻于模型组,其中F1牵张力组滑膜炎性变及关节软骨退变程度最轻。 3、手术8周后,模型对照组和外支架固定3组的关节软骨Mankin's评分均有不同程度的升高,与假手术组对比具有显著性差异(P0.01),其中F1组升高幅度较低。 4、手术8周后,与模型对照组相比外支架固定3组的关节液MMP-1、CTX-Ⅱ的含量均有所降低,F1牵张力组与模型组、F2牵张力组、F3牵张力组相比关节液MMP-1、CTX-Ⅱ的含量降低且有显著性差异(P0.05)。第二部分患者使用微创牵张技术结合口服骨关节炎Ⅰ号方治疗后,较治疗前VSA疼痛评分降低,Baird-Jackson评分升高,AOFAS评分升高。结论： 1、微创牵张技术能够减轻了关节软骨的破坏,延缓山羊膝骨关节炎的发展进程。 2、微创牵张技术配合骨关节炎Ⅰ号方能有效缓解患者马蹄内翻足继发踝骨关节炎踩关节疼痛,改善踝关节功能。
[Abstract]:Objective:
The first part is to establish the model of goats knee osteoarthritis, and observe the effects of minimally invasive stretch technique on the tissue morphology of synovial and articular cartilage and the concentration of MMP-1 and CTX- II in the joint fluid, and explore the mechanism of minimally invasive stretch technique in the treatment of osteoarthritis, and provide a theory for the clinical treatment of osteoarthritis with minimally invasive stretch technique. Basis.
The second part: through the clinical preliminary observation, the minimally invasive traction technique combined with osteoarthritis No. I was used to treat the osteoarthritis of the ankle joint secondary to the malformation of horseshoe varus. By observing the Baird-Jackson score, the VSA pain score and the AOFAS score of the patients before and after the treatment, the effect of the minimally invasive stretch technique combined with the traditional Chinese medicine in the treatment of osteoarthritis was carried out. Objective evaluation provides a basis for further clinical application.
Method:
Part one:
1, the animal pathological models of knee osteoarthritis were established and the animals were divided into groups: 32 goats were randomly divided into 25 group and 7 sham operation group. The model of knee osteoarthritis was established by injection of papain in the knee joint cavity. After 6 weeks, 1 goats were randomly selected and killed in the model group and the sham operation group. Goat articular cartilage and synovial membrane were observed and the inflammatory factors were changed to determine whether the model was successful. After the success of the model, 24 goats were randomly divided into model control group, F1 stretch group, F2 stretch group, F3 stretch group, each group of 6.F1 stretch groups, F2 stretch group, and F3 stretch group to F1 respectively. The tension of F2, F3, the external fixator and the hinge connecting rod were installed. The sham operation group, the model control group did not wear the external fixator. After the goat external fixator was worn, each animal was divided into separate cage, free activity, and the water injection agent penicillin 3D (400 thousand units per day), managed by the special person.
2, sample preparation, specimen pretreatment and index detection: 30 goats were normally kept under the same condition. After 8 weeks of installation of the scaffold, we observed the general conditions of the experimental animals and opened the joint after opening the left knee joint. The articular synovial tissue of the joint was observed by the naked eye and the cartilage was general. The removal of the tibial plateau, the condyle of the femur and the cartilage of the patellar joint were removed. The membrane was fixed on 4% paraformaldehyde fixed, EDTA decalcified, and HE slices were made.
3, statistical processing: the experimental data are expressed in terms of X + S and analyzed by SPSS16.0 software.
The second part:
1, the choice of cases: patients in the orthopedics department of Fujian Provincial People's Hospital, ankle osteoarthritis secondary to talipes varus deformity.
2, observation method: preoperative VSA pain score of ankle joint, Baird-Jackson score, AOFAS score, and so on, the ankle joint deformity was corrected by minimally invasive stretch technique and the unequal stress of the ankle joint was reduced. The oral osteoarthritis No. I was taken orally at the first day after the operation, 2 weeks after the operation, in January, February, and April, the patients were followed up, including VSA pain evaluation. Score, Baird-Jackson score, AOFAS score, etc.
3, statistical processing: the experimental data are expressed in terms of X + S and analyzed by SPSS16.0 software.
Result:
Part one
1, after 8 weeks of operation, the walking gait of the sham operation group were all normal. The model control group had serious claudication, the knee flexion, the extension activity was limited, the external stent was fixed in 3 groups of walking limp and knee flexion, and the extension activity was limited compared with the model control group, and the improvement of F1 traction group was more obvious.
2, after 8 weeks of operation, the knee joint synovitis and articular cartilage degeneration were obvious in the model control group. The 3 groups of knee joint synovitis and articular cartilage degeneration in the 5 groups were obviously lighter than the model group, in which the synovitis and articular cartilage degeneration were the lightest in the F1 traction group.
3, after 8 weeks of operation, the Mankin's scores of articular cartilage in the 3 groups of the model control group and the external stents were increased in different degrees, and there was a significant difference (P0.01) compared with the sham operation group (P0.01), and the increase in the F1 group was lower.
4, after 8 weeks of operation, the content of MMP-1 and CTX- II in the 3 groups of the 3 groups compared with the model control group decreased, and the content of MMP-1 and CTX- II in the F1 traction group and the model group, the F3 tension group and the F3 stretch group decreased and had a significant difference (P0.05).
The second part
The pain score of VSA was lower than that before treatment, and the score of Baird-Jackson increased and the AOFAS score increased.
Conclusion:
1, minimally invasive distraction technique can reduce the damage of articular cartilage and delay the development of goat knee osteoarthritis.
2, minimally invasive distraction technique combined with osteoarthritis No. 1 can effectively relieve foot pain and improve ankle function in patients with talipes talipes secondary ankle osteoarthritis.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R684;R-332

【参考文献】