老年女性膝关节骨关节炎患者前交叉韧带中机械感受器变化的研究
发布时间：2018-07-23 12:32
【摘要】：目的:膝关节骨关节炎(knee joint osteoarthritis,KOA)是一种引起关节疼痛、肿胀,骨质增生、软骨剥脱及滑膜炎症等一系列改变的中老年慢性、退行性疾病。严重影响中老年人的生活质量。因此KOA的早期预防、延缓病情进展及治疗成为一个重大课题。KOA患者不仅存在关节疼痛、僵硬、活动不利等问题,而且膝关节本体感觉也存在缺陷。膝关节的本体感觉主要来源于膝关节周围的肌肉及关节内各种结构中的机械感受器。其中以前交叉韧带(anterior cruciate ligament,ACL)中机械感受器的研究最多。有研究报道,年龄也是膝关节本体感觉缺失的一个重要因素,KOA患者的年龄增长与本体感觉缺失是否存在一定的关系,患者ACL中机械感受器的形态与数量又会发生怎样的变化等此类研究比较少见。同时KOA患者的患病严重程度与本体感觉缺失也存在相关性,但是两者之间存在怎样的量化关系,患者ACL中机械感受器的形态及数量有何变化不得而知。因此,本课题的研究目的在于:(1)观察不同年龄段KOA患者ACL中机械感受器的形态及数量变化,寻找年龄与ACL中机械感受器之间存在的量化关系,进而明确年龄与膝关节本体感觉之间的相关性。(2)观察不同严重程度KOA患者ACL中机械感受器的形态及数量变化,寻找两者的量化关系,进而明确KOA严重程度与膝关节本体感觉之间存在的相关性。方法:为排除性别对实验研究的影响,结合临床KOA患者以女性多见等情况,因此,本实验研究所有入选病例均为女性KOA患者,所有患者临床症状均符合美国风湿病学会(American college of rheumatology,ACR)2001年制定的KOA诊断标准。同时,KOA严重程度以Kellgren-Lawrence膝关节骨关节炎影像学为标准,选取符合标准的女性III级KOA患者36例,IV级患者12例,所有患者均自愿接受全膝关节置换术(total knee arthroplasty,TKA)。36例III级患者按年龄段分为3组,A组(50-60岁,III)、B组(60-70岁,III)、C组(70岁,III),每组12例;12例IV级患者为D组(70岁,IV)。其中,每组随机抽取6例进行HE染色,剩余6例进行免疫组织化学研究。所有患者在接受TKA时,截取胫骨止点部位ACL,放入4%的多聚甲醛固定,48-72h后,取出ACL组织,修剪成0.5×0.5×0.5cm的组织块,常规震洗、脱水、浸蜡、石蜡包埋,切片(厚度约5um),HE染色及免疫组织化学染色检测机械感受器帕西尼小体(Pacinian corpuscles,PC)、鲁菲尼末梢(Ruffini endings,RE)、高尔基腱器官(Golgi tedon organ like ending,GTOE)、游离神经末梢(free nerve endings,FNE)的形态及数量。每组6例HE染色,每例随机不连续切片6张,每张切片用JEDA801D图像形态学分析软件,40倍视野下随机选取5个视野,计数每例患者各类机械感受器总数,求得6例患者各类机械感受器均值,并分别比较年龄因素、KOA严重程度对ACL中各类机械感受器的影响及它们之间存在的量化关系;每组6例免疫组织化学染色,计数及分析方法同上,光镜下观察4组患者ACL中各类机械感受器的数量及形态变化。统计学方法分别分析以年龄段分组的A、B、C 3组患者之间ACL中各类机械感受器数量和以KOA严重程度分组的C、D组之间ACL中各类机械感受器数量有无统计学差异。结果:HE染色结果显示,可检测到机械感受器PC。随着患者年龄的增大,PC感受器外15-30层扁平的神经周细胞组成的葱皮状外囊逐渐萎缩,卵圆形或椭圆形的感受器整体缩小变形,最终呈现不规则外形。统计学分析各组机械感受器PC的均值为A组9.33±1.21,B组7.67±1.03,C组2.67±1.03,D组1.00±0.63,按年龄因素A、B、C 3组之间两两比较,均有显著统计学意义(P0.05)。按KOA严重程度C、D 2组之间比较,两者之间有显著统计学差异(P0.05)。免疫组织化学结果显示,可检测到机械感受器RE及FNE。(1)RE结果显示:随着年龄的增长,圆形或卵圆形的感受器,整体外形逐渐缩小,外层薄壁结缔组织囊不规则改变,萎缩变形。统计学分析A组均值14.33±4.08,B组10.33±1.86,C组6.00±2.45,D组2.50±1.23,按年龄因素A、B、C 3组之间两两比较,均有显著统计学意义(P0.05),按KOA严重程度C、D 2组之间比较,两者之间有显著统计学差异(P0.05)。(2)FNE结果显示:随着年龄增长,感受器排列紊乱、松散,长轴方向与韧带方向由平行转为不规则排列,整体形态萎缩变形。统计学分析A组均值为22.33±4.08,B组16.50±3.21,C组10.00±3.74,D组5.50±1.05,按年龄因素A、B、C 3组之间两两比较,均有显著统计学差异(P0.05)。按KOA严重程度C、D 2组之间比较,两者之间有显著统计学差异(P0.05)。HE染色及免疫组织化学染色,均未检测出机械感受器GTOE。结论:(1)随着年龄的增长,KOA患者ACL中机械感受器形态萎缩变形、数量减少,患者膝关节本体感觉日益下降。(2)KOA患者ACL中机械感受器随着KOA严重程度的增加,萎缩变形、数量减少,患者膝关节本体感觉下降。
[Abstract]:Objective: knee joint osteoarthritis (KOA) is a chronic, degenerative disease that causes pain, swelling, hyperosteogeny, cartilaginous exfoliation and synovitis. It seriously affects the quality of life of the middle-aged and the elderly. Therefore, the early prevention of KOA, the delay of the disease progress and the treatment become a major one. .KOA patients not only have problems such as joint pain, stiffness, and adverse activities, but also have defects in the proprioception of the knee joint. The proprioception of the knee is mainly derived from the mechanoreceptor in the muscles around the knee joint and in the various structures in the joint. Among them, the anterior cruciate ligament (ACL) is a mechanoreceptor in the anterior cruciate ligament (ACL). It is reported that age is also an important factor in the loss of proprioception in the knee joint. There is a certain relationship between the age of KOA patients and the absence of proprioception, and the changes in the morphology and quantity of the mechanical receptors in the patient's ACL are rare. At the same time, the severity of the patients with KOA is serious. There is also a correlation with the loss of proprioception, but what is the quantitative relationship between the two and the changes in the morphology and quantity of the mechanoreceptor in patients ACL are not known. Therefore, the purpose of this study is to observe the morphological and quantitative changes of the mechanical receptor in the ACL of KOA patients of different ages, and to find the age and ACL in the ACL. The quantitative relationship between the mechanical receptors and the relationship between the age and the proprioception of the knee joint. (2) to observe the morphological and quantitative changes of the mechanoreceptor in ACL of KOA patients with different severity, and to find the quantitative relationship between them, and then to clarify the correlation between the severity of KOA and the proprioception of the knee. The effect of sex on the experimental study was excluded, and the clinical KOA patients were more common in women. Therefore, all the selected cases were female KOA patients. All the patients' clinical symptoms were in accordance with the KOA diagnostic criteria of the American Society of Rheumatology (American College of Rheumatology, ACR) in 2001. Meanwhile, the severity of KOA was Kellg. Ren-Lawrence knee osteoarthritis imaging was the standard, 36 patients with III grade KOA and 12 IV patients were selected. All patients were voluntarily accepted total knee arthroplasty (total knee arthroplasty, TKA).36 cases of III class patients were divided into 3 groups according to age group, A group (50-60 years, III), 60-70 years old, 12 group (70 years old, 12), 12 in each group 12. 12 patients with grade IV were group D (70 years of age, IV). Among them, 6 cases of each group were randomly selected for HE staining, and the remaining 6 cases were studied by immunohistochemistry. All the patients were intercepted at the tibial stop point ACL, put in 4% polyformaldehyde, and removed ACL tissue after 48-72h, and trimmed into 0.5 x 0.5 x 0.5cm tissue blocks, routine shock washing, dehydration, wax soaking, Paraffin embedded, slice (thickness about 5um), HE staining and immunohistochemical staining for the detection of the Pacinian corpuscles (PC), the end of Ruffini (Ruffini endings, RE), the organ of the Golgi tendon (Golgi tedon organ like), the form and quantity of the free nerve endings. 6 cases in each group Color, each case was randomly divided into 6 pieces. Each slice was selected by JEDA801D image morphological analysis software and 5 fields of visual field randomly selected from 40 times. The total number of various mechanical receptors in each patient was counted, and the average of all kinds of mechanical receptors in 6 patients were calculated, and the influence of KOA severity on various kinds of mechanical receptors in ACL were compared. The quantitative relationship between them; 6 cases of immunohistochemical staining, counting and analysis in each group were the same. The number and morphological changes of various kinds of mechanoreceptor in the 4 groups of ACL were observed under light microscope. Statistical methods were used to analyze the number of various kinds of mechanoreceptor in the group of A, B, and C 3 groups of age groups and the degree of KOA severity in ACL. The number of various kinds of mechanoreceptor in the group of C and D group had no statistical difference. Results: the results of HE staining showed that as the age of the patient was increased, the cutaneous outer capsule of the 15-30 layers of flat nerve peripheral cells outside the PC receptor was gradually atrophied, and the oval or oval receptors were reduced to the whole. The mean value of PC was 9.33 + 1.21 in group A, 7.67 + 1.03 in group B, 2.67 + 1.03 in group C and 1 in group D in group A, B, and C 3 group, respectively. There were significant statistical differences between the KOA seriousness C, D 2, and there were significant statistical differences. The results of immunohistochemical staining showed that the results of RE and FNE. (1) RE showed that the overall shape of the circular or oval receptors gradually narrowed with the age, and the outer thin wall connective tissue sac was irregular and atrophic. The mean value of the A group was 14.33 + 4.08, the B group was 10.33 + 1.86, the C group was 6 + 2.45, and the D group was 2.50 + 1. .23, according to age factors A, B, C 3 groups, there are significant statistical significance (P0.05), according to KOA severity C, D 2 groups, there is a significant statistical difference between the two groups (P0.05). (2) FNE results show that as the age increases, the receptors are arranged in disorder, loose, and the long axis direction and ligament direction from parallel to irregular arrangement, the whole Morphological atrophy deformation. The mean value of group A was 22.33 + 4.08, group B was 16.50 + 3.21, C group was 10 + 3.74, D group 5.50 + 1.05. There were significant statistical differences (P0.05) between group D and A, B, C 3 groups. There were significant statistical differences between the two groups (P0.05) staining and immunohistochemistry, according to KOA severity C, D 2 groups No mechanoreceptor GTOE. conclusion was detected. (1) with the increase of age, the morphology of the mechanoreceptor in KOA patients was atrophied, the number of the patients decreased. (2) the mechanoreceptor in KOA patients with ACL increased with the severity of KOA, atrophied and reduced, and the proprioception of the knee was decreased.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
本文编号：2139423
[Abstract]:Objective: knee joint osteoarthritis (KOA) is a chronic, degenerative disease that causes pain, swelling, hyperosteogeny, cartilaginous exfoliation and synovitis. It seriously affects the quality of life of the middle-aged and the elderly. Therefore, the early prevention of KOA, the delay of the disease progress and the treatment become a major one. .KOA patients not only have problems such as joint pain, stiffness, and adverse activities, but also have defects in the proprioception of the knee joint. The proprioception of the knee is mainly derived from the mechanoreceptor in the muscles around the knee joint and in the various structures in the joint. Among them, the anterior cruciate ligament (ACL) is a mechanoreceptor in the anterior cruciate ligament (ACL). It is reported that age is also an important factor in the loss of proprioception in the knee joint. There is a certain relationship between the age of KOA patients and the absence of proprioception, and the changes in the morphology and quantity of the mechanical receptors in the patient's ACL are rare. At the same time, the severity of the patients with KOA is serious. There is also a correlation with the loss of proprioception, but what is the quantitative relationship between the two and the changes in the morphology and quantity of the mechanoreceptor in patients ACL are not known. Therefore, the purpose of this study is to observe the morphological and quantitative changes of the mechanical receptor in the ACL of KOA patients of different ages, and to find the age and ACL in the ACL. The quantitative relationship between the mechanical receptors and the relationship between the age and the proprioception of the knee joint. (2) to observe the morphological and quantitative changes of the mechanoreceptor in ACL of KOA patients with different severity, and to find the quantitative relationship between them, and then to clarify the correlation between the severity of KOA and the proprioception of the knee. The effect of sex on the experimental study was excluded, and the clinical KOA patients were more common in women. Therefore, all the selected cases were female KOA patients. All the patients' clinical symptoms were in accordance with the KOA diagnostic criteria of the American Society of Rheumatology (American College of Rheumatology, ACR) in 2001. Meanwhile, the severity of KOA was Kellg. Ren-Lawrence knee osteoarthritis imaging was the standard, 36 patients with III grade KOA and 12 IV patients were selected. All patients were voluntarily accepted total knee arthroplasty (total knee arthroplasty, TKA).36 cases of III class patients were divided into 3 groups according to age group, A group (50-60 years, III), 60-70 years old, 12 group (70 years old, 12), 12 in each group 12. 12 patients with grade IV were group D (70 years of age, IV). Among them, 6 cases of each group were randomly selected for HE staining, and the remaining 6 cases were studied by immunohistochemistry. All the patients were intercepted at the tibial stop point ACL, put in 4% polyformaldehyde, and removed ACL tissue after 48-72h, and trimmed into 0.5 x 0.5 x 0.5cm tissue blocks, routine shock washing, dehydration, wax soaking, Paraffin embedded, slice (thickness about 5um), HE staining and immunohistochemical staining for the detection of the Pacinian corpuscles (PC), the end of Ruffini (Ruffini endings, RE), the organ of the Golgi tendon (Golgi tedon organ like), the form and quantity of the free nerve endings. 6 cases in each group Color, each case was randomly divided into 6 pieces. Each slice was selected by JEDA801D image morphological analysis software and 5 fields of visual field randomly selected from 40 times. The total number of various mechanical receptors in each patient was counted, and the average of all kinds of mechanical receptors in 6 patients were calculated, and the influence of KOA severity on various kinds of mechanical receptors in ACL were compared. The quantitative relationship between them; 6 cases of immunohistochemical staining, counting and analysis in each group were the same. The number and morphological changes of various kinds of mechanoreceptor in the 4 groups of ACL were observed under light microscope. Statistical methods were used to analyze the number of various kinds of mechanoreceptor in the group of A, B, and C 3 groups of age groups and the degree of KOA severity in ACL. The number of various kinds of mechanoreceptor in the group of C and D group had no statistical difference. Results: the results of HE staining showed that as the age of the patient was increased, the cutaneous outer capsule of the 15-30 layers of flat nerve peripheral cells outside the PC receptor was gradually atrophied, and the oval or oval receptors were reduced to the whole. The mean value of PC was 9.33 + 1.21 in group A, 7.67 + 1.03 in group B, 2.67 + 1.03 in group C and 1 in group D in group A, B, and C 3 group, respectively. There were significant statistical differences between the KOA seriousness C, D 2, and there were significant statistical differences. The results of immunohistochemical staining showed that the results of RE and FNE. (1) RE showed that the overall shape of the circular or oval receptors gradually narrowed with the age, and the outer thin wall connective tissue sac was irregular and atrophic. The mean value of the A group was 14.33 + 4.08, the B group was 10.33 + 1.86, the C group was 6 + 2.45, and the D group was 2.50 + 1. .23, according to age factors A, B, C 3 groups, there are significant statistical significance (P0.05), according to KOA severity C, D 2 groups, there is a significant statistical difference between the two groups (P0.05). (2) FNE results show that as the age increases, the receptors are arranged in disorder, loose, and the long axis direction and ligament direction from parallel to irregular arrangement, the whole Morphological atrophy deformation. The mean value of group A was 22.33 + 4.08, group B was 16.50 + 3.21, C group was 10 + 3.74, D group 5.50 + 1.05. There were significant statistical differences (P0.05) between group D and A, B, C 3 groups. There were significant statistical differences between the two groups (P0.05) staining and immunohistochemistry, according to KOA severity C, D 2 groups No mechanoreceptor GTOE. conclusion was detected. (1) with the increase of age, the morphology of the mechanoreceptor in KOA patients was atrophied, the number of the patients decreased. (2) the mechanoreceptor in KOA patients with ACL increased with the severity of KOA, atrophied and reduced, and the proprioception of the knee was decreased.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
【参考文献】
相关期刊论文 前2条
1 张秋霞;花秀琴;施永健;;踝关节本体感觉的测量方法研究与应用[J];中国组织工程研究与临床康复;2011年35期
2 俞晓杰;吴毅;胡永善;白玉龙;范文可;;膝关节骨关节炎患者等长、等速向心和等速离心测试的比较观察[J];中华物理医学与康复杂志;2006年07期
，本文编号：2139423
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