髌骨倾斜导致髌软骨软化超微结构观察  

Ultrastructural Observation of Chondromalacia Patella Resulting from Tilted Patella

作　　者：亓建洪[1,2,3] 黄煌渊[1,2,3] 钟慈声[1,2,3] 陈世益[1,2,3] 李鸿儒 阮汝清[1,2,3] 鲁玉来 

机构地区：[1]泰山医学院附属医院骨科 [2]上海医科大学华山医院骨科 [3]上海医科大学电镜室

出　　处：《中华骨科杂志》1998年第3期168-171,I004,共5页Chinese Journal of Orthopaedics

摘　　要：目的：探讨低应力环境下髌软骨软化的发病机制。方法：２８只新西兰兔，随机分成４组。右膝髌骨采用手术方法造成倾斜状态为实验侧，左膝实施假手术为对照侧，定期处死动物后进行生物力学测试、软骨组织学观察及电镜观察。结果：实验膝髌骨倾斜后髌骨内侧面接触应力明显降低，软骨发生变性；髌骨外侧面软骨接触压力无明显变化，软骨无明显变性。透射电镜下，髌内侧面软骨术后６周时深层软骨细胞代谢与分泌功能障碍；１２周时深层软骨细胞变性加剧，累及周围基质并向中层蔓延；１８～２４周时中层与深层软骨细胞变性坏死，胶原纤维破坏并异常聚合，逐渐向表层发展；髌外侧面软骨细胞则代谢活跃，胶原纤维增粗排列致密。扫描电镜下，髌骨内侧面软骨表面形成裂隙；外侧面软骨表面粗糙呈“割草地样”。结论：髌骨倾斜导致髌内侧面软骨应力减低，致使深层软骨细胞首先变性，继之周围基质变性，软骨变性逐渐由深层向表层发展。Purpose: To investigate the pathogenesis of chondromalacia patella. Methods: Twenty-eight New Zealand rabbits were randomly divided into four groups. Tilted patella was surgically produced on both knees. The right side was used as the experimental and the left as controls. The contact pressure of patellofemoral joint, ultrastuctural and histological changes of the patellar cartilage were investigated at four different intervals. Result: On the experimental side, there was a decrease of contact pressure and marked degeneration of cartilage over the medial aspect of the patella however, there was no similar changes on the lateral aspect. Under the transmission electron microscope, the synthesis and secretion activity of proteoglycans and procollagens of deep chondrocytes were inhibited in medial aspect at the 6th postoperative week. The degeneration of chondrocytes took place initially, and then followed the extracellular matrix 12 weeks later. Necrosis of chondrocytes and abnormal aggregated collagen fibrils were found at 18 and 24 weeks. Under scanning electron microscope, fissures in medial aspect and “well mowed lawn ” like change in lateral aspect were found. Conclusions: tilted patella decreased the contact pressure of medial aspect of the patellar cartilage and brounht about degeneration from deep chondrocytes to extracelluar matrix.

关 键 词：髌骨 软骨疾病 超微结构 应力 

分 类 号：R681.302[医药卫生—骨科学]