核心蛋白聚糖治疗创伤性膝关节粘连的实验研究  

Experimental study of decorin for traumatic adhesion of knee

作　　者：汤翔宇 许浩然 刘朝旭 程浩 TANG Xiang-yu;XU Hao-ran;LIU Chao-xu;CHENG Hao(Department of Radiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院放射科,武汉430030 [2]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《骨科》2018年第5期396-399,共4页ORTHOPAEDICS

基　　金：国家自然科学基金(31300799)

摘　　要：目的研究核心蛋白聚糖(decorin,DCN)对创伤性膝关节粘连的影响。方法采用36只新西兰兔建立动物模型,首先用手术刀片切除髌上囊前壁的滑膜组织,再用骨膜剥离子剥离髌上囊后壁在股骨前方的结合部,去除少量髌上囊后壁和髌下脂肪垫。切除前后交叉韧带,并将膝关节过伸45°以破坏后方的关节囊。最后,使用1.6 mm克氏针将膝关节完全固定于屈曲位。36只动物平均分为3组,其中2组每隔1 d分别向膝关节腔内注射100 nmol/L(100 nmol/L DCN组)、200 nmol/L(200 nmol/L DCN组)的DCN,各1 ml,共15次,对照组注射生理盐水。术后8周处死动物,测量各组动物的膝关节活动度,检测髌上囊前壁滑膜组织中的胶原含量,并对髌上囊前壁滑膜组织进行组织学分析,以了解DCN对膝关节粘连进程的影响。结果术后8周,100 nmol/L DCN组和200 nmol/L DCN组的关节活动度分别为56.27°±10.30°和62.23°±14.08°,均显著高于对照组的31.14°±11.57°;2个实验组髌上囊前壁滑膜组织中的新生血管数量及纤维组织比例显著低于对照组;对照组髌上囊前壁滑膜组织中的胶原含量为(42.15±6.78)μg/mg,亦显著高于2个实验组[(30.24±8.12)μg/mg和(24.19±6.89)μg/mg]。2个实验组与对照组比较,上述几项指标的差异均有统计学意义(P均<0.05)。结论关节腔内运用DCN治疗可明显改善兔膝关节粘连及强直的程度,从而增加关节活动度。Objective To study the effect of decorin （DCN） on adhesion of knee. Methods A total of 36 New Zealand rabbits were randomly divided into three groups. Anterior synovium of suprapatellar bursa was scraped with blades. Posterior synovium of suprapatellar bursa was detached from femur with shanks. The anterior cruciate ligament and posterior cruciate ligament were transected. Additionally, the joint was hyperextended to 45？ to disrupt the posterior capsule. The joint was then fully flexed and immobilized with a 1.6 mm Kirschner wire （K-wire） for 8 weeks following this operation. The 12 right limbs in different groups received intra-articular injections of 1 ml 100 nmol/L DCN （100 nmol/L DCN group） or 200 nmol/L DCN （200 nmol/L DCN group） over two weeks in the frequency of every other day after operation. Saline was administrated in control group. Joint adhesions, range of motion and collagen content in synovium were evaluated 8 weeks later. Results Histological analysis showed that the new vessels and fibrotic tissues in synovium of suprapatellar bursa were significantly decreased in DCN groups compared to control group. The mean collagen content in control group （42.15±6.78 μg/mg） was significantly higher than that in 100 nmol/L DCN group ［（30.24±8.12） μg/mg］ and 200 nmol/L DCN group [（24.19±6.89） μg/mg] （P＜0.05）. Additionally, the average range of motion in 100 nmol/L DCN group, 200 nmol/L DCN group and control group was 56.27°±10.30°, 62.23°±14.08° and 31.14°±11.57°, respectively. There were significant differences between DCN groups and control group （P＜0.05）. Conclusion Hyaluronic acid may be considered a promising biochemical agent to release the knee adhesion and stiffness after 8 weeks of external fixation.

关 键 词：膝关节 粘连 核心蛋白聚糖 纤维化 胶原 

分 类 号：R684[医药卫生—骨科学]