针刀干预对早期膝骨关节炎兔软骨下骨的影像学及形态学影响  

Effect of Acupotomy on Imaging Characteristics and Morphology of Subchondral Bone in Rabbits with Early Knee Osteoarthritis

作　　者：尹孟庭 郭妍 秦路雪 王军美 刘聪 郭长青[1] YIN Meng-ting;GUO Yan;QIN Lu-xue;WANG Jun-mei;LIU Cong;GUO Chang-qing(School of Acupuncture-Moxibustion and Tuina,Beijing University of Chinese Medicine,Beijing 100029;Beijing Hospital of Traditional Chinese Medicine,Beijing 100010)

机构地区：[1]北京中医药大学针灸推拿学院,北京100029 [2]北京中医医院,北京100010

出　　处：《世界中西医结合杂志》2022年第5期890-895,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：北京市自然科学基金面上项目(7192110)。

摘　　要：目的观察针刀对早期膝骨关节炎(Knee osteoarthritis,KOA)兔软骨下骨微结构的影响,探讨针刀抑制软骨下骨吸收治疗KOA的效用。方法6月龄24只新西兰雄兔随机分为空白组、模型组、针刀组和药物组,每组各6只;制动左后肢膝关节6周制备KOA模型;空白组和模型组不作干预,针刀组(1次/周)和药物组(皮下注射二膦酸盐,0.01 mg/kg,1次/d)干预3周。用Micro-CT结合三维重建和专用的骨骼分析软件,观察软骨下骨微结构变化,对骨形态计量学参数进行相关分析;采用光镜观察软骨—软骨下骨复合体的HE染色,并进行Mankin评分和Image-pro plus6.0分析。结果Micro-CT显示,造模后模型组骨小梁排列紊乱,连接中断,空隙增大,数量明显减少,与空白组比较骨小梁厚度(Trabecular thickness,Tb.Th)、骨小梁数量(Trabecular number,Tb.N)、骨体积分数(Bone Volume Fraction,BV/TV)及体积骨密度(Volumetric bone mineral density,vBMD)明显下降(P<0.01),骨小梁间隙(Trabecular separation,Tb.Sp)明显上升(P<0.01);HE染色软骨退变,潮线复制前移,较空白组软骨全层厚度(Total articular cartilage thickness,TAC)与软骨下骨板厚度(Subchondral bone plate thickness,SCP)明显降低(P<0.01),软骨钙化层厚度(Articular calcified cartilage thickness,ACC)明显升高(P<0.01),Mankin评分明显升高(P<0.01)。干预后,骨小梁排列整齐,连接有序,空隙减小,数量增多,Tb.Sp较模型组明显降低(P<0.01),其他参数较模型组明显升高(P<0.05,P<0.01);HE染色软骨结构较完整,潮线复制减少,TAC和SCP明显增加(P<0.05,P<0.01),ACC明显降低(P<0.05,P<0.01),针刀组与药物组各参数比较,差异无统计学意义(P>0.05),Mankin评分明显降低(P<0.01)。干预后的Tb.Th依旧明显低于空白组(P<0.01),其他参数与空白组比较,差异无统计学意义(P>0.05)。结论针刀干预能抑制早期KOA软骨下骨吸收,促进软骨及软骨下骨微结构损伤修复,从而达到治疗KOA的效用。Objective To observe the effect of acupotomy on subchondral bone microstructure of rabbits with early knee osteoarthritis(KOA),and to explore the inhibitory effect of acupotomy on subchondral bone resorption.Methods A total of 246-month-old female New Zealand rabbits were randomized into blank group(no intervention),model group(no intervention),acupotomy group(once/week,3 weeks),and drug group(bisphosphonate,i.h.,0.01 mg/kg,once/day,3 weeks),6 each group.The left hind knee was immobilized for 6 weeks to induce the KOA.Micro-CT was combined with 3 D reconstruction and special bone analysis software to observe the changes of subchondral bone microstructure and analyze the correlation of bone morphometric parameters.HE staining of the chondro-subchondral bone complex was observed under light microscope.Mankin score was determined and Image-pro plus6.0 analysis was performed.Results Micro-CT showed disordered and disconnected bone trabeculae with large voids and small number in the model group.Compared with blank group,the model group demonstrated decrease in trabecular thickness(Tb.Th),trabecular number(Tb.N),bone volume fraction(BV/TV),and volumetric bone mineral density(vBMD)(P<0.01),increase in trabecular separation(Tb.Sp)(P<0.01),tidemark duplication(therefore,advancement)and degeneration of cartilage,reduction of the thickness oftotal articular cartilage(TAC)and subchondral bone plate(SCP)(P<0.01),and rise of cartilage calcification layer thickness(ACC)(P<0.01)and Mankin score(P<0.01).After intervention,bone trabeculae showed ordered arrangement and connection,with decreased voids and large number.Tb.Sp decreased(P<0.01)and other parameters increased compared with those in the model group(P<0.01 or P<0.05).The HE-stained cartilages had intact structure with reduced tidemark duplication.Moreover,increase in TAC and SCP(P<0.01 or P<0.05)and decrease in ACC(P<0.01 or P<0.05)were observed.There was no statistically significant difference in the parameters between the acupotomy group and the duy group(P<0.05)and Man

关 键 词：膝骨关节炎 针刀 软骨下骨 影像学 骨重塑 

分 类 号：R285.5[医药卫生—中药学]