关节镜联合胫骨高位截骨术促进膝关节内侧间室骨性关节炎软骨再生的机制研究  

Mechanism of arthroscopy combined with high tibial osteotomy inpromoting cartilage regeneration in medial compartment of knee osteoarthritis

作　　者：吴疆[1] 赵斌[1] 陈啸[1] 赵谦[1] 骆巍 任富继 黄竞敏[1] WU Jiang;ZHAO Bin;CHEN Xiao;ZHAO Qian;LUO Wei;REN Fu-ji;HUANG Jing-min(Department of Sports Injury and Arthroscopy WardⅡ,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院运动损伤与关节镜二病区,天津300211

出　　处：《天津医科大学学报》2023年第3期317-321,共5页Journal of Tianjin Medical University

基　　金：天津市卫生健康委员会科技项目(ZC20086)。

摘　　要：目的:探究关节镜联合胫骨高位截骨术(HTO)对膝关节内侧间室骨性关节炎软骨再生的影响及机制。方法:对2020年8月—2021年8月接受关节镜联合HTO的50例膝关节内侧间室骨性关节炎合并膝内翻患者进行回顾性分析,于术后1年进行二次关节镜检查观察软骨再生情况。并取部分新生组织进行病理学HE、甲苯胺蓝和Ⅱ型胶原免疫组织化学染色,以明确新生组织为新生软骨。同时取部分新生组织和正常软骨进行荧光定量PCR和Western印迹分子生物学检测,观察丝裂原活化蛋白激酶激酶(MEK)-细胞外信号调节激酶(ERK)信号通路在膝骨关节炎患者软骨再生中的作用。结果:通过二次关节镜检查,绝大多数患者的膝关节内侧间室病变区域软骨可观察到新生组织;HE和甲苯胺蓝染色结果表明,新生组织周围具有关节软骨的结合或覆盖,并可见明显的纤维化软骨或软骨陷窝。免疫组化结果显示,Ⅱ型胶原呈阳性表达,证明这些新生组织为再生软骨。另外,通过荧光定量PCR和Western印迹进一步验证了Ⅱ型胶原在新生软骨组织中的表达(均P>0.05)。而且磷酸化MEK(p-MEK)和p-ERK也高表达于这些组织中(t=12.8、15.44,均P<0.05)。结论:关节镜联合HTO可以降低膝关节内侧间室所受的机械应力负荷,并通过MEK-ERK信号通路介导软骨的再生过程。Objective:To explore the effect of arthroscopy combined with high tibia osteotomies(HTO)on cartilage regeneration in medial compartment of knee osteoarthritis and related mechanisms.Methods:From August 2020 to August 2021,50 patients with medial compartment osteoarthritis and knee varus who underwent arthroscopy combined with HTO were retrospectively analyzed,and a second arthroscopy was performed 1 year after the operation to observe the state of cartilage.Some nascent tissues were taken for HE,toluidine blue and typeⅡcollagen immunohistochemical staining to confirm that the nascent tissue was cartilage.At the same time,some nascent tissue and normal cartilage were taken for fluorescence quantitative PCR andWestern blotting analysis to observe the role of MEK-ERK signaling pathway in cartilage regeneration in patients with knee osteoarthritis.Results:Through the second arthroscopic examination,nascent tissues could be observed in the cartilage in the medial compartment of the knee joint in most patients;the results of HE and toluidine blue staining showed that the new tissue was bonded or covered by articular cartilage,and obvious fibrotic cartilage or cartilage lacuna could be found.Immunohistochemical staining results showed positive expression of typeⅡcollagen,proving that these new tissues were regenerated cartilage.In addition,the expression of typeⅡcollagen in new cartilage tissue was further verified by quantitative PCR and Western blotting(both P>0.05).Moreover,phosphorylated MEK(p-MEK)and p-ERK were also highly expressed in these tissues(t=12.8,15.44,both P<0.05).Conclusion:Arthroscopy combined with HTO can reduce the mechanical stress load on the medial compartment of the knee joint,and mediate the cartilage regeneration process through the MEK-ERK signaling pathway.

关 键 词：关节镜 胫骨高位截骨术 膝骨关节炎 软骨再生 ERK 

分 类 号：R684.2[医药卫生—骨科学] R681.8[医药卫生—外科学]