膝关节骨性关节炎股骨髁负重区与非负重区组织形态学观察的研究  

Research on histomorphology of weight-bearing area and non weight-bearing area of femoral condyle in knee osteoarthritis

作　　者：陈德胜 张晨 王硕 袁昂 王文鹏 郭凤英[3] 李燕[3] CHEN Desheng;ZHANG Chen;WANG Shuo;YUAN Ang;WANG Wenpeng;GUO Fengying;LI Yan(Department of Orthopaedics,People's Hospital of Ningxia Hui Autonomous Region,Ningxia Hui Autonomous Region,Yinchuan 750002,China;Clinical Medicine,Ningxia Medical University,Ningxia Hui Autonomous Region,Yinchuan 750004,China;Basic Medical Sciences,Ningxia Medical University,Ningxia Hui Autonomous Region,Yinchuan 750004,China)

机构地区：[1]宁夏回族自治区人民医院骨科,宁夏银川750002 [2]宁夏医科大学临床医学院,宁夏银川750004 [3]宁夏医科大学基础医学院,宁夏银川750004

出　　处：《中国当代医药》2023年第20期5-8,F0003,共5页China Modern Medicine

基　　金：国家自然科学基金资助项目(82060408);宁夏回族自治区重点研发计划项目(2021BEG03049);宁夏回族自治区留学人员创新创业项目(2020-75)。

摘　　要：目的观察膝关节骨性关节炎患者股骨髁负重区与非负重区软骨组织形态学的改变,从而探讨膝关节骨性关节炎软骨退变的病理过程。方法选取2021年8月至2022年9月就诊于宁夏回族自治区人民医院行人工全膝关节置换术的56例原发性膝骨性关节炎伴内翻畸形患者为研究对象,采集患者术中截取的股骨髁部分作为临床标本,将股骨髁磨损严重的关节软骨作为负重区(观察组),将股骨髁磨损较轻的关节软骨作为非负重区(对照组),进行HE染色和番红O染色,镜下观察观察组与对照组的组织病理形态;通过扫描电子显微镜观察对比观察组及对照组软骨表面的超微结构特征。结果大体观察显示,观察组股骨髁软骨面缺损明显,粗糙欠平整,边缘形成了部分骨赘,软骨下骨可见松质骨硬化灶,对照组股骨髁软骨面光滑且平整,软骨表面色泽清亮、均匀,边缘无骨赘生成。HE染色显示,观察组中软骨细胞数目大量减少,排列不整齐,细胞增生异常,成簇出现,对照组关节软骨基质染色均匀,软骨细胞数目正常,形态完整饱满,细胞核、细胞质清晰可见。番红O染色显示,观察组中软骨细胞形态明显改变,软骨层纤维化,软骨基质淡染,对照组软骨细胞大小形态正常,排列较为整齐,软骨基质染色均匀,潮线正常;扫描电子显微镜观察:观察组关节软骨表面结构层次不清,可见大量大小不一的孔隙分布,胶原纤维不成形,正常软骨细胞极少见;对照组关节软骨表面相对平整,胶原纤维呈束且排列整齐,可见正常软骨细胞。结论软骨细胞生理功能的正常发挥需要软骨细胞基质代谢水平的稳定,KOA患者是由于多种原因引起软骨基质变化引起膝关节软骨退行性变。Objective To observe the histological changes of cartilage in weight-bearing and non weight-bearing areas of the femoral condyle in patients with knee osteoarthritis,and to explore the pathological process of cartilage degeneration in knee osteoarthritis.Methods From August 2021 to September 2022,56 patients with primary osteoarthritis of the knee and varus deformity who were treated with total knee arthroplasty in the People's Hospital of Ningxia Hui Autonomous Region were selected as research objects.The femoral condyles were collected as clinical specimens,the articular cartilage with severe wear of the femoral condyle was used as the weight bearing area(observation group),and the articular cartilage with less wear of the femoral condyle was used as the non weight bearing area(control group),HE staining and safranine O staining were performed to observe the histopathological morphology of observation group and control group under microscope.The ultrastructural characteristics of the surface of observation group and control group were observed and compared by scanning electron microscopy.Results Macroscopic observation showed that in the observation group,the cartilage surface of the femoral condyle was obviously defective,rough and uneven,with some osteophytes formed at the edges,and cancellous bone sclerosis was visible in the subchondral bone.In the control group,the cartilage surface of the femoral condyle was smooth and flat,with clear and uniform color,and no osteophytes formed at the edges.HE staining showed that the number of chondrocytes in the observation group decreased significantly,the arrangement was irregular,the cell proliferation was abnormal,and the cells appeared in clusters.In the control group,the articular cartilage matrix was stained evenly,the number of chondrocytes was normal,the shape was complete and full,and the nucleus and cytoplasm were clearly visible.Safranine O staining showed that the morphology of chondrocytes in the observation group was significantly changed,the cartilage la

关 键 词：膝关节骨性关节炎 关节软骨 软骨细胞 软骨基质 间充质干细胞 退行性变 

分 类 号：R684[医药卫生—骨科学]