双极射频治疗山羊髌骨软骨退变的实验研究

目的探讨双极射频在治疗髌骨软骨退变中价值。方法采用髌骨外侧支持带紧缩和内侧支持带松解的方法制造16只山羊髌骨软骨退变的动物模型。3个月后对右髌骨退变的软骨进行双极射频成形手术，左膝为对照侧，两侧同时进行恢复髌股关节对合的手术。观察双极射频对退变软骨的即刻效应和后期效应。结果造模方法可以造成山羊髌股关节倾斜，3个月后发生以髌骨内侧面OuterbridgeⅠ级和Ⅱ级为主的病变。即刻观察发现射频处理后的软骨表面光整，小的裂隙被融合。浅层的少量软骨细胞死亡，深层细胞受到的影响比较小。3个月后发现治疗侧髌骨软骨表面仍光滑，改良Mankin’8软骨评分结果显示治疗侧（8．50±2．51）分，对照组（11．00±4．15）分（t=2．57，P〈0．05），治疗侧软骨损伤比对照侧轻。流式细胞学检测发现治疗侧软骨细胞死亡率（18．69±7．26）％，和对照侧（25．66±13．04）％相比，差异无统计学意义（t：1．94，P〉0．05）。结论一个能级的双极射频不会对软骨细胞造成明显的损害，软骨成形术是治疗髌骨软骨退变的有效方法之一。

The study of bipolar radiofrequency chondroplasty in the treatment of cartilage degeneration of goat's patella

Objective To evaluate the clinical value of the bipolar radiofrequency chondroplasty to cartilage degeneration. Methods Sixteen goats underwent lateral retinaeular overlap suture and medial retinacular release to establish the patella cartilage degeneration modle are included in our study. We adopted bipolar frequency energy chondroplasty to treat the degenerated articular cartilage three months after operation. The left knee was regarded as sham-operated control. We observed the zero time effects and later changes of radiofrequency on cartilage surface and chondrocytes. Results At zero time, the roughed cartilage surface became smo9th, and clefts were melted. Some chondrocytes were found dead in the superficial layer, cells in deeper layer remained alive. Three months later, the surface of the articular was smoother than the sham-operated side. The histological modified Mankin＇ s score of cartilage was significantly higher than that of the sham-operated side （t = 2. 57, P 〈 0.05）. The result of Fluorecence-activated cell sorter （FACs） showed that there was no significant difference of dead chondrocyte between operated side and shamoperatedside, （ 18.69 ± 7.26 ） % and （ 25.66 ± 13.04 ） % , （ t = 1.94, P 〉 0.05 ）. Conclusions Bipolar radiofrequency energy （ 1 grade） did not cause more chondrocyte death than the sham-operated side. Bipolar radiofrequency chondroplasty may be an appropriate method in the treatment of patella articular cartilage degeneration.