关节镜下应用“微骨折”方法修复关节软骨缺损

目的:探讨关节镜下应用“微骨折”技术对膝关节全层关节软骨缺损修复的效果。方法:对68例全层关节软骨缺损患者进行随机分组:实验组(35例),男17例,女18例,平均年龄35.1岁,采用关节清理后应用“微骨折”技术进行处理,即利用骨刀设计的特性和适度的锤击力量造成软骨下的骨组织微小骨折,刺激软骨生长。对照组(33例),男17例,女16例,平均年龄31.6岁,仅作关节清理术。结果:术后随访6~18个月,平均8.6个月,按Lysholm评分标准,实验组明显优于对照组(P<0.01)。结论:关节镜下应用“微骨折”技术能够显著减轻关节疼痛,增加关节活动度,改善关节功能,是一种简单有效的修复全层关节软骨缺损方法。     

兔关节软骨细胞的分离、培养和形态学特征

[目的]探讨兔关节软骨细胞的分离、培养方法,观察单层高浓度培养时细胞表型表达情况.[方法]无菌条件下,从 2周龄新西兰白兔的颞颌关节及四肢关节髁突面削取软骨片,采用机械-酶消化法分离软骨细胞,经台盼蓝拒染计数,将细胞按 1× 106个 /孔接种于 6孔培养板,传代培养,描绘生长曲线.利用相差显微镜及透射电镜观察细胞形态.应用甲苯胺蓝及Ⅱ型胶原免疫组化对细胞进行鉴定.[结果]每克软骨能获取 1 5× 106个软骨细胞,活性率为 95%.培养 2～ 3 d,细胞贴壁、变形,呈多角形; 8 d左右,细胞融合成层.透射电镜观察显示细胞核圆形,有丰富的粗面内质网、高尔基体及分泌的基质成分.甲苯胺蓝及Ⅱ型胶原染色阳性.细胞传至 5代后,出现"成纤维细胞样".[结论]本研究建立了简单易行的软骨细胞分离、培养方法;初代、第 2代细胞生长良好,适合于实验研究;软骨细胞 5代培养后,细胞表型发生改变.     

High-resolution imaging of progressive articular cartilage degeneration.

The objective of this study was to develop and verify a new technique for monitoring the progression of osteoarthritis (OA) by combining a rat model with the imaging modality optical coherence tomography (OCT). Time-sequential, in vivo, OCT imaging was performed on the left femoral condyles of 12 Wistar rats following sodium-iodoacetic acid-induced OA progression. The right femoral condyles (untreated) were also imaged and served as controls. Imaging was performed on days 0, 10, 20, 30, and 60 with an OCT system capable of acquiring images at four frames per second and an axial resolution of 5 microm. Progressive changes were analyzed using an OA scoring system. OCT successfully identified progressive cartilage degeneration as well as alteration of the cartilage/bone interface. Significant changes to both of these structures were observed in the sodium-iodoacetic acid-injected condyles. Structural changes detected with OCT were confirmed histologically. OCT in combination with a well-known model used in arthritis research represents a powerful tool for following degenerative joint disease progression in a given animal by detecting changes to the cartilage/bone interface and articular cartilage.     

ULTRASTRUCTURAL INVESTIGATION ON THE ARTICULAR CARTILAGE FROM RABBIT KNEE JOINT AFTER IMMOBILIZATION IN CAST

The articular cartilages from the left knee of 30 rabbits immobilized in casts in functional position were studied under transmission electron microscope. The pathological changes which begin at early stage of immobilization included both degeneration and repair of cartilage. The striking morphological features observed were: (1) most chondrocytes in various layers of cartilage underwent progresive degeneration; (2) the concomitant abnormal proliferation of some chondrocytes happened in a brief period. The changes in mechanical stress caused by immobilization affected the nutrition of cartilage and finally led to its reactive structural reformation.     

舟月骨间韧带在腕尺桡偏时舟月骨三维运动中的作用

目的 观察在腕关节尺桡偏运动时,舟月骨间韧带(scapholunate interosseous ligament,SLIL)及其各亚区分级切断后对舟骨与月骨三维运动的影响,从亚区水平对SLIL在舟月骨三维运动中的作用进行研究.方法 取12例新鲜冰冻成人上肢标本(左、右侧各6例),共分为正常对照组、断SLIL近侧组、断SLIL近+背侧组、断SLIL近+掌侧组、SLIL全断组(每组6例).采用三维激光扫描及图像重建技术,测定在腕关节尺桡偏时舟骨与月骨的三维运动数据,并进行统计学处理.结果 在正常腕关节做尺桡偏运动时,舟、月骨同时也做尺桡偏运动,但还伴有明显的屈伸方向上的运动;与此同时,舟、月骨还做一定的旋前、旋后活动.在切断近+掌和近+背侧亚区组,舟月骨的活动受到影响.全切断SLIL会导致舟骨掌屈度增加,月骨掌屈活动减弱.结论 采用三维激光扫描及图像重建技术可准确测定腕舟月骨的三维活动度,从SLIL亚区水平上进行的研究表明,部分或全部切断SLIL后会对舟月骨的掌屈程度产生明显影响,但SLIL近侧亚区在控制舟、月骨的活动上不起主要作用.     

张力带治疗后交叉韧带胫止点撕脱骨折

自1999年12月-2004年2月采用切开复位张力带内固定治疗后交叉韧带胫止点撕脱骨折18例，术后骨折愈合良好，关节功能满意，现介绍如下。     

人和大鼠腰椎关节突关节的SP能神经纤维的分布

目的：证实支配腰椎关节突关节的神经支配和化学性质，方法：用逆行荧光素标记结合免疫组化法，研究７只大鼠腰部脊神经节细胞的周围突分支投射到腰椎关节突关节及其递质性质以及３例人腰椎关节突关节囊上神经末梢的化学性质，结果：发现大鼠一侧Ｌ５和Ｌ６之间的关节突关节受同侧Ｌ２－５节段的脊神经节的部分细胞周围突分支支配，其中有３３．３９９％的中型和小型细胞为中ＳＰ能免疫反应阳性，人的关节突关节囊含有ＳＰ阳性的神经     

Contrasting in vitro effects of retinol and mononuclear cell factor on young and old human cartilage

Studies with young animal cartilage have shown that retinol and mononuclear cell-factor (MCF) cause in vitro breakdown of the cartilage, mediated by the living chondrocyte (indirect degradation). We studied the effects of retinol and MCF on healthy human articular cartilage of different ages, measuring the effects on proteoglycan (PG) content of the cartilage, and on PG synthesis during 8 days of culture. This study shows: Retinol and MCF induce indirect degradation of young, but not of old human cartilage of the humeral head; Both retinol and MCF suppress PG synthesis of young and stimulate PG synthesis of old cartilage; The effects of retinol and MCF on cartilage PG content and on PG synthesis are related to the metabolic state of the chondrocyte; Therefore mononuclear cell-factor may have a destructive or beneficial effect on cartilage depending on whether proteoglycan synthesizing activity is high or low, respectively.     

Changes in extracellular potassium concentration in cat spinal cord in response to innocuous and noxious stimulation of legs with healthy and inflamed knee joints

Summary In 20 cats anaesthetized with alpha-chloralose and spinalized at the thoracolumbar junction we investigated the role of stimulation induced accumulation of extracellular potassium in the spinal cord in the processing of nociceptive discharges from the knee joint. For that we electrically stimulated the posterior articular nerve of the knee. We further performed innocuous and noxious stimulation of the knee and of other parts of the leg and studied the effect of an acute inflammation of the knee on [K⁺]₀ in the spinal cord. Innocuous stimulation of the skin (brushing or touching) and innocuous movements in the knee joint all induced rises in [K⁺]₀ which were maximal at recording depths of 1500 to 2200 m below the surface of the cord dorsum. Peak increases were 0.4 mM for touching the leg and 1.7 mM during rhythmic flexion/ extension of the knee joint. Noxious stimulation of the skin, the paw, the tendon and noxious movements of the knee joint also produced rises in [K⁺]₀, which were somewhat larger for the individual types of stimuli than those produced by innocuous intensities. Electrical stimulation of the posterior articular nerve induced rises in [K⁺]₀ by up to 0.6 mM. Stimulus intensities sufficient to activate unmyelinated group IV fibers were only slightly effective in raising [K⁺]₀ above the levels reached during stimulation of myelinated group II and III fibers. During development of an acute inflammation of the knee joint (induced by kaolin and carrageenan), increases in [K⁺]₀ and associated field potentials became larger by about 25%. We assume that this reflects an increase in neuronal responses. In conclusion, changes in [K⁺]₀ in the spinal cord are some-what larger during noxious stimulation than during innocuous stimulation. The absolute level reached depended more on the site and type of stimulation than on the actual stimulus intensity itself. Hence a critical role of spinal K⁺ accumulation for nociception is unlikely.