关节软骨MR影像表现特点和各种影响因素

目的探讨关节软骨的ＭＲＩ表现特点以及各种因素对软骨层次、厚度和信号强度的影响。方法取１２只新鲜人膝关节标本,行各种位置和序列的ＭＲ成像。标本脱钙、切片、染色后用偏光显微镜观察。结果ＭＲＩ上关节软骨的厚度、层次和信号强度与软骨内纤维排列方向、软骨基质的含量、各区域宽度、容积效应、化学位移、各向异性和成像序列密切相关。结论ＭＲＩ检查判断关节软骨结构需兼顾年龄和其他诸多技术因素     

Vastus medialis cross-sectional area is associated with patella cartilage defects and bone volume in healthy women

OBJECTIVES: Although vastus medialis and vastus lateralis are important muscular determinants of patellofemoral joint function, it is unclear how these muscles relate to the structure of the patellofemoral joint. The aim of this cross-sectional study was to determine the relationship between the vasti muscles and patella cartilage volume and defects and patella bone volume. METHODS: One hundred and seventy-five women, aged 40-67 years, with no knee pain or clinical lower-limb disease had magnetic resonance imaging (MRI) of their dominant knee. The cross-sectional areas of the distal vastus medialis and lateralis were measured 37.5mm superior to the quadriceps tendon insertion at the proximal pole of the patella. Patella cartilage volume and defects and patella bone volume were measured from these images using validated methods. RESULTS: There was no significant association between the distal vastus medialis cross-sectional area and patella cartilage volume. For every 1mm(2) increase in the distal vastus medialis cross-sectional area, there was an associated increased risk of patella cartilage defects [odds ratio (OR): 1.2; 95% confidence interval (CI) 1.004, 1.5; P=0.05], and an associated increase in patella bone volume (OR: 3.9; 95% CI 2.0, 5.8; P<0.001) after adjustment for potential confounders. There was no significant relationship between vastus lateralis cross-sectional area and measures of patella cartilage or bone. CONCLUSION: An increased cross-sectional area of the distal portion of the vastus medialis muscle is associated with an increased risk of patella cartilage defects, and an increase in patella bone volume among healthy women. Although these results need to be confirmed in longitudinal studies, they suggest that an increase in the distal vastus medialis cross-sectional area is associated with structural change at the patellofemoral joint.     

兔椎间失稳软骨终板退变的实验研究

[目的]通过电镜研究软骨终板在椎间失稳环境下的退变过程,为椎间盘退变的治疗提供新的思路和方法.[方法]取48只6个月龄日本大耳白兔,雌雄不限,体重为(2.5±0.2)kg,随机进行分组,分为对照组和实验组,对照组为21只;实验组为27只;先将实验组兔腰背部皮毛剪除,用安定注射液1.25 mg/kg、氯胺酮0.02 g/kg、阿托品0.125 mg/kg顺次耳缘静脉注射麻醉后,俯卧固定于手术台上,用1%碘伏消毒手术区域,以髂嵴平对椎间隙(即L6.7)为中心,从正中取一长约4 cm纵行切口,切开皮肤及皮下组织,锐性分离,暴露棘突、椎板及上下关节突,将附着于棘突、椎板及小关节的肌肉全部分离开,然后依次切除L6.7棘上及棘间韧带,咬除第6腰椎两侧下关节突,造成椎间失稳,用无菌生理盐水冲洗切口,依次缝合各层组织;术后动物在笼中自由活动.实验组分别在术后2个月、4个月、6个月取材,对照组在相同条件下饲养后2个月、4个月、6个月取材;对椎间盘软骨终板用透射电镜观察软骨终板的结构,以综合判断软骨终板的退变过程.[结果]椎间失稳可导致椎问软骨终板胶原纤维结构由整齐有序、排列紧密向杂乱无章、排列松散退变.[结论]椎间失稳能明显导致椎间软骨终板的退变.     

Absence of the mutated Trp2 allele but a common polymorphism of the COL9A2 collagen gene is associated with early recurrence after lumbar discectomy in a German population

Genetic factors seem to play a role in symptomatic lumbar disc disease (LDD). It has been shown previously that a tryptophan mutation of the COL9A2 gene is a major risk factor for LDD in a Finish population. The impact of collagen gene variations on the relapse rate after lumbar discectomy, however, has not been studied so far. Here, we conducted a cross-sectional genotyping study of patients who underwent lumbar discectomy to determine the influence of a COL9A2 mutation on the recurrence rates. Biopsy samples from 288 patients suffering from LDD with and without relapse were analyzed by PCR restriction fragment analysis and direct sequencing. The mutated Trp2 allele was not detected in the patients’ samples of the present study. However, nine patients with recurrent LDD, but only two without recurrence were homozygous for the Arg allele. Homozygosity for the Arg allele of Col9A2 seems to be more frequent in the patient group with early recurrence although the differences in the allele frequencies were statistically not significant. In contrast, the Trp2 mutation seems not to be a major susceptibility factor for LDD in a German population.     

hIGF-1基因转染促进退变椎间盘Ⅱ型胶原的表达

[目的]探讨人胰岛素样生长因子(human insulin-like growth factor-1,hIGF-1)基因在退变椎间盘中的表达及对椎间盘中Ⅱ型胶原表达的影响.[方法]参考文献[1]制备出腰椎间盘退变(intervertebral disk degeneration,IVDD)动物模型24只,随机分为携带hIGF-1基因重组腺病毒(Ad/CMV-hIGF-1)、hIGF-1生长因子及PBS组.L4、5、L5、6椎间盘中分别注射25 μl第2代Ad/CMV-hIGF-1 (8×108 PFU)、hIGF-1生长因子(100 μg/L)、PBS.注射后1、2、4、8周,Western blot检测hIGF-1蛋白表达;半定量RT-PCR检测Ⅱ型胶原mRNA的表达.[结果]hIGF-1蛋白带出现在7 540.00 u.Ad/CMV-hIGF-1组hIGF-1蛋白表达持续达4周以上,hIGF-1组表达持续约2周;PBS注射组无hIGF-1蛋白表达.Ⅱ型胶原电泳条带出现在200～300 bp;在注射后1～4周,Ad/CMV-hIGF-1组内Ⅱ型胶原mRNA相对表达量进行性增加,8周轻度下降,4个时期比较(F=12.18,P＜0.001);注射后1～8周,hIGF-1注射组、PBS注射组Ⅱ型胶原mRNA相对表达量进行性下降(F=27.38、21.56,P＜0.001).相同时间点3组比较,Ⅱ型胶原mRNA相对表达量Ad/CMV-hIGF-1组最高,PBS组最低(F=27.31～39.85,P＜0.001).[结论]hIGF-1基因在退变椎间盘中的表达能够促进合成Ⅱ型胶原.     

黑虎丹治疗兔骨关节炎的实验研究

目的 观察黑虎丹治疗骨关节（OA）的效果及其对OA软骨细胞增殖和凋亡的影响。方法 36只雄性新西兰大白兔切断左膝前、后交叉韧带及内侧半月板,建立兔OA模型。随机分为对照组和用药组,各18只。对照组不用药;用药组术后第13周起口服黑虎丹1粒／天。分别于术后第16、20、24周处死动物,取股骨内髁及胫骨内侧平台软骨标本进行光镜、透射电镜、扫描电镜观察,采用免疫组化、末端原位标记分别观察软骨细胞增殖和凋亡状况。结果 用药组骨关节炎病理表现与对照组无显著差别,用药组软骨细胞增殖和凋亡指数随时间延长而减少,在术后24周时均低于对照组。结论 长期服用黑虎丹能减少晚期OA软骨细胞的凋亡,并维持OA软骨细胞增殖和凋亡的平衡。     

基质金属蛋白酶-3和其组织抑制剂-1在椎间盘中的表达及其意义

目的：检测突出和非突出椎间盘中是否有基质金属蛋白酶－3（MMP3）及其组织抑制剂－1（TIMP）的表达,了解椎间盘退变和突出的发病机制。方法：采用ABC免疫组化方法,测定60例突出椎间盘标本（分为凸出型,脱出型,游离型）和16例非突出椎间盘标本内MMP3和TIMP1的表达情况,结果：突出椎间盘中的MMP3比非突出椎间盘的多,其差异有显著性意义。脱出型及游型内的MMP3比突出型的多,其差异有显著性意义。脱出突型及游离型内的MMP3无显著性差异,非突出椎间盘和凸出型椎间盘内TIMP1为阴性,脱出型和游离内TIMP1为阳性,但无显著性差异,结论：MMP3和TIMP1的不平衡表达也许是椎间盘退变的因素,椎间盘退变程度的差异可能是椎间盘突出症临床分型的基础。     

Autologous osteochondral transplantation using the diamond bone-cutting system (DBCS): 6–12 years’ follow-up of 35 patients with osteochondral defects at the knee joint

Thirty-five patients with severe osteochondral defects were treated by autologous osteochondral transplantation between 1986 and 1992. The majority of patients (27) suffered from osteochondrosis dissecans, while 8 patients presented with posttraumatic osteochondral defects. The grafts were harvested with a diamond bone cutter from the posterior part of the medial or lateral femoral condyle. In 29 patients the lesion was located at the lateral part of the medial femoral condyle, in 3 it was at the lateral femoral condyle, and in 3 at the patella. Twenty-nine patients could be examined at the follow-up between 6 and 12 years later (mean follow up 8.1 years). Using the standard cartilage evaluation form, the transplanted knees of 12 patients were graded as normal (grade I), 14 knees were nearly normal (grade II), while 3 patients presented with an abnormal result (grade III). All 3 of them had a varus malalignment and refused a high tibial correction osteotomy against our advice. No patient was assessed as severely abnormal (grade IV). The majority of patients improved their activity level and the functional status of the joint. Twelve patients developed new radiological signs of osteoarthrosis with a decrease in the radiological score of Kellgren and Lawrence by about one stage. We conclude that autologous osteochondral transplantation with the diamond bone-cutting system is an effective method in the treatment of severe osteochondral defects. Received: 17 April 2000     

Possibility of "distraction arthrogenesis": first report in rabbit model

We investigated the possibility of articular cartil-age distraction for use in reconstructing joint structure and for increasing the donor site of osteochondral grafts. Intraarticular osteotomy was performed at the femoral condyle in 12 Japanese white rabbits. The bone segment was fixed with a specially designed external fixator. After a 3-week waiting period, distraction was performed intermittently for 3 weeks (0.7 mm × 3 times per week) in the distraction group (n = 7) and, in the remaining animals (gap group; n = 5), a gap of 6.3 mm in length was made at surgery. All rabbits received etidronate injections (20 mg/kg ×2 times per week) for 5 weeks, to slow mineralization. The femoral condyle was harvested 9 weeks postoperatively and decalcified sagittal sections were stained and evaluated, using a histological grading scale. In the distraction group, distraction of 4.2 ± 1.4 mm was achieved, and the distracted cartilage area was filled with regenerated cartilage, without any gap between the regenerated and the adjacent articular cartilage. This regenerated cartilage showed metachromasia with toluidine blue. In the gap group, newly formed cartilage tissue was folded from the edge of the osteotomy site and fibrous tissue was interposed in the gap. The histological grading score was significantly lower in the distraction group (P < 0.02). Our preliminary results demonstrated the possibility of cartilage distraction; however, long-term observation will be necessary to confirm the characteristics of the distracted cartilage. We may call the process "distraction arthrogenesis", because the entire articular entity, which consists of cartilage, subchondral bone, and bone, could be distracted at once. Received: April 5, 2001 / Accepted: July 15, 2001     

细胞因子与骨性关节炎软骨退变的研究现状

骨性关节炎是最常见关节疾患之一,是导致中老年残疾的最常见原因,严重危害着中老年人的生活质量。骨性关节炎的主要病理是软骨的改变,软骨细胞分解和合成活动的平衡有助于维持软骨细胞外基质结构和功能的完整性,而软骨细胞的这种平衡受到细胞因子制约,本文就近年来细胞因子与OA软骨退变之间的研究现状综述。