膝关节腔内注射皮质类固醇对关节软骨损害的研究──病理组织学和超微结构观察

３０只健康新西兰白兔，随机分为两组，每组１５只。Ａ组右膝关节腔内注射醋酸强的松龙，每次７．５ｍｇ／ｋｇ，每周１次；Ｂ组右膝关节内注射生理盐水，每次０．３７５ｍｌ／ｋｇ，每周１次。每组分别于第３、５、７、９、１１周的第１天，各取３只动物，在光镜下观察双侧膝关节和股骨头软骨标本有无病理组织学改变，并在第５、９、１１周加作超微结构观察。结果显示，Ａ组用药２次后即见双侧股骨头、膝关节软骨下区髓腔内脂肪细胞增多，造血组织减少。用药６次后可见右侧膝关节软骨组织出现灶性溶解、坏死。电镜下可见软骨细胞核固缩明显，胞浆内脂滴增多、细胞器坏死、溶解，Ｂ组所有标本未见组织学和超微结构改变。结果提示，关节内注射皮质类固醇对关节软骨的损害是肯定的，且随给药次数的增加而加重。故而，临床疼痛治疗工作中，关节内注射皮质类固醇宜免用。

Osteoarticular Damage Induced by Intraarticular Injection of Corticosteroids

Thirty healthy New Zealand white rabbits were classified into two groups (Group A and B, 15 each). In group A, the right knee joint was injected with pnednisolone acetate 7 5mg/kg per week. In group B, normal saline was injected as a control. Biopsy of cartilage was taken from three rabbits of each group at the time of 3rd, 5th, 7th, 9th and 11th week during the expermental period. Ultrastructural changes of the 5th, 9th and 11th week biopsies were als observed. Results: (1)In group A, the bone marrow tissue sections of the bilateral femoral heads and the knee joint cartilage, taken after the 2nd injection, a decrease of the haematopoietic tissue and increase of fatty cells were seen. Focal lysis and necrosis of the knee joint cartilage occured after the 6th injection. The severity of changes mentioned above was enhanced by more injections. Under electron microscopy, an increase of cartilage cells showed nuclear pyknosis, number of fatty droplets in cytoplasma, vacuolar degeneration necrosis and lysis. (2) In group B, no histological and ultrastructural changes were found. It is concluded that the cartilage damaging effect of intraarticular injection of corticosteroid can be produced, and increases in severty as more injections administed. Thus, the intraarticular injection of cortisocteroid for treatment of osteo articular pain whould be avoided.