牵伸联合低强度脉冲超声对兔膝关节挛缩影响的研究

Study on the therapeutic effects of stretching combined with low intensity pulsed ultrasound on knee con⁃tracture in rabbits

目的:观察牵伸联合低强度脉冲超声(low intensity pulsed ultrasound,LIPUS)对固定诱导的兔膝关节囊纤维化的影响,并明确牵伸联合LIPUS对兔膝关节源性挛缩的影响。方法:选取新西兰白兔30只,随机分为以下5组,每组6只:对照组(C)、自然恢复组(NR)、LIPUS组(LT)、牵伸组(ST)、牵伸联合LIPUS组(CT)。C组不进行任何处理,其余4组将兔左膝关节伸直位固定6周后,再解除固定分为:NR组进行自然恢复,LT组进行LIPUS干预,ST组进行牵伸干预,CT组进行牵伸联合LIPUS干预。各组干预时间为4周,通过关节活动测量仪检测各组膝关节源性挛缩角度、马松(Masson)染色分析膝关节前囊胶原沉积百分比、蛋白质免疫印迹分析(Western blot)膝关节前囊内转化生长因子(TGF)-β1、α-平滑肌肌动蛋白(SMA)、Ⅰ型胶原(CollagenⅠ)、Ⅲ型胶原(CollagenⅢ)的蛋白表达水平。结果:在干预4周后,与NR组比较,LT组、ST组、CT组均能有效减小膝关节源性挛缩角度(P<0.05);LT组、ST组、CT组均能减轻关节囊纤维化(P<0.05),表现为胶原沉积百分比降低(P<0.05)以及TGF-β1、α-SMA、CollagenⅠ、Colla⁃genⅢ的蛋白表达水平降低(P<0.05)。值得注意的是,CT组取得最好的干预效果(与其他干预组相比均P<0.05)。结论:牵伸联合低强度脉冲超声通过降低膝关节囊内胶原沉积和TGF-β1、α-SMA、CollagenⅠ、CollagenⅢ的蛋白水平表达来减轻关节囊的纤维化,继而改善膝关节源性挛缩角度。

Objective:To observe the effect of stretching combined with low-intensity pulsed ultrasound(LIPUS)on immobilization-induced knee capsular fibrosis in rabbits,and to clarify the therapeutic effect of stretching combined with LIPUS on arthrogenic contracture of knee in rabbits.Method:30 New Zealand white rabbits were selected and randomly divided into the following 5 groups(n=6 each):control group(C),natural recovery group(NR),LIPUS group(LT),stretching group(ST),and stretching combined with LIPUS group(CT).Group C did not receive any treatment,while the other 4 groups received the left knee joint fixation in the extended position for 6 weeks,and then the immobilization was abolished:NR group for natural recovery,LT group for LIPUS intervention,ST group for stretching intervention,and CT group for stretching combined with LIPUS intervention.The intervention time of each group was 4 weeks.The angle of arthrogenic contracture of knee was detected by joint activity meter,the percentage of collagen deposition in anterior capsule of knee joint was analyzed by Masson staining,and Western blot analysis was performed to measure the protein expression levels of transforming growth factor(TGF)-β1,α-smooth muscle actin(SMA),CollagenⅠand CollagenⅢin the anterior capsule of knee joint.Result:After 4 weeks of intervention,compared with NR group,LT group,ST group and CT group exhibited the reduced angle of arthrogenic contracture of knee(P<0.05).The LT,ST,and CT groups exhibited the alleviative fibrosis of the joint capsule(P<0.05),as the percentage of Collagen deposition was decreased(P<0.05),and the protein expression levels of TGF-β1,α-SMA,CollagenⅠ,and CollagenⅢwere decreased(P<0.05).Of note,the CT group had the best intervention effect(all P<0.05 compared with other intervention groups).Conclusion:The stretching combined with low-intensity pulsed ultrasound can reduce the collagen deposition and the expression of TGF-β1,α-SMA,CollagenⅠand CollagenⅢin the knee capsule,and then improve the angle of arthrogenic contracture of knee.