膝关节软骨游离体的组织形态及其生理学特性

Morphological and physiological features of cartilaginous loose bodies in the knee joint

目的:评价和分析膝关节软骨游离体的组织学特性和生理学活性,探讨其组织形态和生理功能变化的机制。方法:实验于2005-01/2006-01分别在安徽医科大学第一附属医院病理科、安徽医科大学理化中心、安徽医科大学附属省立医院电镜室完成。①经关节镜手术取出的软骨性游离体标本30例为实验组,其中<6个月组14例,6～12个月组10例,>12个月组6例;另取30例同腔非负重面全层关节软骨标本作为对照组。②所有标本进行大体形态学测量、病理学染色光镜观察、Ⅱ型胶原免疫组织化学检测、透射电镜观察和钙、磷、胶原含量测定。结果:①游离体<6个月组的软骨游离体与同腔对照组标本相比,两者有着相同或相近的组织形态、软骨细胞超微结构、细胞外基质分布等情况,两组标本中钙、磷、胶原总量和Ⅱ型胶原值差异无显著性[钙:(3.120±0.224),(3.090±0.231)mg/g;磷:(0.432±0.045),(0.455±0.067)mg/g;胶原:(462.43±17.12)(466.71±14.59)mg/g]。大体上说,与同腔对照组关节软骨标本相比,游离体<6个月组的软骨游离体具有基本正常的组织学特性和生理学活性。②游离体6～12个月组和游离体>12个月组标本分别与同腔对照组标本相比,光镜和电镜观察示软骨组织有纤维化的趋势,变性、坏死的软骨细胞增多,细胞外基质(蛋白多糖和Ⅱ型胶原)含量下降、分布不均,游离体>12个月组较6～12个月组的变化趋势明显,但是6～12个月组和游离体>12个月组软骨组织中仍以大量有活性的软骨细胞为主;胶原总量[(441.20±16.49),(417.33±8.38)mg/g]和Ⅱ型胶原值减少,钙、磷值增加[钙:(3.696±0.442),(6.469±0.555)mg/g;磷:(0.523±0.068),(0.683±0.056)mg/g]。总的说来,与同腔对照组关节软骨标本相比,游离体6～12个月组、>12个月组软骨游离体的组织学结构和生理学活性有改变。结论:膝关节软骨游离体在关节腔生理环境中能长久的保持或部分保持其组织学特性和生理学活性,但随着时间的延长而呈现进行性组织结构破坏、生理活性下降的趋势。

AIM： To evaluate and analyze the morphological property and physiological activity of cartilaginous loose bodies in the knee joint, to research the changeable mechanism of histological morphous and physiological function. METHODS： The experiment was conducted at the Department of Pathology of the First Affiliated Hospital of Anhui Medical University, the Physical Testing ＆ Chemical Analysis Center of Anhui Medical University, and the Electron Microscope Center of Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2005 to January 2006. （1）Experimental samples were 30 cartilaginous loose bodies all through arthroscopy as experimental group in which Group A （less than 6 months） had 14 samples and group B （between 6 and 12 months） 10, group C （more than 12 months） 6. Another 30 control samples were originated from non-weight loading side of articular cartilage through special equipment by arthroscopy. （2） All samples were carried out the morphological measurement, light and transmission electron microscope exam, Ⅱ-collagen immunohistochemical stain, the measurement of collagen, calcium and fosforus. RESULTS： （1）To compare the samples in the group A and control group, they had the identical or similar morphosis, microscopic structure of chondrocyte and distribution of extracellular matrix, the statistical treatments of the content of calcium, fosforus and collagen showed that the differences of scores between two groups were not statistically significant [calcium ： （3.120±0.224）, （3.090±0.231） mg/g ;fosforus： （0.432±0.045）, （0.455±0.067） mg/g ;collagen： （462.43±17.12） （466.71±14.59） mg/g]. General speaking, companng with the control articular cartilage, the loose bodies in group A had the normal histological property and physiological activity. （2）Compared with control group, the samples in group B and C had the tendency of fibrous degeneration： necrotic or degenerative chondrocytes increasing, the contents of proteoglycan and Ⅱ-collagen decreasing, the tendency in group C more than group B, but the cartilaginous loose bodies in group B and C had many active chondrocytes mainly. Total content of collagen [（441.20±16.49）, （417.33±8.38） mg/g] and Ⅱ-collagen decreased, while the contents of calcium and fosforus increased [calcium： （3.696±0.442）,（6.469±0.555） mg/g;fosforus： （0.523±0.068）, （0.683±0.056） mg/g]. Generally, compared with the control articular cartilage, the histological property and physiological activity of the loose bodies in groups B and C had changed. CONCLUSION： The cartilaginous loose bodies can remain its histological property and physiological activity in the knee articular cavity for a long time, but it has the tendency of disorganization and physiological activity descending as time prolongs.