三种软骨保护剂在关节开放性手术中对兔关节软骨中蛋白多糖含量的影响

Effect of three kinds of protectants on proteoglycan contents in rabbit arthrodial cartilage arthrotomy

背景:关节的损伤很多需要开放手术治疗。开放手术治疗中,关节软骨暴露于空气中发生干燥,干燥会造成关节软骨的进一步损伤,对已经损伤的关节软骨采取保护措施是非常必要的。设计、时间及地点:随机对照动物实验,于2007-10/12在唐山工人医院中心实验室完成。目的:观察复方氯化钠、50g/L甘露醇、透明质酸钠3种不同软骨保护剂在关节切开术中对兔关节软骨中蛋白多糖含量的影响。材料:雌性4月龄新西兰大白兔65只,体质量2.5～3.0kg。采用随机数字表法分成实验组60只和正常对照组5只,实验组再随机分成4个亚组,软骨暴露无保护组、软骨暴露复方氯化钠保护组、50g/L甘露醇保护组、透明质酸钠保护组,每组15只兔。方法:实验组兔膝关节暴露于室温22℃,湿度65%空气中,定量打击器造成股骨内髁软骨低能量钝性损伤模型。保护组手术过程中分别用复方氯化钠、50g/L甘露醇、透明质酸钠溶液湿润软骨。无保护组不做处理。术后2h及第1,2,4,8周末,每个实验组随机各取兔3只,正常对照组各取1只,麻醉后处死,取双膝股骨内侧髁全层软骨。主要观察指标:术后不同时间点各组兔关节软骨蛋白多糖含量。结果:65只兔全部进入结果分析。术后各时间点,无保护组蛋白多糖含量低于对照组(P<0.01)。术后即刻、术后1周及2周各保护组蛋白多糖含量低于对照组(P<0.01)。术后4周、8周各保护组蛋白多糖含量分别与对照组比较,差异无显著性意义(P>0.05)。术后不同时间点,各保护组蛋白多糖含量均高于无保护组同期值(P<0.01)。术后8周,各保护组间蛋白多糖含量比较,差异无显著性意义(P>0.05)。结论:受到钝性损伤的关节软骨完全暴露于空气条件情况下,软骨蛋白多糖含量进一步减少,8周末未完全恢复。而在复方氯化钠、50g/L甘露醇、透明质酸钠3种药物定期湿润保护下,软骨蛋白多糖含量损失较少,8周末完全恢复正常,3种药物无明显不同。

BACKGROUND： Most of osteoarticu-lar injuries need surgical treatment, in which cause further damage to articular cartilage by exposed to air and drying, it is necessary to take some protective measures in surgery. OBJECTIVE： To investigate the effect of three kinds of protectants including sodium chloride, 50 g/L mannitol and sodium hyaluronate on proteoglycan content in rabbit arthrodial cartilage arthrotomy. DESIGN, TIME AND SETTING： The randomized control animal experiment was completed in the Central Laboratory of Workers＇Hospital of Tangshan from October to December in 2007. MATERIALS： Sixty-five female New Zealand white rabbits with 4-month-old, weighting 2.5-3.0 kg were divided into the experiment group （n=60） and the control group （n=5） by random number table. The experiment group were divided into 5 subgroups with 15 rabbits in each according to treated with sodium chloride, 50g/L mannitol, sodium hyaluronate and unprotected, respectively. METHODS： The knee joints of rabbits in the experiment group were exposed to air with the 22 ℃ and 65% humidity, articular cartilage of femoral medial condyle was damaged by quantitative strike assembly to create low-energy damaged models. Rabbits in the protection group were moisted by sodium chloride, 50 g/L mannitol, and sodium hyaluronate, respectively. There were no treatment in the unprotection group. At 2 hours, 1, 2, 4, 8 weekend postoperative, 3 rabbits in every experiment group and 1 rabbit in two control groups were selected and took articular cartilage of femoral medial condyle after deeply anesthetized and then killed. MAIN OUTCOME MEASURES： Proteoglycan contents of arthrodial cartilage were assessed at different times after operation. RESULTS： A total of 65 rabbits were included in the result analysis. At each time points after operation, the proteoglycan contents in unprotection group were lower than that of the control group （P 〈 0.01）. The proteoglycan contents in each protection groups were lower than that of the control group at immediate postoperative period, 1 week, and 2 weeks after operation （P 〈 0.01）. Compared with the control group, the proteoglycan contents in each protection groups showed no significant difference at 4 weeks and 8 weeks postoperative （P 〉 0.05）. The proteoglycan contents in the protection group were greater than that of the unprotection group at each time postoperation （P 〈 0.01）. At 8 weeks postoperative, there were no statistically significant difference in each protection group （P 〉 0.05）. CONCLUSION： When the damaged articular cartilage was exposed to air, proteoglycan contents will further reduced, which result in unrecovery in 8 weeks. While moisted by sodium chloride, 50 g/L mannitol, or sodium hyaluronate can reduce the loss of the proteoglycan contents, accelerate articular cartilage recovery completely at the end of 8 weeks, but there are no singnificant differences among three protective angents.