Ilizarov技术对关节软骨病理改变的实验观察

Effects of Ilizarov technique on the histopathological changes of articular cartilage

目的:了解在Ilizarov技术下,受牵拉的实验踝关节软骨之间的压力改变对关节软骨的影响,为临床提供理论依据。方法:在18只实验狗左后足踝关节处分别装上Ilizarov外固定支架,采用1mm/d的牵拉速度,先制造内翻畸形,时间3周,致踝关节内翻15°,摄X线片证实后,停止牵拉3周,再以相同的速度(1mm/d)矫正畸形,时间3周。并于第3、7、9周(分组为:A组、B组、C组)取实验足内侧关节软骨和健足内侧关节软骨(D组),通过HE染色,观察内侧关节软骨形态学改变。通过免疫组织化学染色,应用软件ImagePro Plus6.0取得图像灰度值,用SPSS13.0进行统计学处理。使用透射电镜观察软骨的显微结构。结果:①Mankin得分:手术后A组和B组Mankin得分差异有统计学意义(P=0.043<0.05);手术后B组和C组Mankin得分差异有统计学意义(P=0.038<0.05)。②灰度值:A组和B组比较,P=0.047<0.05,差异有统计学意义;B组和C组比较,P=0.045<0.05,差异有统计学意义;A组和D组比较,P=0.039<0.05,差异有统计学意义;C组和D组比较,P=1.23>0.05,差异无统计学意义。结论:在Ilizarov牵张技术牵拉下,当踝关节软骨面之间压力增大时,关节软骨会发生压力性坏死;当关节软骨面之间压力逐渐减小后,关节软骨可逐渐恢复再生。

Objective：To study the effects of pressure changes on the experimental articular cartilage by utilizing Ilizarov distraction technique.Methods：The Ilizarov external fixators were fixed at the left ankle joints of 18 experimental dogs,and the fixators were stretched with a speed of 1 mm /d to create a varus deformity.After three weeks,the ankle varus was 15 degree;when the degree was confirmed by X ray film,the same traction was retained for 3 weeks.Then the traction decreased at the same speed of 1 mm /d to correct the deformity for 3 weeks.At the 3rd,7th and 9th weeks,articular cartilages were separated from medial foot of the experimental and normal side to do morphology observation after HE stain,which were group A,group B,group C and group D respectively separately.The gray scale values were obtained using Image Pro Plus 6.0 software and compared among the 4 groups using SPSS 13.0.The microstructure of cartilage was observed through transmission electron microscopy.Results：① The Mankin scores：there was significant difference between group A and group B（P=0.043〈0.05）;and significant difference between group B and group C（P=0.038〈0.05）.② The values of gray scale：there was significant difference between group A and group B（P=0.047〈0.05）;significant difference between group B and group C（P=0.045〈0.05）;significant difference between group A and group D （P=0.039〈0.05）;no significant difference between group C and group D （P=1.23〉0.05）.Conclusion：Using Ilizarov technique,when the pressure between the cartilage surface of the ankle joint increases,the necrosis of articular cartilage occurred;and when the stress between the articular cartilage surface decreases,the damaged articular cartilage can be restored.