腰椎管狭窄与膝骨关节退变相关性的实验观察

Experimental correlation study of lumbar spinal stenosis and knee joint degeneration

目的通过建立兔子的腰椎管狭窄模型，观察其后肢运动功能及关节软骨病理形态改变，来阐明腰椎病变和膝骨关节病之间的相互关系。方法36只健康成年兔子数字表法随机分为模型组和对照组；模型组用椎管内填塞骨片法制作腰椎管狭窄模型，对照组只打开椎管，椎管内不填塞任何材料。造模后4、8、12周时依据改良Tarlov法评价其运动功能，光镜观察股骨内侧髁关节软骨，依据Mankin’s评分标准对病理改变进行评分。结果模型组4、8周时可见早期骨关节炎的改变，表现为滑膜充血增生，关节渗出增多，软骨表层不平整，基质染色轻染，Mankin评分为3．3～4．5分，运动功能Tarlov评分3～4分；12周时可见骨关节炎中期改变，表现为滑膜增生明显，滑液少，软骨表层裂隙形成，软骨细胞排列紊乱，基质染色不均，Mankin评分为7～9分，Tarlov评分2～3分。对照组大部分为正常关节软骨，Mankin评分0～1分，Tarlov评分4分。结论腰椎管狭窄与膝关节软骨退变可能存在相关性。

Objective To explore the correlation of lumbar stenosis and knee osteoarthritis by establishing a rabbit lumbar spinal stenosis model and observing the hind limb movement function and pathological change of articular cartilage of knee joint. Methods A total of 36 healthy adult rabbits were randomly divided into model group and control group. In the model group, spinal canal was filled with bone pieces to make lumbar spinal stenosis; in the control group, sham operation was performed and materials were inserted into spinal canal. Movement function was evaluated by Tarlov method and pathological features were observed by Mankin＇ s scores under light microscope at 4, 8 and 12 weeks. Results Early degenerative changes of knee cartilage were observed in the model group at 4 and 8 weeks post-operation. There were synovial hyperemia and hyperplasia, increased synovial fluid effusion and lightly-stained cartilage. The Mankin score was 3.3 -4.5 and Tarlov score 3 -4. Intermediate stage changes of osteoarthritis were found in the model group at 12 weeks post-operation, showing synovial hyperplasia, decreased synovial fluid, fissure in cartilage surface, tangled cartilage cells and unevenly stained matrix. The Mankins score was 7 - 9 and Tarlov score 2 - 3. Most of articular cartilage was normal in the control group with Mankin score of 0 - 1 and Tarlov score of 4. Conclusion Lumbar stenosis may be correlated with knee Joint degeneration.