透明质酸预防关节滑膜切除所致软骨退行性变的实验研究

Preventive effects of sodium hyaluronate on degeneration of articular cartilage induced by synovectomy

目的 :观察关节腔内注射透明质酸钠 (HA)对滑膜切除术所致兔膝关节软骨退行性病变的抑制作用。方法 :行兔双侧膝关节滑膜切除术后 ,左膝关节腔内注射 1%HA溶液 0 .4ml,每周 1次 ,对侧注入同体积生理盐水为对照。分别于术后 3周 (组Ⅰ )和 6周 (组Ⅱ )处死动物 ,取股骨下端和胫骨上端关节面软骨进行组织学检查 ,对软骨的结构、细胞、基质的着色性、潮线的完整以及血管翳生成等指标进行观察并按分级进行评价。结果 :Ⅰ组HA处理膝股骨下端和胫骨上端的病变发生率较对照组均明显低 (5 0 %vs 83.3% ,33.3%vs 83.3% ,P <0 .0 5 ) ,病变程度也较对照组明显轻 ,组织学评分 (4.1vs 8.4 ,5 .3vs 10 .9,P <0 .0 1) ;Ⅱ组的结果也表明HA处理膝的病变发生率和病变程度 ,股骨下端 (5 8.3%vs 10 0 % ,5 .3vs 10 .9)、胫骨上端(41.7%vs 91.7% 3.1vs 7.5 ) ,股骨下端 ,胫骨上端明显低于对照组。结论 :1%HA溶液关节腔内注射可抑制滑膜切除术导致的软骨退行性病变 。

Objective: To study the preventive effects of hyaluronate on degenerative changes of articular cartilage induced by synovectomy. Methods: Synovectomy was performed in both knees of rabbits and 1% Na-hyaluronate solution(HA) 0.4ml was injected intra-articularly inte one side immediately after the surgery and equivalent volume of saline into another side for comparison. Then, such injections were qiven at weekly intervals.The rabbits were killed to examine the degenerative changes of articular cartilage 3 weeks (group Ⅰ)and 6 weeks(group Ⅱ) after surgery.The samples of articular cartilage were observed under photomicroscope to evaluate the changes in structure , chondrocytes, matrix staining intensity, and tide line, and the formation of pannus according to the histological-histochemical grading criterion established by Mankin. Results: The rate and intensity of degenerative changes of the cartilage in HA treated knees were significantly lower than those in the saline treated in both group Ⅰand group Ⅱ. Conclusion: The results indicated that Sodium hyaluronate solution has preventive effects on degenerative changes of the articualr cartilage induced by synovectomy of rabbit knees.