不同方法治疗距腓前韧带撕裂伤踝关节软骨退变后自身修复的比较研究

Different methods for treatment of talofibular ligament sprain and the comparison research of repair injury of ankle joint cartilage degeneration

目的通过2种不同方法(即单纯石膏固定法和韧带缝合石膏固定法)治疗急性距腓前韧带损伤,观察不同方法治疗后踝关节软骨的退变及自身修复情况,为临床治疗距腓前韧带撕裂伤提供实验性依据。方法采用随机分组方法,将48只实验动物随机分成单纯固定和韧带缝合固定2组,每组24只。造模后将单纯固定组随机分成A1、A2、A3、A4四组,将韧带缝合固定组随机分成B1、B2、B3、B4四组。术后3周去除所有动物患肢的石膏固定,同时将A1、B1组实验动物处死、取材;于术后3个月将A2、B2组实验动物处死、取材;于术后6个月将A3、B3组实验动物处死、取材;于术后9个月将A4、B4组实验动物处死、取材。观察各组实验动物踝关节软骨Ⅱ型胶原免疫组化染色测定Ⅱ型胶原,并用JD801图像分析系统进行图像分析。结果单纯石膏固定组内A4组Ⅱ型胶原阳性表达灰度值最高,其次是A3组,再次是A1组,A2组Ⅱ型胶原阳性表达灰度值最低。韧带缝合固定组内B1组Ⅱ型胶原阳性表达灰度值均最高,其次是B2组,B3组和B4组Ⅱ型胶原阳性表达灰度值最低且相等。不同治疗方法同一实验时间点,即A1、B1两组之间踝关节软骨Ⅱ型胶原阳性表达灰度值差异无统计学意义(P>0.05),A2与B2组差异有统计学意义(P<0.05)、A3组与B3组差异有统计学意义(P<0.05)、A4组与B4差异有统计学意义(P<0.05),认为B2组踝关节软骨Ⅱ型胶原阳性表达灰度值低于A2组,同样的结论适用于A3组与B3组、A4组与B4组。结论 1石膏固定踝关节后出现的关节软骨退变在拆除石膏后关节软骨表现出一定的自身修复能力。2单纯石膏固定法治疗距腓前韧带损伤后出现踝关节不稳,关节软骨出现进行性退变;韧带缝合固定法治疗效果可靠。

Objective To observe different methods for treatment of ankle joint cartilage degeneration and repair itself, through two different ways （that is, the simple plaster fixation method and ligament suture plaster fixation method） in treatment of acute talofibular ligament damage, for clinical treatment of talofibular ligaments before laceration to provide experimental basis. Methods Using randomized method, 48 experimental animals were randomly divided into fixed and ligament suture and fixed in the two groups, each group of 24. After building a fixed group were randomly divided into A1, A2, A3, four groups of A4, ligament suture fixation group were randomly divided into four group B1, B2, B3 and B4. After 3 weeks to remove all animal limb plaster fixation, at the same time will kill A1, Blgroup of experimental animals, materials; In postoperative 3 months will kill, A2, B2, group of experimental animals, drawing; In 6 months after the A3 and B3 group of experimental animals to death and materials; In 9 months after will kill A4, B4, group of experimental animals, drawing. Observed between groups of experimental animals on the surface of the ankle Ⅱ collagen type determination collagen type Ⅱ immunohistochemical staining, and the image analysis JD801 image analysis system. Results Simple plaster fixation group in A4 Mankin score and collagen type Ⅱ positive expression grey value are the highest, followed by A3 group, again is A1, A2 group collagen type Ⅱ positive expression of grey value minimum. Ligament suture fixation group in B1 collagen typeⅡ positive expression grey value are the highest, followed by group B2, B3 and B4 group collagen type Ⅱ positive expression of grey value minimum and equal. The different treatment method at the same time, namely A1, BI ankle joint cartilage collagen type Ⅱ positive expression of grey value no difference （P〉0.05）, there are differences between the A2 and B2 group （P〈0.05）, there are differences between the A3 and B3 group （P〈0.05）, there are differences between the A4 and B4 （P〈0.05）, group think B2 ankle joint cartilage collagen type Ⅱ positive expression of grey value is lower than B 1 group, at the same conclusion is suitable for A3 and B3 group, A4 and B4 group. Conclusion （1） Plaster fixation after ankle in articular cartilage degeneration of articular cartilage after demolition of gypsum show a certain ability to repair itself. （2） Simple plaster fixation method of treatment of unstable ankle ligament injuries, before Philip developed progressive articular cartilage degeneration. Ligament suture fixation of therapeutic effect is reliable.