低能量体外冲击波对兔膝骨关节炎软骨细胞修复和重塑能力的影响

Repair ability and restore function research of low-energy extracorporeal shock wave on rabbit knee osteoarthritis cartilage

目的研究低能量体外冲击波（ESW）对兔膝骨关节炎软骨细胞刺激作用。方法清洁级健康5月龄30只大白兔,体质量2.0~2.8 kg。随机分为研究组、模型组与对照组,各10只。研究组与模型组采用石膏固定6周成功建立膝骨关节炎模型,对照组未建模;其中研究组采用0.1 m J/mm2 ESW治疗1 000次,余2组不采用任何干预措施。进行组织病理检查,做Moran评分、Mankin法评分,实验室测定基质金属蛋白酶（MMP）-1、MMP-3、MMP-13基因表达和白细胞介素（IL）-1β、肿瘤坏死因子（TNF）-α水平。结果 4周后,研究组兔膝骨关节软骨变薄,表面见少量疏松纤维组织,软骨表面部分修复;模型组兔膝骨关节呈典型关节炎改变;对照组兔膝骨关节光滑,软骨结构清晰。与对照组比较,研究组和模型组Moran评分明显降低,Mankin法评分和软骨细胞凋亡率明显增高,软骨MMP-1、MMP-3、MMP-13基因表达水平均明显升高,关节滑液IL-1β、TNF-α水平明显升高,差异有统计学意义（P〈0.05）。研究组膝骨关节Moran评分明显高于模型组,Mankin法评分和软骨细胞凋亡率明显低于模型组,差异有统计学意义（P〈0.05）。研究组软骨MMP-1、MMP-3、MMP-13基因表达水平均明显低于模型组,关节滑液IL-1β、TNF-α水平明显低于模型组,差异有统计学意义（P〈0.05）。结论低能量体外冲击波通过降低软骨MMP与关节滑液炎性因子水平,从而改善兔膝骨关节炎软骨细胞修复能力和重塑作用,值得临床推广应用。

Objective To study the effects of low-energy extracorporeal shock wave（ESW） on rabbit knee osteoarthritis carti- lage repair ability and restore function. Methods Thirty healthy 5-month-old rabbits with body weight of 2.0 - 2.8 were ran- domly divided into research group, model group and control group, with 10 in each group. Knee osteoarthritis models were successfully established in research group and model group with plaster fixation for 6 weeks, while no model was established in control group. The research group was given 0.1 mJ/mm2 ESW treatment for 1 000 times, while the other groups without inter- vention. Results After 4 weeks, the rabbit knee joint cartilages in research group became thinner with small loose fibrous tissue on the surface, and cartilage surface portion was repaired. Typical arthritis change occurred at rabbit knee joint in model group. In control group, the rabbit knee joints were smooth, and cartilage showed clear structure. Compared with control group, Moran scores in research group and model group decreased significantly, while Mankin score and cartilage cell apoptosis rate were increased significantly, and gene expression levels of cartilage matrix metalloproteinase（MMP）-l, MMP-3 and MMP-13 were significantly increased, joint synovial fluid interleukin lβ（IL-1β） and tumor necrosis factor-ot（TNF-α level increased signifi- cantly, and the differences were statistically significant（P 〈 0.05）. The knee joint Moran score of research group was significantly higher than that of model group, while Mankin score and cartilage cells apoptosis rate were significantly lower than that of model group, and the differences were statistically significant（P 〈 0.05）. The gene expression levels of cartilage MMP-1, MMP- 3 and MMP-13 were significantly lower than that of model group, and joint synovial fluid IL-1β, TNF-α levels were signifi- cantly lower than that of model group, and the differences were statistically significant（P 〈 0.05）. Conclusion It is demonstrat- ed that low-energy ESW improves rabbit knee osteoarthritis cartilage repair ability and restore function by decreasing MMP levels of cartilage and joint synovial inflammation factor, which is worthy of clinical application.