针刀“解结法”对膝骨关节炎兔软骨形态学及影像学的影响

Effects of “knot-loosing” of acupotomy on motor function and morphological changes of knee joint in knee osteoarthritis rabbits

目的:观察针刀"解结法"对膝骨关节炎(KOA)兔软骨形态学及影像学的影响,为临床针刀治疗KOA提供实验依据。方法:健康雄性新西兰兔随机分为空白组、模型组、针刀组,每组8只。采用改良Videman法左后肢伸直位石膏固定制动6周复制KOA模型。针刀组采用针刀"解结法"治疗,治疗点包括"鹤顶次""髌内下""髌外下""成腓间""委阳次""阴陵次",每7 d干预1次,共干预4次。干预结束后1周,用Lequesne膝关节级别评估法评价兔左膝关节Lequesne评分;用X线和MRI影像学观察兔左膝关节间隙、积液、软骨光滑度,并进行MOAKS评分;肉眼观察左膝关节软骨表面光滑度并进行软骨肉眼观评分;用HE染色及Mankin评分评价软骨病理改变。结果:与空白组比较,模型组左膝关节Lequesne评分明显增高(P<0.05),关节间隙变窄,关节腔内积液增多、软骨面欠光滑,MOAKS评分、软骨肉眼观评分、Mankin评分均明显升高(P<0.05)。与模型组比较,针刀组Lequesne评分明显降低(P<0.05),关节间隙增宽(P<0.05),关节腔积液减少,软骨面变光滑,MOAKS评分、软骨肉眼观评分、Mankin评分均明显降低(P<0.05)。结论:基于经筋理论针刀"解结法"能有效提高KOA兔模型膝关节行为能力,并修复软骨病理形态,其作用机制可能与调整关节间隙、减少关节腔积液有关。

Objective To observe the effect of "knot-loosing method" of acupotomy on morphological changes in knee osteoarthritis(KOA) rabbits, so as to provide experimental basis for clinical acupotomy treatment of KOA. Methods Male New Zealand rabbits were randomly divided into blank control, model and acupotomy groups, with 8 rabbits in each group. By using the modified Videman method, the left hindlimb was immobilized for 6 weeks with a plaster cast to replicate the KOA model. The knot-loosing manipulation of acupotomy was applied to "Hedingci"(located at the attachment of the positive upper margin of the quadriceps tendon and the patella),"Binneixia"(at "Neixiyan" [EX-LE4], the medial side of ligamentum patella), "Binwaixia"(at "Waixiyan" [ST35], the lateral side of patellar ligament), "Chengfeijian"(at the lateral collateral ligament of the knee in the la-teral joint space), "Weiyangci"(at the medial margin of the biceps femoris and the lateral side of the transverse striation), and "Yinlingci"(at the end-point of the medial tibia of the goose foot tendon), respectively, once a week for 4 times. One week after the last intervention, the left knee joint dysfunction severity(pain, maximum walking distance, and some activities of daily living) was evaluated by using modified Lequesne Index score. X-ray and magnetic resonance imaging(MRI)examinations were conducted to assess the articular space size, effusion and cartilage smoothness of the left knee for which the MRI Osteoarthritis Knee Score(MOAKS) was given according to their severity. The histopathologic changes of the cartilage of the left knee were observed by Hematoxylin-eosin(H.E.) staining and light microscope, which Mankin score was given. In addition, the surface of the cartilage was also examined by macroscopic observation. Results(1)Following modeling, the Lequesne Index score, MOAKS, macroscopic observation score and Mankin score were significantly increased in the model group(P<0.05). X-ray and MRI imaging showed a narrower joint space, more effusion, rough cartilage surface;and H.E. staining displayed rough cartilage surface, and disordered arrangement and occasional clusters of the chondrocytes in the left knee joint.(2)In comparison with the blank control group, the Lequesne Index, MOAKS, macroscopic observation and Mankin scores were significantly down-regulated in the acupo-tomy group(P<0.05). The abovementioned injury changes shown by X-ray, MRI, macroscopic and microscopic observations were relatively milder in the acupotomy group. Conclusion Acupotomy loosing based on the "Jingjin theory" of traditional Chinese medicine can effectively improve the motor ability of knee joint and repair pathological changes of the cartilage in KOA rabbits.