膝关节纤维化的病理组织学评估与临床关节功能的相关性分析

Correlation of clinical joint function with histopathological features of knee joint fibrosis

目的探讨人工膝关节置换术后关节纤维化患者病理组织学分级与关节功能的相关性,为关节纤维化的早期组织学诊断及预后预测提供依据。方法回顾性分析2015年10月至2020年10月于北京积水潭医院行人工膝关节置换术,由于术后关节纤维化导致的关节屈曲或者伸直活动受限而行关节翻修术的病例,共29例,女性22例,男性7例。年龄41~79岁,平均63岁。进行组织学观察及无菌性淋巴细胞为主型血管炎相关病变(Aseptic Lymphocytic Vasculitis Associated Lesion,ALVAL)评分,对纤维化及炎性细胞进行分级评估,并辅助免疫组织化学染色及特殊染色。结果镜下关节纤维化的早期病理改变为肌纤维母细胞及纤维母细胞增生,后期广泛纤维组织增生伴玻璃样变性。免疫组织化学显示平滑肌肌动蛋白阳性,Masson染色显示蓝色。淋巴细胞散在分布或灶状聚集。组织学评分显示纤维化以3级居多(26例),淋巴细胞分级以1级居多(23例),ALVAL评分以中度多见(25例)。纤维化评分和关节活动度呈现极高的相关度。ALVAL评分与西安大略和麦克马斯特大学关节炎指数(Western Ontario and McMaster Universities Arthritis Index,WOMAC)评分有较高的相关性。炎性细胞浸润程度与患者的疼痛程度评分直接相关。纤维化联合ALVAL评分对于关节置换术后关节功能具有较好的预测效果。结论人工膝关节置换术后关节纤维化患者的组织学分级评估与关节功能密切相关,并能对关节置换术后的关节功能具有较好的预测作用。

Objective To investigate the correlation between the joint function and the histologic grading after total knee arthroplasty,to aid in the early diagnosis and prognostication of arthrofibrosis.Methods A total of 29 patients including 22 females and 7 males were enrolled retrospectively from October 2015 to October 2020.These patients had a mean age of 63 years(range 41 to 79 years)and underwent total knee revision in Jishuitan Hospital due to joint contraction or loss of range of motion.Histologic assessment was carried out by utilizing immunohistochemistry(IHC)and the Masson staining to evaluate the fibrosis and inflammation of the samples.Results By light microscopy,early stage arthrofibrosis showed massive proliferation of myofibroblasts and fibroblasts with SMA expression by IHC.In late stage arthrofibrosis,hyaline degeneration occured with extensive hyperplasia of fibrosis-related tissue.The arthrofibrosis samples appeared blue with Masson staining.Lymphocytes showed perivascular distribution.The arthrofibrosis tissue was mostly grade 3(26 samples)in histologic assessment,moderate grade(25 samples)in ALVAL score,and grade 1(23 samples)in lymphocyte grading.Fibrosis grading showed an overwhelming correlation with range of motion(ROM)of the joint.The ALVAL score was highly correlated with the WOMAC score.There was also a direct correlation between inflammatory cell infiltration and pain.The fibrosis grading joint with ALVAL score showed a good predictive value of joint function after joint replacement surgery.Conclusions The histologic assessment score is closely correlated to the joint function with predictive values for the prognosis after joint replacement surgery.