摘要
目的观察内翻膝关节内外侧软骨-软骨下骨组织学变化及成骨破骨活性。方法术前影像学检查测量患者下肢力线,内翻角度及软骨磨损情况,根据纳入标准及排除标准筛选,收集2017年5月至2019年5月在我院行人工全膝关节置换术的42例KOA患者的胫骨平台,对胫骨平台内、外侧中央负重区进行大体观察并将其分为内侧磨损组和外侧组。两组分别行HE染色及Masson染色,并利用免疫组化方法检测两组软骨下骨中的TRAP、SOX9和OCN含量。结果X线片观察内翻角度8°~22°,平均12.6°;大体观察发现内侧磨损组软骨平台表面粗糙无光泽,多见软骨下骨暴露,平台边缘多发骨赘形成;组织学分析发现,软骨细胞疏松且排列紊乱,潮线紊乱,软骨下骨板异常增厚,有较多血管翳从潮线通过,侵蚀破坏关节软骨,外侧组胫骨平台无明显软骨退变;免疫组化染色结果显示,内侧磨损组与外侧组相比TRAP、SOX9和OCN表达均明显增加(P<0.05)。结论钙化层和软骨下骨在内翻型膝关节OA的发病和病情进程中发挥着重要作用。
Objective To observe the histological changes and osteogenic and osteoclastic activity of medial and lateral cartilaginous-subchondral bone of varus knee joint.Methods Preoperative imaging examination was used to measure the axial alignment of the lower extremity,varus angle and cartilage wear.According to the inclusion criteria and exclusion criteria,the tibial plateau of 42 patients with KOA who underwent total knee arthroplasty(TKA)in our hospital from May 2017 to May 2019 was collected.With the general observation on the medial and lateral central load-bearing areas of the tibial plateau,the patients were divided into medial wear group and lateral wear group.The two groups were given hematoxylin-eosin(HE)staining and Masson staining respectively.The contents of TRAP,SOX9 and OCN in subchondral bone of the two groups were detected by immunohistochemistry.Results X-ray showed that the varus angle was 8~22 degrees,with an average of 12.6 degrees.Gross observation showed that the surface of cartilage plateau in the medial wear group was rough and lusterless,with subchondral bone exposure and multiple osteophytes on the edge of the plateau.Histological analysis revealed loose chondrocytes in disorder,malalignment in tidal line,abnormal thickening of subchondral bone plate,considerable amount of pannus passing through the tidal line which eroded and destroyed articular cartilage,and no obvious cartilage degeneration in tibial plateau in the lateral wear group.The results of immunohistochemical staining showed that the expression of TRAP,SOX9 and OCN in the medial wear group was significantly higher than that in the lateral wear group(P<0.05).Conclusion The calcified layer and subchondral bone play an important role in the pathogenesis and progression of varus knee osteoarthritis.
作者
邬波
柳椰
马旭
王佳媛
王译晗
焦递进
Wu Bo;Liu Ye;Ma Xu;Wang Jiayuan;Wang Yihan;Jiao Dijin(Key Laboratory of Osteoarthropathy of Liaoning Province;Department of Joint Surgery,Shenyang Orthopedic Hospital,Shenyang 110044 China)
出处
《锦州医科大学学报》
CAS
2020年第6期10-14,共5页
Journal of Jinzhou Medical University
基金
辽宁省自然基金指导计划项目,项目编号:2019-ZD-0989。
