摘要
目的观察研究膝骨关节炎（osteoarthritis,OA）患者交叉韧带中机械感受器与年龄、病程以及骨关节炎严重程度的关联情况。方法将2015年10月至2016年5月符合行全膝人工关节置换术的OA患者按年龄分为A（年龄≤50岁）、B（51~60岁）、C（61~70岁）、D（年龄〉70岁）4组,按病程分为a（病程≤10年）、b（11~20年）、c（20~30年）、d（病程〉30年）4组,按WOMAC评分（评估OA严重程度）分为Ⅰ（评分≤80分）、Ⅱ（81~120分）、Ⅲ（评分〉120分）3组。在全膝人工关节置换术中将前交叉韧带（anterior cruciate ligament,ACL）及后交叉韧带（posterior cruciate ligament,PCL）完整取出,均3等分为胫骨端、中间部和股骨端,每部分切冰冻切片6张,随机选3张行HE染色,3张行免疫组化染色,光镜下观察机械感受器类型、数量。结果共观察到机械感受器2081个,ACL与PCL胫骨端机械感受器共1072个,中间部126个,股骨端883个。4个年龄组的机械感受器分别为：A组32.22±2.72,B组23.30±1.81,C组16.20±1.15,D组12.47±1.39,A、B、C、D 4组间两两比较差异均有统计学意义（P均〈0.05）。4个病程组机械感受器分别为：a组22.99±1.28,b组21.98±1.32,c组11.80±1.80,d组8.63±2.38,a组与b、c、d组比较差异均有统计学意义（P均〈0.05）,b组与c、d组比较差异均有统计学意义（P均〈0.05）,c、d两组比较差异无统计学意义（P〉0.05）。WOMAC评分3个组机械感受器分别为：Ⅰ组27.17±11.21,Ⅱ组18.80±7.13,Ⅲ组14.21±5.69,Ⅰ、Ⅱ、Ⅲ 3组间两两比较,差异均有统计学意义（P均〈0.05）。多因素析因设计资料的方差分析后得出：不同年龄阶段、病程、WOMAC评分主效应都有差异（P〈0.05）,尚不能认为各因素之间存在交互作用（P〉0.05）。结论机械感受器主要集中在交叉韧带胫骨附丽点和股骨附丽点,机械感受器数量随着OA患者年龄增长、OA病程的延长、OA病情加重而减少。
Objective To investigate the relationship between mechanoreceptors in the cruciate ligament and the age, course and severity of disease in the patients with knee osteoarthritis（ OA）. Methods The patients with knee OA who were treated with total knee arthroplasty from October 2015 to May 2016 were divided into 4 groups： group A（ ≤50 years）, group B（ 51- 60 years）, group C（ 61- 70 years） and group D（ 70 years） according to their ages. And meanwhile, they were divided into 4 groups： group a（ ≤10 years）, group b（ 11- 20 years）, group c（ 20- 30 years） and group d（ 30 years） according to the course of disease. According to the Western Ontario and Mc Master Universities Osteoarthritis Index（ WOMAC）, which was meant to assess the severity of OA, all the patients were divided into 3 groups： group Ⅰ（ score ≤80）, group Ⅱ（ 81- 120） and group Ⅲ（ score 120）. The anterior cruciate ligament（ ACL） and posterior cruciate ligament（ PCL） were completely taken out during the total knee arthroplasty, both of which were divided into 3 parts： the tibial end, the intermediate part and the femoral end. Six pieces of frozen sections were cut from each part, 3 pieces of which were randomly selected for hematoxylin-eosin（ HE） staining, and the other 3 pieces for immunohistochemical staining. The light microscope was used to observe the type and amount of mechanoreceptors. Results A total of 2081 mechanoreceptors were observed. There were 1072 mechanoreceptors in the tibial end, 126 in the intermediate part and 883 in the femoral end of the ACL and PCL.The numbers of mechanoreceptors were（ 32.22 ± 2.72） in group A,（ 23.30 ± 1.81） in group B,（ 16.20 ± 1.15） in group C and（ 12.47 ± 1.39） in group D, and there were statistically significant differences between each 2 groups of A, B, C and D（ P 0.05）. The numbers of mechanoreceptors were（ 22.99 ± 1.28） in group a,（ 21.98 ± 1.32） in group b,（ 11.80 ± 1.80） in group c and（ 8.63 ± 2.38） in group d. There were statistically significant differences between group a and group b/c/d（ P 0.05）, and there were statistically significant differences between group b and group c/d（ P 0.05）. There were no statistically significant differences between group c and group d（ P 0.05）. The numbers of mechanoreceptors were（ 27.17 ± 11.21） in group Ⅰ,（ 18.80 ± 7.13） in group Ⅱ, and（ 14.21 ± 5.69） in group Ⅲ, and there were statistically significant differences between each 2 groups of Ⅰ, Ⅱ and Ⅲ（ P 0.05）. Based on the results from the multi-factor analysis of variance in the multiple factorial design, there were statistically significant differences in the main effects of the ages, courses of disease and WOMAC scores（ P 0.05）, but there was no interaction among these factors（ P 0.05）. Conclusions The mechanoreceptors are mainly concentrated at the attachment points of the tibia and femur. The number of the mechanoreceptors is decreased with the increase of the age of OA patients, the prolongation of the course of OA and the aggravation of OA.
作者
党保平
毛立彪
第五维龙
张琦
闫金洪
杨旻
韩一生
DANG Bao-ping MAO Li-biao DIWU Wei-long ZHANG Qi YAN Jin-hong YANG Min HAN Yi-sheng(Department of Orthopedics, Xij＇ing Hospital the fourth Military Medical University, Xi＇an, Shanxi, 710032, PRC)
出处
《中国骨与关节杂志》
CAS
2016年第12期909-914,共6页
Chinese Journal of Bone and Joint
关键词
骨关节炎
膝
机械感受器
前交叉韧带
后交叉韧带
膝关节
Osteoarthritis
knee
Mechanoreceptors
Anterior cruciate ligament
Posterior cruciate ligament
Knee joint
