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前交叉韧带横断后犬关节软骨的滑膜炎和骨关节炎变化。手术止血的影响。

Synovitis and osteoarthritic changes in canine articular cartilage after anterior cruciate ligament transection. Effect of surgical hemostasis.

作者信息

Myers S L, Brandt K D, O'Connor B L, Visco D M, Albrecht M E

机构信息

Rheumatology Division, Indiana University School of Medicine, Indianapolis 46202-5103.

出版信息

Arthritis Rheum. 1990 Sep;33(9):1406-15. doi: 10.1002/art.1780330913.

Abstract

Anterior cruciate ligament transection (ACLT) in the dog produces changes in the articular cartilage of the unstable knee that are consistent with those of osteoarthritis (OA). To determine whether the degrees of severity of OA cartilage changes, of synovitis, and of synovial iron deposition were related to adequacy of hemostasis at the time of ACLT, a modified surgical technique was devised, whereby electrocautery was used to obtain meticulous control of bleeding when the ligament was severed and irrigation was used to remove intraarticular blood before closure of the joint. When no particular attention was given to hemostasis, 69% of the dogs showed synovitis in the OA knee 10 weeks after ACLT; when electrocautery and irrigation were used to maintain hemostasis, synovitis was present in only 24% of the OA knees 10 weeks after ACLT (P less than 0.01). Iron deposits were present in 75% of synovial samples obtained after routine ACLT, but in only 6% (P less than 0.001) when attention was given to hemostasis. Hypertrophy of articular cartilage, chondrocyte cloning, fibrillation, and changes in tangential zone chondrocytes were less prominent in the OA knee when electrocautery and irrigation were used. However, the water content, uronic acid concentration, and rate of net 35S-labeled glycosaminoglycan synthesis were similarly increased regardless of the surgical technique used, and presumably, these changes reflect the reaction of joint cartilage to mechanical instability in this model of OA.

摘要

犬前交叉韧带横断术(ACLT)会导致不稳定膝关节的关节软骨发生变化,这些变化与骨关节炎(OA)一致。为了确定OA软骨变化、滑膜炎和滑膜铁沉积的严重程度是否与ACLT时的止血充分性有关,设计了一种改良手术技术,即在切断韧带时使用电灼仔细控制出血,并在关闭关节前用冲洗去除关节内血液。当不特别注意止血时,69%的犬在ACLT后10周出现OA膝关节滑膜炎;当使用电灼和冲洗来维持止血时,仅24%的OA膝关节在ACLT后10周出现滑膜炎(P<0.01)。常规ACLT后获得的滑膜样本中75%存在铁沉积,但在注意止血时仅为6%(P<0.001)。当使用电灼和冲洗时,OA膝关节中关节软骨肥大、软骨细胞克隆、纤维化和切线区软骨细胞的变化不那么明显。然而,无论采用何种手术技术,水含量、糖醛酸浓度和35S标记糖胺聚糖的净合成率同样增加,推测这些变化反映了在这种OA模型中关节软骨对机械不稳定的反应。

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