Maeda Shugo, Tsuda Eiichi, Mizukami Hiroki, Yamamoto Yuji, Inaba Wataru, Sasaki Norihiro, Ishibashi Yasuyuki
Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Department of Pathology and Molecular Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2015 Feb 24;2(2):56-62. doi: 10.1016/j.asmart.2014.12.004. eCollection 2015 Apr.
The clinical use of low-intensity pulsed ultrasound (LIPUS) was recently evaluated in cases of osteochondritis dissecans of the humeral capitellum (elbow OCD). However, the mechanism underlying the effect of LIPUS in elbow OCD is not well understood. The aim of this study was to histopathologically evaluate the effect of LIPUS irradiation on elbow OCD.
Fifteen patients with elbow OCD were enrolled in this study. All patients were juvenile baseball players (average age, 13.1 years). LIPUS was performed under the same conditions as the fracture treatment for an average length of 15.1 days in the preoperative period in seven patients (LIPUS group). Cylindrical tissue specimens obtained at the time of surgery were stained with hematoxylin and eosin and alcian blue, and were also immunostained to detect type 1 collagen (Col-1), osteopontin (OPN), and Runx2. The state of the cartilage and subchondral bone and expression levels of Col-1, OPN, and Runx2 were evaluated with a semiquantitative grading system by a blinded pathologist. Histological and immunohistological findings in both groups were compared using Fisher's exact test.
Both groups showed reparative tissue and cartilaginous metaplasia at the separation level near the subchondral bone; Col-1 was expressed in the reparative tissue. Furthermore, OPN and Runx2 were expressed in the interstitial cells near the separation level. The cartilage and subchondral bone findings in histological evaluations did not differ significantly between the LIPUS and control groups. The distribution of OPN expression levels in the two groups was as follows: Grade 0-LIPUS group, zero patients, and control group, five patients; Grade 1-LIPUS group and control group, two patients each; Grade 2-LIPUS group, five patients and control group, one patient; Grade 3-LIPUS group, one patient and control group, zero patients. OPN expression was significantly higher in the LIPUS group than in the control group ( = 0.04).
LIPUS stimulation increased the expression levels of OPN in elbow OCD.
最近对低强度脉冲超声（LIPUS）在肱骨小头剥脱性骨软骨炎（肘部骨软骨炎）病例中的临床应用进行了评估。然而，LIPUS对肘部骨软骨炎作用的潜在机制尚不清楚。本研究的目的是从组织病理学角度评估LIPUS照射对肘部骨软骨炎的影响。
15例肘部骨软骨炎患者纳入本研究。所有患者均为青少年棒球运动员（平均年龄13.1岁）。7例患者（LIPUS组）在术前与骨折治疗相同的条件下进行LIPUS治疗，平均时长15.1天。手术时获取的圆柱形组织标本用苏木精-伊红和阿尔辛蓝染色，并进行免疫染色以检测Ⅰ型胶原（Col-1）、骨桥蛋白（OPN）和Runx2。由一位不知情的病理学家采用半定量分级系统评估软骨和软骨下骨的状态以及Col-1、OPN和Runx2的表达水平。使用Fisher精确检验比较两组的组织学和免疫组织学结果。
两组在软骨下骨附近的分离水平处均显示出修复组织和软骨化生；Col-1在修复组织中表达。此外，OPN和Runx2在分离水平附近的间质细胞中表达。组织学评估中，LIPUS组和对照组的软骨和软骨下骨表现无显著差异。两组中OPN表达水平的分布如下：0级-LIPUS组0例患者，对照组5例患者；1级-LIPUS组和对照组各2例患者；2级-LIPUS组5例患者，对照组1例患者；3级-LIPUS组1例患者，对照组0例患者。LIPUS组的OPN表达明显高于对照组（P = 0.04）。
LIPUS刺激增加了肘部骨软骨炎中OPN的表达水平。
