Namazi Hamid, Emami Mohammad J, Nazhvani Fatemeh Dehghani, Dehghani Nazhvani Ali, Kargarshouroki Zeinab
Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Oral and Maxillofacial Pathology, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran.
Arch Bone Jt Surg. 2019 May;7(3):269-277.
One of the major challenges in orthopedic surgery is the prevention of arthrofibrosis, which can be successfully alleviated in its early stages. Many studies suggest the administration of methylene blue (MB) as an accessible and effective agent for the prevention of post-operation adhesions. The purpose of this study was to evaluate the efficacy of MB in the prevention of arthrofibrosis.
This study was conducted on 18 New Zealand white female mature rabbits. The anterior cruciate ligament of the left stifle joint of each animal was cut during aseptic surgery. In the next step, the rabbits were divided into three groups based on their treatments. The rabbits in the first, second, and third groups were subjected to the injection of normal saline, 1% MB solution, and 2% MB solution into their synovial space, respectively. The postoperative stifle range of motion was measured every week. After 4 weeks, the animals were euthanized and all joints were dissected for histopathology.
The histopathological evaluation of tissues indicated the presence of fibrotic connective tissue as a sign of fibrosis in all groups. The fibrosis rate, inflammatory rate, tissue disarrangement, fibroblastic cellularity, and granulation tissue formation were at their highest levels in the 1% MB group. The integrity of articular cartilage in the 2% MB group was lower than the other groups. The level of bone degeneration was similar in both MB groups; however, it was more than the control saline group. The range of motion was reduced during the first week, then increased in the second and third weeks, and finally decreased in the fourth week.
The MB was not an effective method regarding the prevention or treatment of arthofibrosis and the subsequent osteoarthritis. In contrast with previous studies, fibrosis was lower in the high dose MB group, compared to the low dose MB group. The alterations in the range of motion were related to the reduced movement caused by the pain and stiffness of the operated joints. The current study can be considered as the first report addressing the adverse effect of MB on synovial components.
I.
骨科手术的主要挑战之一是预防关节纤维化，在其早期阶段可成功缓解。许多研究表明，亚甲蓝（MB）作为一种可及且有效的预防术后粘连的药物。本研究的目的是评估MB预防关节纤维化的疗效。
本研究对18只新西兰白色雌性成年兔进行。在无菌手术过程中切断每只动物左膝关节的前交叉韧带。接下来，根据治疗方法将兔子分为三组。第一组、第二组和第三组的兔子分别向其滑膜腔注射生理盐水、1% MB溶液和2% MB溶液。每周测量术后膝关节活动范围。4周后，对动物实施安乐死，并解剖所有关节进行组织病理学检查。
组织的组织病理学评估表明，所有组均存在纤维化结缔组织，作为纤维化的标志。纤维化率、炎症率、组织紊乱、成纤维细胞密度和肉芽组织形成在1% MB组中处于最高水平。2% MB组关节软骨的完整性低于其他组。两个MB组的骨退变水平相似；然而，高于生理盐水对照组。活动范围在第一周减小，然后在第二周和第三周增加，最后在第四周减小。
MB并非预防或治疗关节纤维化及随后骨关节炎的有效方法。与先前研究相反，高剂量MB组的纤维化程度低于低剂量MB组。活动范围的改变与手术关节疼痛和僵硬导致的活动减少有关。本研究可被视为第一份阐述MB对滑膜成分不良影响的报告。
I级
