Clinic of Orthopaedic and Traumatology, Çorlu State Hospital, Tekirdağ, Turkey.
Department of Orthopaedic and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey.
Acta Orthop Traumatol Turc. 2021 Sep;55(5):385-390. doi: 10.5152/j.aott.2021.20364.
The aim of this study was to investigate whether collagenase clostridium histolyticum (CCH) reduces intra-articular fibrotic adhesion formation in a rat model of arthrofibrosis.
A total of 24 male Wistar rats (7 months old, weighing 220 -275 g) were randomly and equally assigned to one of two groups: the collagenase group and the control group (n = 12 each). In each group, a partial capsulotomy, and synovectomy were performed in knee. After a partial capsulotomy and synovectomy were performed in each group, the collagenase group received intra-articular CCH of 0.008 mg in 0.1 mL saline solution while the control group received the equal volume of intra-articular saline solution alone. After 6 weeks of surgery, the rats were sacrificed by decapitation, and the following outcome measures were collected. Knee range of motion (ROM) was measured using with a goniometer under 20 g force. Adhesion formation was rated using the macroscopic visual scoring system after the knee joint was exposed through a lateral parapatellar approach. Histological evaluation was performed on samples including connective tissue and fibrotic adhesions, and fibroblast cell numbers were measured performed per square. Levels of interleukin 1 (IL-1) and fibroblast growth factor (FGF) were assayed by ELISA from the intra-articular fluid.
The macroscopic visual scoring system was significantly lower in the collagenasegroup (median = 1, range = 0-2) than in the control group (median = 2, range = 1-3)( < 0.001).ROMwas significantly higher in the collagenase group (102° ± 12.1°) than in the control group (77° ±8.94°) (P <0.001). The number of fibroblasts obtained from the scar tissue were considerably lower in the collagenase group (mean = 16.5 ± 2.74) compared tothe control group (mean = 30.1± 4.89) (P < 0.001). Levels of IL-1 andFGF were significantly lower in the collagenase group (mean = 18.6 ng/l ± 4.39,mean = 36.3 ng/l ± 2.03; respectively) compared to the control group (mean = 31.7ng/l ± 3.75, mean = 38.7 ng/l ± 2.19; respectively) (P < 0.001).
Evidence from this study has revealed that CCH injection can inhibit the development ofarthrofibrosis, decreasing the precursor inflammatory cytokines (IL-1 and FGF-1) and histologic fibrosis in a rat knee arthrofibrosis model.
Level IV, Therapeutic study.
本研究旨在探讨胶原酶组织溶菌素（CCH）是否能减少关节纤维化大鼠模型中的关节内纤维粘连形成。
将 24 只雄性 Wistar 大鼠（7 个月大，体重 220-275g）随机平均分为两组：胶原酶组和对照组（每组 12 只）。在每组中，进行膝关节部分囊切开术和滑膜切除术。在每组进行部分囊切开术和滑膜切除术后，胶原酶组接受 0.008mg 关节内 CCH 溶于 0.1ml 生理盐水，而对照组接受等量的关节内生理盐水。术后 6 周，通过断头法处死大鼠，收集以下结果测量值。在 20g 力的作用下，使用量角器测量膝关节活动度（ROM）。通过经外侧髌旁入路暴露膝关节后，使用宏观视觉评分系统对粘连形成进行评分。对包括结缔组织和纤维粘连在内的样本进行组织学评估，并测量每平方的成纤维细胞数量。通过酶联免疫吸附试验（ELISA）从关节液中测定白细胞介素 1（IL-1）和成纤维细胞生长因子（FGF）的水平。
胶原酶组的宏观视觉评分系统明显低于对照组（中位数=1，范围=0-2）（<0.001）。胶原酶组的 ROM 明显高于对照组（102°±12.1°）（P<0.001）。胶原酶组从疤痕组织中获得的成纤维细胞数量明显低于对照组（平均值=16.5±2.74）（P<0.001）。胶原酶组的白细胞介素 1 和 FGF 水平明显低于对照组（平均值=18.6ng/l±4.39，平均值=36.3ng/l±2.03；分别）（P<0.001）。
本研究结果表明，CCH 注射可抑制关节纤维化的发展，减少大鼠膝关节关节纤维化模型中前炎性细胞因子（IL-1 和 FGF-1）和组织学纤维化。
IV 级，治疗研究。
