本文選題：關節(jié)鏡 + 乆窩囊腫��； 參考：《大連醫(yī)科大學》2015年碩士論文

【摘要】：乆窩囊腫是指乆窩深部滑囊腫大或者向后突出的總稱,是關節(jié)骨科常見的一種臨床病理癥候群。近些年來,隨著科學技術(shù)的不斷創(chuàng)新和發(fā)展,治療乆窩囊腫的手術(shù)方式發(fā)生了日新月異的變化。在當下對于此病的臨床治療中,關節(jié)鏡漸漸取代了傳統(tǒng)的手術(shù)方式。本論文中將選取一定數(shù)量的病例來評價關節(jié)鏡技術(shù)對于乆窩囊腫的臨床治療效果。目的:評價關節(jié)鏡對于乆窩囊腫的臨床效用。方法:采集2013-2014年大連醫(yī)科大學附屬第一醫(yī)院關節(jié)外科30名經(jīng)過MRI檢查并確診為乆窩囊腫的患者的臨床病例資料。其中,男性患者20人,女性患者10人。年齡為25到65歲。平均52歲。所選取的所有病例只有一側(cè)患有疾病,對側(cè)未有累及。其中,左膝出現(xiàn)病理變化者17例,右膝出現(xiàn)病理變化者13例。乆窩處的局部隆起是手術(shù)前的主要癥狀。疾病所累及的關節(jié)處有輕重不一的疼痛感。通過B超技術(shù)的使用,手術(shù)前確診囊腫均與關節(jié)腔相連通。術(shù)前根據(jù)Rauschning和Lindgren分級法:Ⅰ級8例,Ⅱ10例,Ⅲ12例。對比術(shù)前術(shù)后Rauschning和Lindgren的評分,測評手術(shù)后患者的疾病改善情況。結(jié)果:所選取的所有患者的關節(jié)內(nèi)疾病都已經(jīng)被確診。其中,半月板撕裂的患者占有17人,骨性關節(jié)炎者9人,前交叉韌帶撕裂的患者則有4人。經(jīng)過術(shù)后一段時間的觀察,出血、切口裂開、乆窩內(nèi)部結(jié)構(gòu)損傷的現(xiàn)象沒有出現(xiàn)。手術(shù)后3天之內(nèi)出院。隨訪時間8至24個月。平均12個月。絕大部分患者術(shù)后恢復情況良好。Rauschning和Lindgren評分的結(jié)果:治療后Ⅱ級患者2例,再次復發(fā)者一例。結(jié)論:關節(jié)鏡下對于乆窩囊腫的治療操作簡單,對機體的損傷小,易于患者的恢復。關節(jié)軟骨為透明軟骨,具有彈性,能夠減低外力的沖擊,維持局部組織的穩(wěn)定性。創(chuàng)傷、炎癥等因素可以使關節(jié)軟骨損傷,造成軟骨細胞細胞外基質(zhì)的合成和分解失去平衡,進而為骨性關節(jié)炎的發(fā)生提供基礎。軟骨組織中不存在血管、神經(jīng)和淋巴,因此其再生功能非常局限。關節(jié)軟骨主要由軟骨細胞和細胞外基質(zhì)組成.其中,Ⅱ型膠原、蛋白多糖、無機鹽和水構(gòu)成了胞外基質(zhì)的有形成分。作為軟骨細胞胞外基質(zhì)的特異性膠原,Ⅱ型膠原占胞外基質(zhì)膠原總量的90%以上,隨著軟骨細胞代數(shù)、密度和培養(yǎng)時間的增加,Ⅱ型膠原的表達量逐漸減少,Ⅰ型膠原的表達量逐漸增加。同時,軟骨細胞的外形在此過程中發(fā)生了變化,由圓形或多角形逐漸變?yōu)槌衫w維細胞樣的長梭形。生理條件下,關節(jié)軟骨浸泡在關節(jié)滑液中,當關節(jié)運動時,其產(chǎn)生的流體剪切力對于維持軟骨細胞正常功能的維持具有重要作用。由于骨性關節(jié)炎是力學因素和生物化學因素等多種因素共同作用的結(jié)果。因此,研究模擬流體剪切力和其他復合因素對于軟骨細胞表型的維持作用的影響顯得格外重要。目的:流體剪切力對于軟骨表型的變化至關重要。本研究以微流控芯片技術(shù)為基礎,建立了一個能夠同時產(chǎn)生四個大小剪切力芯片的平臺來研究低流速流體剪切力對于軟骨細胞表型的影響。同時,還加入了分解性細胞因子和P38MAPK抑制劑SB203580,來考察多種不同因素的共同作用下軟骨細胞表型的維持和變化的情況。方法:1.提取和培養(yǎng)大鼠的原代軟骨細胞。2.用光刻膠技術(shù)制作芯片的模板,以PDMS為原材料制作成芯片。將PDMS芯片和玻璃片用等離子照射后進行不可逆封接。3.通過CFD模擬和電路類比的方法對芯片結(jié)構(gòu)進行數(shù)值模擬。4.應用免疫熒光染色的方法對經(jīng)過剪切力作用后的軟骨細胞進行Ⅰ型膠原,Ⅱ型膠原和Glut-1染色。結(jié)果:1.Ⅱ型膠原隨著流體剪切力的增強表達量逐漸增加,軟骨細胞的去分化作用隨著剪切力的增加而作用明顯。2.P38MAPK抑制劑能夠有效的阻斷機械力信號通路,使軟骨細胞的表型持續(xù)表達。3.分解性細胞因子TNF-α與流體剪切力的共同作用下,軟骨細胞的特征性表型隨著剪切力的增加而破壞加重。同時,去分化效果也顯著增加。4.低流速流體剪切力對于葡萄糖轉(zhuǎn)運蛋白-1(Glut-1)的表達起促進作用。結(jié)論:低流速流體剪切力對于軟骨細胞表型的影響是一把雙刃劍,一方面,隨著剪切力的增大流體剪切力能夠?qū)浌羌毎奶禺愋员硇推鸬骄S持作用。另一方面,流體剪切力的增大也加速了軟骨細胞的去分化作用。P38MAPK抑制劑SB203580能夠有效抑制機械力信號通路,阻斷剪切力對于軟骨細胞表型維持和去分化的作用。炎性因子TNF-α對于軟骨細胞的表型維持起到相反作用。
[Abstract]:The cyst of the fossa is the general name of the deep or backward protrusion of the fossa fossa. It is a common clinical pathological syndrome in the joint Department of orthopedics. In recent years, with the continuous innovation and development of science and technology, the surgical methods for the treatment of the cyst of the fossa have changed rapidly. A certain number of cases were selected to evaluate the clinical efficacy of arthroscopy in the treatment of cyst of the fossa cyst. Objective: To evaluate the clinical efficacy of arthroscopy for the cyst of fossa fossa. Methods: 2013-2014 years of 2013-2014 years of joint surgery in the first hospital of Dalian Medical University were examined and confirmed as the diagnosis. There were 20 male patients and 10 female patients. The average age was 25 to 65 years old. The average age was 52 years. All cases were only one side of the disease and the opposite side was not involved. Among them, there were 17 pathological changes in the left knee and 13 cases with pathological changes in the right knee. The local bulge at the fossa was before the operation. Main symptoms. There was a different sense of pain in the joints involved in the disease. Through the use of B-ultrasound technique, all the diagnosed cysts were connected with the articular cavity before operation. Before operation, 8 cases, 10 cases, and 12 cases were classified according to the Rauschning and Lindgren classification method. The scores of Rauschning and Lindgren were compared before and after operation, and the improvement of the disease after operation was evaluated. Results: all of the patients' intra-articular diseases were confirmed. Among them, 17 patients with meniscus tear, 9 patients with osteoarthritis and 4 patients with anterior cruciate ligament tears were observed after a period of time, bleeding, incision split, and internal structural injury in the fossa. 3 days after the operation. The follow-up time was 8 to 24 months. An average of 12 months. The recovery of most patients was good.Rauschning and Lindgren score: 2 cases of second class patients after treatment and one recurrence. Conclusion: the treatment of the cyst under arthroscopy is simple, the injury to the body is small, the recovery of the patient is easy. The cartilage, with elasticity, can reduce the impact of external force, maintain the stability of the local tissue. Trauma, inflammation and other factors can cause articular cartilage damage, cause the synthesis and decomposition of the extracellular matrix of cartilage cells to lose balance, and thus provide the basis for the occurrence of osteoarthritis. The regeneration function is very limited. Articular cartilage consists mainly of chondrocytes and extracellular matrix. Among them, type II collagen, proteoglycan, inorganic salt and water constitute the tangible components of the extracellular matrix. As the specific collagen of the extracellular matrix of cartilage cells, type II collagen accounts for more than 90% of the total extracellular matrix of the extracellular matrix, with the cartilage cell algebra and density. The expression of type II collagen decreased gradually and the expression of type I collagen increased gradually. At the same time, the shape of cartilage cells changed from round or polygonal to fibroblast like long spindle. Under physiological conditions, the articular cartilage was soaked in synovial fluid, when joint movement, The shear force produced by the fluid plays an important role in maintaining the normal function of cartilage cells. Osteoarthritis is the result of a variety of factors such as mechanical and biochemical factors. Therefore, the study of the influence of simulated fluid shear force and other complex factors on the maintenance of chondrocyte phenotype appears to be a lattice. Objective: Objective: fluid shear force is very important for the change of cartilage phenotype. Based on microfluidic chip technology, a platform which can produce four shear force chips at the same time was established to study the effect of low velocity fluid shear force on chondrocyte phenotype. Meanwhile, the decomposable cytokine and P38MA were added. PK inhibitor SB203580, to investigate the maintenance and change of chondrocyte phenotype under the common action of a variety of different factors. Methods: 1. extract and cultivate the primary chondrocytes of the rat.2. using photoresist technology to make the chip template, and make the chip with PDMS as the raw material. The PDMS chip and the glass slice are irradiated by plasma. Reverse sealing and connecting.3. through CFD simulation and circuit analogy method to simulate the structure of chip.4. application immunofluorescence staining method for collagen type I, type II collagen and Glut-1 staining after shear force action. Results: 1. type II collagen increased gradually with the increase of fluid shear force, cartilage cell Dedifferentiation effect with the increase of shear force obviously the.2.P38MAPK inhibitor can effectively block the mechanical signal pathway, which makes the phenotype of chondrocytes continuously express the.3. decomposed cytokine TNF- alpha and the fluid shear force, and the characteristic phenotype of chondrocytes is aggravated with the increase of shear force. The effect of.4. low velocity fluid shear force on the expression of glucose transporter -1 (Glut-1) was also promoted. Conclusion: the effect of low velocity fluid shear force on chondrocyte phenotype is a double-edged sword. On the one hand, with the increase of shear force, the fluid shear force can maintain the specific phenotype of cartilage cells. On the other hand, the increase of fluid shear force also accelerates the dedifferentiation of cartilage cells..P38MAPK inhibitor SB203580 can effectively inhibit the mechanical signaling pathway and block the effect of shear force on the phenotype maintenance and dedifferentiation of chondrocytes. Inflammatory factor TNF- alpha plays the opposite role in the maintenance of chondrocyte phenotype.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.4

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