老年女性膝關(guān)節(jié)骨關(guān)節(jié)炎患者前交叉韌帶中機(jī)械感受器變化的研究
發(fā)布時(shí)間：2018-07-23 12:32
【摘要】：目的:膝關(guān)節(jié)骨關(guān)節(jié)炎(knee joint osteoarthritis,KOA)是一種引起關(guān)節(jié)疼痛、腫脹,骨質(zhì)增生、軟骨剝脫及滑膜炎癥等一系列改變的中老年慢性、退行性疾病。嚴(yán)重影響中老年人的生活質(zhì)量。因此KOA的早期預(yù)防、延緩病情進(jìn)展及治療成為一個(gè)重大課題。KOA患者不僅存在關(guān)節(jié)疼痛、僵硬、活動不利等問題,而且膝關(guān)節(jié)本體感覺也存在缺陷。膝關(guān)節(jié)的本體感覺主要來源于膝關(guān)節(jié)周圍的肌肉及關(guān)節(jié)內(nèi)各種結(jié)構(gòu)中的機(jī)械感受器。其中以前交叉韌帶(anterior cruciate ligament,ACL)中機(jī)械感受器的研究最多。有研究報(bào)道,年齡也是膝關(guān)節(jié)本體感覺缺失的一個(gè)重要因素,KOA患者的年齡增長與本體感覺缺失是否存在一定的關(guān)系,患者ACL中機(jī)械感受器的形態(tài)與數(shù)量又會發(fā)生怎樣的變化等此類研究比較少見。同時(shí)KOA患者的患病嚴(yán)重程度與本體感覺缺失也存在相關(guān)性,但是兩者之間存在怎樣的量化關(guān)系,患者ACL中機(jī)械感受器的形態(tài)及數(shù)量有何變化不得而知。因此,本課題的研究目的在于:(1)觀察不同年齡段KOA患者ACL中機(jī)械感受器的形態(tài)及數(shù)量變化,尋找年齡與ACL中機(jī)械感受器之間存在的量化關(guān)系,進(jìn)而明確年齡與膝關(guān)節(jié)本體感覺之間的相關(guān)性。(2)觀察不同嚴(yán)重程度KOA患者ACL中機(jī)械感受器的形態(tài)及數(shù)量變化,尋找兩者的量化關(guān)系,進(jìn)而明確KOA嚴(yán)重程度與膝關(guān)節(jié)本體感覺之間存在的相關(guān)性。方法:為排除性別對實(shí)驗(yàn)研究的影響,結(jié)合臨床KOA患者以女性多見等情況,因此,本實(shí)驗(yàn)研究所有入選病例均為女性KOA患者,所有患者臨床癥狀均符合美國風(fēng)濕病學(xué)會(American college of rheumatology,ACR)2001年制定的KOA診斷標(biāo)準(zhǔn)。同時(shí),KOA嚴(yán)重程度以Kellgren-Lawrence膝關(guān)節(jié)骨關(guān)節(jié)炎影像學(xué)為標(biāo)準(zhǔn),選取符合標(biāo)準(zhǔn)的女性III級KOA患者36例,IV級患者12例,所有患者均自愿接受全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty,TKA)。36例III級患者按年齡段分為3組,A組(50-60歲,III)、B組(60-70歲,III)、C組(70歲,III),每組12例;12例IV級患者為D組(70歲,IV)。其中,每組隨機(jī)抽取6例進(jìn)行HE染色,剩余6例進(jìn)行免疫組織化學(xué)研究。所有患者在接受TKA時(shí),截取脛骨止點(diǎn)部位ACL,放入4%的多聚甲醛固定,48-72h后,取出ACL組織,修剪成0.5×0.5×0.5cm的組織塊,常規(guī)震洗、脫水、浸蠟、石蠟包埋,切片(厚度約5um),HE染色及免疫組織化學(xué)染色檢測機(jī)械感受器帕西尼小體(Pacinian corpuscles,PC)、魯菲尼末梢(Ruffini endings,RE)、高爾基腱器官(Golgi tedon organ like ending,GTOE)、游離神經(jīng)末梢(free nerve endings,FNE)的形態(tài)及數(shù)量。每組6例HE染色,每例隨機(jī)不連續(xù)切片6張,每張切片用JEDA801D圖像形態(tài)學(xué)分析軟件,40倍視野下隨機(jī)選取5個(gè)視野,計(jì)數(shù)每例患者各類機(jī)械感受器總數(shù),求得6例患者各類機(jī)械感受器均值,并分別比較年齡因素、KOA嚴(yán)重程度對ACL中各類機(jī)械感受器的影響及它們之間存在的量化關(guān)系;每組6例免疫組織化學(xué)染色,計(jì)數(shù)及分析方法同上,光鏡下觀察4組患者ACL中各類機(jī)械感受器的數(shù)量及形態(tài)變化。統(tǒng)計(jì)學(xué)方法分別分析以年齡段分組的A、B、C 3組患者之間ACL中各類機(jī)械感受器數(shù)量和以KOA嚴(yán)重程度分組的C、D組之間ACL中各類機(jī)械感受器數(shù)量有無統(tǒng)計(jì)學(xué)差異。結(jié)果:HE染色結(jié)果顯示,可檢測到機(jī)械感受器PC。隨著患者年齡的增大,PC感受器外15-30層扁平的神經(jīng)周細(xì)胞組成的蔥皮狀外囊逐漸萎縮,卵圓形或橢圓形的感受器整體縮小變形,最終呈現(xiàn)不規(guī)則外形。統(tǒng)計(jì)學(xué)分析各組機(jī)械感受器PC的均值為A組9.33±1.21,B組7.67±1.03,C組2.67±1.03,D組1.00±0.63,按年齡因素A、B、C 3組之間兩兩比較,均有顯著統(tǒng)計(jì)學(xué)意義(P0.05)。按KOA嚴(yán)重程度C、D 2組之間比較,兩者之間有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。免疫組織化學(xué)結(jié)果顯示,可檢測到機(jī)械感受器RE及FNE。(1)RE結(jié)果顯示:隨著年齡的增長,圓形或卵圓形的感受器,整體外形逐漸縮小,外層薄壁結(jié)締組織囊不規(guī)則改變,萎縮變形。統(tǒng)計(jì)學(xué)分析A組均值14.33±4.08,B組10.33±1.86,C組6.00±2.45,D組2.50±1.23,按年齡因素A、B、C 3組之間兩兩比較,均有顯著統(tǒng)計(jì)學(xué)意義(P0.05),按KOA嚴(yán)重程度C、D 2組之間比較,兩者之間有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。(2)FNE結(jié)果顯示:隨著年齡增長,感受器排列紊亂、松散,長軸方向與韌帶方向由平行轉(zhuǎn)為不規(guī)則排列,整體形態(tài)萎縮變形。統(tǒng)計(jì)學(xué)分析A組均值為22.33±4.08,B組16.50±3.21,C組10.00±3.74,D組5.50±1.05,按年齡因素A、B、C 3組之間兩兩比較,均有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。按KOA嚴(yán)重程度C、D 2組之間比較,兩者之間有顯著統(tǒng)計(jì)學(xué)差異(P0.05)。HE染色及免疫組織化學(xué)染色,均未檢測出機(jī)械感受器GTOE。結(jié)論:(1)隨著年齡的增長,KOA患者ACL中機(jī)械感受器形態(tài)萎縮變形、數(shù)量減少,患者膝關(guān)節(jié)本體感覺日益下降。(2)KOA患者ACL中機(jī)械感受器隨著KOA嚴(yán)重程度的增加,萎縮變形、數(shù)量減少,患者膝關(guān)節(jié)本體感覺下降。
[Abstract]:Objective: knee joint osteoarthritis (KOA) is a chronic, degenerative disease that causes pain, swelling, hyperosteogeny, cartilaginous exfoliation and synovitis. It seriously affects the quality of life of the middle-aged and the elderly. Therefore, the early prevention of KOA, the delay of the disease progress and the treatment become a major one. .KOA patients not only have problems such as joint pain, stiffness, and adverse activities, but also have defects in the proprioception of the knee joint. The proprioception of the knee is mainly derived from the mechanoreceptor in the muscles around the knee joint and in the various structures in the joint. Among them, the anterior cruciate ligament (ACL) is a mechanoreceptor in the anterior cruciate ligament (ACL). It is reported that age is also an important factor in the loss of proprioception in the knee joint. There is a certain relationship between the age of KOA patients and the absence of proprioception, and the changes in the morphology and quantity of the mechanical receptors in the patient's ACL are rare. At the same time, the severity of the patients with KOA is serious. There is also a correlation with the loss of proprioception, but what is the quantitative relationship between the two and the changes in the morphology and quantity of the mechanoreceptor in patients ACL are not known. Therefore, the purpose of this study is to observe the morphological and quantitative changes of the mechanical receptor in the ACL of KOA patients of different ages, and to find the age and ACL in the ACL. The quantitative relationship between the mechanical receptors and the relationship between the age and the proprioception of the knee joint. (2) to observe the morphological and quantitative changes of the mechanoreceptor in ACL of KOA patients with different severity, and to find the quantitative relationship between them, and then to clarify the correlation between the severity of KOA and the proprioception of the knee. The effect of sex on the experimental study was excluded, and the clinical KOA patients were more common in women. Therefore, all the selected cases were female KOA patients. All the patients' clinical symptoms were in accordance with the KOA diagnostic criteria of the American Society of Rheumatology (American College of Rheumatology, ACR) in 2001. Meanwhile, the severity of KOA was Kellg. Ren-Lawrence knee osteoarthritis imaging was the standard, 36 patients with III grade KOA and 12 IV patients were selected. All patients were voluntarily accepted total knee arthroplasty (total knee arthroplasty, TKA).36 cases of III class patients were divided into 3 groups according to age group, A group (50-60 years, III), 60-70 years old, 12 group (70 years old, 12), 12 in each group 12. 12 patients with grade IV were group D (70 years of age, IV). Among them, 6 cases of each group were randomly selected for HE staining, and the remaining 6 cases were studied by immunohistochemistry. All the patients were intercepted at the tibial stop point ACL, put in 4% polyformaldehyde, and removed ACL tissue after 48-72h, and trimmed into 0.5 x 0.5 x 0.5cm tissue blocks, routine shock washing, dehydration, wax soaking, Paraffin embedded, slice (thickness about 5um), HE staining and immunohistochemical staining for the detection of the Pacinian corpuscles (PC), the end of Ruffini (Ruffini endings, RE), the organ of the Golgi tendon (Golgi tedon organ like), the form and quantity of the free nerve endings. 6 cases in each group Color, each case was randomly divided into 6 pieces. Each slice was selected by JEDA801D image morphological analysis software and 5 fields of visual field randomly selected from 40 times. The total number of various mechanical receptors in each patient was counted, and the average of all kinds of mechanical receptors in 6 patients were calculated, and the influence of KOA severity on various kinds of mechanical receptors in ACL were compared. The quantitative relationship between them; 6 cases of immunohistochemical staining, counting and analysis in each group were the same. The number and morphological changes of various kinds of mechanoreceptor in the 4 groups of ACL were observed under light microscope. Statistical methods were used to analyze the number of various kinds of mechanoreceptor in the group of A, B, and C 3 groups of age groups and the degree of KOA severity in ACL. The number of various kinds of mechanoreceptor in the group of C and D group had no statistical difference. Results: the results of HE staining showed that as the age of the patient was increased, the cutaneous outer capsule of the 15-30 layers of flat nerve peripheral cells outside the PC receptor was gradually atrophied, and the oval or oval receptors were reduced to the whole. The mean value of PC was 9.33 + 1.21 in group A, 7.67 + 1.03 in group B, 2.67 + 1.03 in group C and 1 in group D in group A, B, and C 3 group, respectively. There were significant statistical differences between the KOA seriousness C, D 2, and there were significant statistical differences. The results of immunohistochemical staining showed that the results of RE and FNE. (1) RE showed that the overall shape of the circular or oval receptors gradually narrowed with the age, and the outer thin wall connective tissue sac was irregular and atrophic. The mean value of the A group was 14.33 + 4.08, the B group was 10.33 + 1.86, the C group was 6 + 2.45, and the D group was 2.50 + 1. .23, according to age factors A, B, C 3 groups, there are significant statistical significance (P0.05), according to KOA severity C, D 2 groups, there is a significant statistical difference between the two groups (P0.05). (2) FNE results show that as the age increases, the receptors are arranged in disorder, loose, and the long axis direction and ligament direction from parallel to irregular arrangement, the whole Morphological atrophy deformation. The mean value of group A was 22.33 + 4.08, group B was 16.50 + 3.21, C group was 10 + 3.74, D group 5.50 + 1.05. There were significant statistical differences (P0.05) between group D and A, B, C 3 groups. There were significant statistical differences between the two groups (P0.05) staining and immunohistochemistry, according to KOA severity C, D 2 groups No mechanoreceptor GTOE. conclusion was detected. (1) with the increase of age, the morphology of the mechanoreceptor in KOA patients was atrophied, the number of the patients decreased. (2) the mechanoreceptor in KOA patients with ACL increased with the severity of KOA, atrophied and reduced, and the proprioception of the knee was decreased.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.4
本文編號：2139423
[Abstract]:Objective: knee joint osteoarthritis (KOA) is a chronic, degenerative disease that causes pain, swelling, hyperosteogeny, cartilaginous exfoliation and synovitis. It seriously affects the quality of life of the middle-aged and the elderly. Therefore, the early prevention of KOA, the delay of the disease progress and the treatment become a major one. .KOA patients not only have problems such as joint pain, stiffness, and adverse activities, but also have defects in the proprioception of the knee joint. The proprioception of the knee is mainly derived from the mechanoreceptor in the muscles around the knee joint and in the various structures in the joint. Among them, the anterior cruciate ligament (ACL) is a mechanoreceptor in the anterior cruciate ligament (ACL). It is reported that age is also an important factor in the loss of proprioception in the knee joint. There is a certain relationship between the age of KOA patients and the absence of proprioception, and the changes in the morphology and quantity of the mechanical receptors in the patient's ACL are rare. At the same time, the severity of the patients with KOA is serious. There is also a correlation with the loss of proprioception, but what is the quantitative relationship between the two and the changes in the morphology and quantity of the mechanoreceptor in patients ACL are not known. Therefore, the purpose of this study is to observe the morphological and quantitative changes of the mechanical receptor in the ACL of KOA patients of different ages, and to find the age and ACL in the ACL. The quantitative relationship between the mechanical receptors and the relationship between the age and the proprioception of the knee joint. (2) to observe the morphological and quantitative changes of the mechanoreceptor in ACL of KOA patients with different severity, and to find the quantitative relationship between them, and then to clarify the correlation between the severity of KOA and the proprioception of the knee. The effect of sex on the experimental study was excluded, and the clinical KOA patients were more common in women. Therefore, all the selected cases were female KOA patients. All the patients' clinical symptoms were in accordance with the KOA diagnostic criteria of the American Society of Rheumatology (American College of Rheumatology, ACR) in 2001. Meanwhile, the severity of KOA was Kellg. Ren-Lawrence knee osteoarthritis imaging was the standard, 36 patients with III grade KOA and 12 IV patients were selected. All patients were voluntarily accepted total knee arthroplasty (total knee arthroplasty, TKA).36 cases of III class patients were divided into 3 groups according to age group, A group (50-60 years, III), 60-70 years old, 12 group (70 years old, 12), 12 in each group 12. 12 patients with grade IV were group D (70 years of age, IV). Among them, 6 cases of each group were randomly selected for HE staining, and the remaining 6 cases were studied by immunohistochemistry. All the patients were intercepted at the tibial stop point ACL, put in 4% polyformaldehyde, and removed ACL tissue after 48-72h, and trimmed into 0.5 x 0.5 x 0.5cm tissue blocks, routine shock washing, dehydration, wax soaking, Paraffin embedded, slice (thickness about 5um), HE staining and immunohistochemical staining for the detection of the Pacinian corpuscles (PC), the end of Ruffini (Ruffini endings, RE), the organ of the Golgi tendon (Golgi tedon organ like), the form and quantity of the free nerve endings. 6 cases in each group Color, each case was randomly divided into 6 pieces. Each slice was selected by JEDA801D image morphological analysis software and 5 fields of visual field randomly selected from 40 times. The total number of various mechanical receptors in each patient was counted, and the average of all kinds of mechanical receptors in 6 patients were calculated, and the influence of KOA severity on various kinds of mechanical receptors in ACL were compared. The quantitative relationship between them; 6 cases of immunohistochemical staining, counting and analysis in each group were the same. The number and morphological changes of various kinds of mechanoreceptor in the 4 groups of ACL were observed under light microscope. Statistical methods were used to analyze the number of various kinds of mechanoreceptor in the group of A, B, and C 3 groups of age groups and the degree of KOA severity in ACL. The number of various kinds of mechanoreceptor in the group of C and D group had no statistical difference. Results: the results of HE staining showed that as the age of the patient was increased, the cutaneous outer capsule of the 15-30 layers of flat nerve peripheral cells outside the PC receptor was gradually atrophied, and the oval or oval receptors were reduced to the whole. The mean value of PC was 9.33 + 1.21 in group A, 7.67 + 1.03 in group B, 2.67 + 1.03 in group C and 1 in group D in group A, B, and C 3 group, respectively. There were significant statistical differences between the KOA seriousness C, D 2, and there were significant statistical differences. The results of immunohistochemical staining showed that the results of RE and FNE. (1) RE showed that the overall shape of the circular or oval receptors gradually narrowed with the age, and the outer thin wall connective tissue sac was irregular and atrophic. The mean value of the A group was 14.33 + 4.08, the B group was 10.33 + 1.86, the C group was 6 + 2.45, and the D group was 2.50 + 1. .23, according to age factors A, B, C 3 groups, there are significant statistical significance (P0.05), according to KOA severity C, D 2 groups, there is a significant statistical difference between the two groups (P0.05). (2) FNE results show that as the age increases, the receptors are arranged in disorder, loose, and the long axis direction and ligament direction from parallel to irregular arrangement, the whole Morphological atrophy deformation. The mean value of group A was 22.33 + 4.08, group B was 16.50 + 3.21, C group was 10 + 3.74, D group 5.50 + 1.05. There were significant statistical differences (P0.05) between group D and A, B, C 3 groups. There were significant statistical differences between the two groups (P0.05) staining and immunohistochemistry, according to KOA severity C, D 2 groups No mechanoreceptor GTOE. conclusion was detected. (1) with the increase of age, the morphology of the mechanoreceptor in KOA patients was atrophied, the number of the patients decreased. (2) the mechanoreceptor in KOA patients with ACL increased with the severity of KOA, atrophied and reduced, and the proprioception of the knee was decreased.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.4
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 張秋霞;花秀琴;施永健;;踝關(guān)節(jié)本體感覺的測量方法研究與應(yīng)用[J];中國組織工程研究與臨床康復(fù);2011年35期
2 俞曉杰;吳毅;胡永善;白玉龍;范文可;;膝關(guān)節(jié)骨關(guān)節(jié)炎患者等長、等速向心和等速離心測試的比較觀察[J];中華物理醫(yī)學(xué)與康復(fù)雜志;2006年07期
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