本文選題：微創(chuàng)牽張技術(shù) + 骨關(guān)節(jié)炎��； 參考：《福建中醫(yī)藥大學》2012年碩士論文

【摘要】：目的： 第一部分：通過在體實驗,建立山羊膝骨關(guān)節(jié)炎模型,觀察微創(chuàng)牽張技術(shù)對滑膜及關(guān)節(jié)軟骨的組織形態(tài)及關(guān)節(jié)液中MMP-1、CTX-Ⅱ濃度等指標的影響,探討微創(chuàng)牽張技術(shù)有效治療骨關(guān)節(jié)炎的機制,為微創(chuàng)牽張技術(shù)臨床治療骨關(guān)節(jié)炎提供理論依據(jù)。 第二部分：通過臨床初步觀察,應用微創(chuàng)牽張技術(shù)配合骨關(guān)節(jié)炎Ⅰ號方治療馬蹄內(nèi)翻畸形繼發(fā)踝關(guān)節(jié)的骨關(guān)節(jié)炎,通過觀察患者治療前后Baird-Jackson評分,VSA疼痛評分及AOFAS評分情況,對微創(chuàng)牽張技術(shù)結(jié)合中藥治療骨關(guān)節(jié)炎的效果進行客觀評價,為臨床進一步應用,提供依據(jù)。 方法： 第一部分： 1、膝骨關(guān)節(jié)炎動物病理模型建立及動物分組：將32只山羊,隨機分成造模組25只與假手術(shù)組7只,將造模組采用膝關(guān)節(jié)腔注射木瓜蛋白酶的方法建立實驗動物的膝骨關(guān)節(jié)炎模型。行造模術(shù)6周后,造模組和假手術(shù)組各隨機抽取1只山羊處死,取山羊關(guān)節(jié)軟骨和滑膜進行組織形態(tài)學觀察及關(guān)節(jié)液炎癥因子的改變以確定造模是否成功,模型成功后,將造模組24只山羊隨機分模型對照組、F1牽張力組、F2牽張力組、F3牽張力組,每組各6只。F1牽張力組、F2牽張力組、F3牽張力組分別給予F1、F2、F3的牽張力,安裝外固定支架并鎖定鉸鏈連桿。假手術(shù)組、模型對照組均不予配戴外固定支具架。山羊外固定支架佩戴完畢后,每個動物分住在單獨籠內(nèi),自由活動,肌注水劑青霉素3d(40萬單位每天),由專人管理 2、取材、標本預處理及指標檢測：30只山羊在相同條件下正常飼養(yǎng),于安裝支架8周后,觀察實驗動物的一般情況后處死,打開左膝關(guān)節(jié)后,肉眼觀察關(guān)節(jié)滑膜組織、軟骨一般表現(xiàn)。剝?nèi)∽笙リP(guān)節(jié)脛骨平臺、股骨髁部及髕股關(guān)節(jié)處軟骨,切除滑膜,固定于4%多聚甲醛固定,EDTA脫鈣,制作HE切片。 3、統(tǒng)計處理：實驗數(shù)據(jù)以x±S表示,用SPSS16.0軟件進行分析。 第二部分： 1、病例的選擇：選擇于福建省人民醫(yī)院骨傷科住院治療,馬蹄內(nèi)翻足畸形繼發(fā)踝骨關(guān)節(jié)炎患者。 2、觀察方法：術(shù)前對患者踝關(guān)節(jié)VSA疼痛評分,Baird-Jackson評分,AOFAS評分等,予行微創(chuàng)牽張技術(shù)矯正踝關(guān)節(jié)畸形,減輕踝關(guān)節(jié)軟骨受力不均。術(shù)后第1天口服“骨關(guān)節(jié)炎Ⅰ號方”,分別于術(shù)后2周,1月,2月,4月對患者進行隨訪,進行包括VSA疼痛評分,Baird-Jackson評分,AOFAS評分等。 3、統(tǒng)計處理：實驗數(shù)據(jù)以x±S表示,用SPSS16.0軟件進行分析。 結(jié)果： 第一部分 1、手術(shù)8周后,假手術(shù)組行走步態(tài)均正常,模型對照組山羊跛行嚴重,膝關(guān)節(jié)屈曲、伸直活動受限,外支架固定3組行走跛行及膝關(guān)節(jié)屈曲、伸直活動受限與模型對照組相比有所的改善,其中,F1牽張力組改善較為明顯。 2、手術(shù)8周后,模型對照組膝關(guān)節(jié)滑膜炎性變及關(guān)節(jié)軟骨退變明顯,5組組織形態(tài)觀察外支架固定3組膝關(guān)節(jié)滑膜炎性變及關(guān)節(jié)軟骨退變明顯輕于模型組,其中F1牽張力組滑膜炎性變及關(guān)節(jié)軟骨退變程度最輕。 3、手術(shù)8周后,模型對照組和外支架固定3組的關(guān)節(jié)軟骨Mankin's評分均有不同程度的升高,與假手術(shù)組對比具有顯著性差異(P0.01),其中F1組升高幅度較低。 4、手術(shù)8周后,與模型對照組相比外支架固定3組的關(guān)節(jié)液MMP-1、CTX-Ⅱ的含量均有所降低,F1牽張力組與模型組、F2牽張力組、F3牽張力組相比關(guān)節(jié)液MMP-1、CTX-Ⅱ的含量降低且有顯著性差異(P0.05)。 第二部分 患者使用微創(chuàng)牽張技術(shù)結(jié)合口服骨關(guān)節(jié)炎Ⅰ號方治療后,較治療前VSA疼痛評分降低,Baird-Jackson評分升高,AOFAS評分升高。 結(jié)論： 1、微創(chuàng)牽張技術(shù)能夠減輕了關(guān)節(jié)軟骨的破壞,延緩山羊膝骨關(guān)節(jié)炎的發(fā)展進程。 2、微創(chuàng)牽張技術(shù)配合骨關(guān)節(jié)炎Ⅰ號方能有效緩解患者馬蹄內(nèi)翻足繼發(fā)踝骨關(guān)節(jié)炎踩關(guān)節(jié)疼痛,改善踝關(guān)節(jié)功能。
[Abstract]:Objective:
The first part is to establish the model of goats knee osteoarthritis, and observe the effects of minimally invasive stretch technique on the tissue morphology of synovial and articular cartilage and the concentration of MMP-1 and CTX- II in the joint fluid, and explore the mechanism of minimally invasive stretch technique in the treatment of osteoarthritis, and provide a theory for the clinical treatment of osteoarthritis with minimally invasive stretch technique. Basis.
The second part: through the clinical preliminary observation, the minimally invasive traction technique combined with osteoarthritis No. I was used to treat the osteoarthritis of the ankle joint secondary to the malformation of horseshoe varus. By observing the Baird-Jackson score, the VSA pain score and the AOFAS score of the patients before and after the treatment, the effect of the minimally invasive stretch technique combined with the traditional Chinese medicine in the treatment of osteoarthritis was carried out. Objective evaluation provides a basis for further clinical application.
Method:
Part one:
1, the animal pathological models of knee osteoarthritis were established and the animals were divided into groups: 32 goats were randomly divided into 25 group and 7 sham operation group. The model of knee osteoarthritis was established by injection of papain in the knee joint cavity. After 6 weeks, 1 goats were randomly selected and killed in the model group and the sham operation group. Goat articular cartilage and synovial membrane were observed and the inflammatory factors were changed to determine whether the model was successful. After the success of the model, 24 goats were randomly divided into model control group, F1 stretch group, F2 stretch group, F3 stretch group, each group of 6.F1 stretch groups, F2 stretch group, and F3 stretch group to F1 respectively. The tension of F2, F3, the external fixator and the hinge connecting rod were installed. The sham operation group, the model control group did not wear the external fixator. After the goat external fixator was worn, each animal was divided into separate cage, free activity, and the water injection agent penicillin 3D (400 thousand units per day), managed by the special person.
2, sample preparation, specimen pretreatment and index detection: 30 goats were normally kept under the same condition. After 8 weeks of installation of the scaffold, we observed the general conditions of the experimental animals and opened the joint after opening the left knee joint. The articular synovial tissue of the joint was observed by the naked eye and the cartilage was general. The removal of the tibial plateau, the condyle of the femur and the cartilage of the patellar joint were removed. The membrane was fixed on 4% paraformaldehyde fixed, EDTA decalcified, and HE slices were made.
3, statistical processing: the experimental data are expressed in terms of X + S and analyzed by SPSS16.0 software.
The second part:
1, the choice of cases: patients in the orthopedics department of Fujian Provincial People's Hospital, ankle osteoarthritis secondary to talipes varus deformity.
2, observation method: preoperative VSA pain score of ankle joint, Baird-Jackson score, AOFAS score, and so on, the ankle joint deformity was corrected by minimally invasive stretch technique and the unequal stress of the ankle joint was reduced. The oral osteoarthritis No. I was taken orally at the first day after the operation, 2 weeks after the operation, in January, February, and April, the patients were followed up, including VSA pain evaluation. Score, Baird-Jackson score, AOFAS score, etc.
3, statistical processing: the experimental data are expressed in terms of X + S and analyzed by SPSS16.0 software.
Result:
Part one
1, after 8 weeks of operation, the walking gait of the sham operation group were all normal. The model control group had serious claudication, the knee flexion, the extension activity was limited, the external stent was fixed in 3 groups of walking limp and knee flexion, and the extension activity was limited compared with the model control group, and the improvement of F1 traction group was more obvious.
2, after 8 weeks of operation, the knee joint synovitis and articular cartilage degeneration were obvious in the model control group. The 3 groups of knee joint synovitis and articular cartilage degeneration in the 5 groups were obviously lighter than the model group, in which the synovitis and articular cartilage degeneration were the lightest in the F1 traction group.
3, after 8 weeks of operation, the Mankin's scores of articular cartilage in the 3 groups of the model control group and the external stents were increased in different degrees, and there was a significant difference (P0.01) compared with the sham operation group (P0.01), and the increase in the F1 group was lower.
4, after 8 weeks of operation, the content of MMP-1 and CTX- II in the 3 groups of the 3 groups compared with the model control group decreased, and the content of MMP-1 and CTX- II in the F1 traction group and the model group, the F3 tension group and the F3 stretch group decreased and had a significant difference (P0.05).
The second part
The pain score of VSA was lower than that before treatment, and the score of Baird-Jackson increased and the AOFAS score increased.
Conclusion:
1, minimally invasive distraction technique can reduce the damage of articular cartilage and delay the development of goat knee osteoarthritis.
2, minimally invasive distraction technique combined with osteoarthritis No. 1 can effectively relieve foot pain and improve ankle function in patients with talipes talipes secondary ankle osteoarthritis.
【學位授予單位】：福建中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R684;R-332

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