兔膝关节剥脱性骨软骨炎微骨折及关节清理术后修复的组织学及MR定量对比分析
토슬관절박탈성골연골염미골절급관절청리술후수복적조직학급MR정량대비분석
Histological and MR quantitative analysis of repaired tissue following microfracture treatment for knee joint osteochondritis dissecans in rabbit models
  • 万方数据
    中华放射学杂志 중화방사학잡지
    Chinese Journal of Radiology
    2013年 3期 255-260 ,共6页

    陶虹月%王展%李宏%陈爽%冯晓源%华英汇%陈忠清

    도홍월%왕전%리굉%진상%풍효원%화영회%진충청

    骨软骨炎,剥脱性%磁共振成像%组织学 骨軟骨炎,剝脫性%磁共振成像%組織學
    골연골염,박탈성%자공진성상%조직학
    Osteochondritis dissecans%Magnetic resonance imaging%Histology
    目的 与关节清理术对比,研究微骨折治疗关节剥脱性骨关节炎(OCD)的有效性,探讨MR检查结果对应的组织学基础,指导临床更好地应用MR检查结果进行OCD术后的随访.方法 新西兰大耳兔27只,按照随机区组法分成3组,各9只,分别于3、5、7周取材,选单侧膝关节制作OCD模型,6只行微骨折术(微骨折组),3只关节清理作为对照(关节清理组).于术后3、5、7周分别行MR扫描,成像序列主要为3D双回波稳态序列(3D-DESS)、T2-mapping,计算修复厚度指数和T2指数、绘制T2-mapping；截取手术部位制作组织学切片,包括HE染色、Masson染色,采用O’driscoll改良法进行组织学半定量评分.单因素方差分析比较不同时间点修复的组织学及MR表现,独立样本t检验比较微骨折组和关节清理组在各相同时间点的组织学及MR表现.结果 微骨折组和关节清理组术后修复厚度指数逐渐增加(F值分别为33.940、28.841,P值＜0.05),T2指数逐渐减低(F值分别为80.183、206.206,P值＜0.05),O'driscoll评分逐渐增高(F值分别为29.867、17.167,P值＜0.05).各个时间点,微骨折组厚度指数均大于关节清理组(3周时分别为0.743±0.048和0.624±0.013,t =4.077;5周时分别为0.813±0.031和0.734±0.015,t=4.107;7周时分别为0.972±0.064和0.777±0.039,t =4.782;P值均＜0.05),7周时,微骨折组基本完全填充,关节清理组未完全填充.微骨折组3周时的T2指数低于关节清理组(分别为1.338 ±0.043和1.510 ±0.009,t=6.583,P＜0.05),5周和7周时的T2指数大于关节清理组(5周时分别为1.284±0.097和1.116±0.068,t=2.663；7周时分别为0.916±0.036和0.843±0.016,t=3.283；P值均＜0.05).微骨折组各个时间点O’driscoll评分均高于关节清理组(3周时分别为7.167±0.753和4.667±0.577,t =5.000；5周时分别为9.833±1.169和7.667±0.577,=2.960;7周时分别为11.167 ±0.753和8.333±1.155,t=4.520;P值均＜0.05).微骨折组以纤维软骨修复,逐渐成熟,生成的胶原纤维增多、分布均匀；关节清理组最终以纤维瘢痕修复.结论 OCD微骨折术后修复厚度和组织构成均优于关节清理；MR3D-DESS、T2-mapping能分别反映OCD术后修复组织的厚度、组织构成,能有效评估修复情况,对临床OCD术后的随访具有重要价值.
    목적 여관절청리술대비,연구미골절치료관절박탈성골관절염(OCD)적유효성,탐토MR검사결과대응적조직학기출,지도림상경호지응용MR검사결과진행OCD술후적수방.방법 신서란대이토27지,안조수궤구조법분성3조,각9지,분별우3、5、7주취재,선단측슬관절제작OCD모형,6지행미골절술(미골절조),3지관절청리작위대조(관절청리조).우술후3、5、7주분별행MR소묘,성상서렬주요위3D쌍회파은태서렬(3D-DESS)、T2-mapping,계산수복후도지수화T2지수、회제T2-mapping；절취수술부위제작조직학절편,포괄HE염색、Masson염색,채용O’driscoll개량법진행조직학반정량평분.단인소방차분석비교불동시간점수복적조직학급MR표현,독립양본t검험비교미골절조화관절청리조재각상동시간점적조직학급MR표현.결과 미골절조화관절청리조술후수복후도지수축점증가(F치분별위33.940、28.841,P치＜0.05),T2지수축점감저(F치분별위80.183、206.206,P치＜0.05),O'driscoll평분축점증고(F치분별위29.867、17.167,P치＜0.05).각개시간점,미골절조후도지수균대우관절청리조(3주시분별위0.743±0.048화0.624±0.013,t =4.077;5주시분별위0.813±0.031화0.734±0.015,t=4.107;7주시분별위0.972±0.064화0.777±0.039,t =4.782;P치균＜0.05),7주시,미골절조기본완전전충,관절청리조미완전전충.미골절조3주시적T2지수저우관절청리조(분별위1.338 ±0.043화1.510 ±0.009,t=6.583,P＜0.05),5주화7주시적T2지수대우관절청리조(5주시분별위1.284±0.097화1.116±0.068,t=2.663；7주시분별위0.916±0.036화0.843±0.016,t=3.283；P치균＜0.05).미골절조각개시간점O’driscoll평분균고우관절청리조(3주시분별위7.167±0.753화4.667±0.577,t =5.000；5주시분별위9.833±1.169화7.667±0.577,=2.960;7주시분별위11.167 ±0.753화8.333±1.155,t=4.520;P치균＜0.05).미골절조이섬유연골수복,축점성숙,생성적효원섬유증다、분포균균；관절청리조최종이섬유반흔수복.결론 OCD미골절술후수복후도화조직구성균우우관절청리；MR3D-DESS、T2-mapping능분별반영OCD술후수복조직적후도、조직구성,능유효평고수복정황,대림상OCD술후적수방구유중요개치.
    Objective To quantitatively analyze the histological and MR images of repaired tissue (RT) following microfracture for knee joint osteochondritis dissecans (OCD) in rabbit models at different time points,make comparisons with the RT performances of joint debribement,explore the efficiency of the microfracture treatment for OCD.Methods Twenty-seven New Zealand rabbits were randomly assigned into 3 groups (sacrificed at the end of 3,5 and 7 weeks post-operation respectively),with 9 in each group.For each rabbit,one knee joint was made into an OCD model.In each group,6 were for microfracture treatment,and the other 3 were for joint debridement as control.MR scan,which mainly included sequences of 3D double echo steady state sequence (3D-DESS) and T2-mapping,was taken at 3,5 and 7 weeks postoperation.The thickness index and T2 value index of RT were calculated and T2-mapping of repaired region was drafted.Then the operation sites were removed to make histological sections of HE and Masson staining.The modified O' Driscoll score system was employed to make semi-quantitative evaluation for the histological performance of RT.Comparisons were made with respect to MR and histological findings between two treatments at each time point using unpaired Student t test.Effects of two treatments were evaluated longitudinally by comparing the results of three time points using one-way ANOVA.Results The post-operation thickness indexes of two groups increased gradually (F =33.940,28.841,P ＜ 0.05),T2 value indexes decreased (F =80.183,206.206,P ＜ 0.05),and O'driscoll scores increased gradually (F =29.867,17.167,P ＜ 0.05).At each time point,the thickness index of microfracture was higher than that of debridement group(3-week:0.743 ±0.048 vs 0.624 ±0.013,t =4.077 ;5-week:0.813 ±0.031 vs 0.734 ±0.015,t =4.107 ; 7-week: 0.972 ± 0.064 vs 0.777 ± 0.039,t =4.782 ; P ＜ 0.05),and the defects of microfracture in 7-week group were almost fully recovered while the defects of the debridement in 7-week group were not.The T2 value index of microfracture group was lower than that of debridement group at 3-week point(1.338 ±0.043 vs 1.510 ± 0.009,t =6.583,P ＜ 0.05),but it was higher than that of debridement group at 5-week and 7-week points (5-week: 1.284 ± 0.097 vs 1.116 ± 0.068,t =2.663 ; 7-week: 0.916 ± 0.036 vs 0.843 ± 0.016,t =3.283 ; P ＜ 0.05).The O'Driscoll score of microfracture group was higher than that of joint debridement at every time point(3-week:7.167 ±0.753 vs 4.667 ±0.577,t =5.000;5-week: 9.833 ± 1.169 vs 7.667 ± 0.577,t =2.960 ; 7-week: 11.167 ± 0.753 vs 8.333 ± 1.155,t =4.520 ; P ＜ 0.05).For microfracture group,the RT was mainly repaired by fibrocartilage and got matured gradually with more production of well-distributed collagen fibrils ; while for joint debridement group,the RT was mainly repaired by fibrous and scar tissue.Conclusions The post-operation repairing thickness and tissue composition of microfracture for OCD are superior to that of joint debridement.MR 3D-DESS and T2-mapping can show the thickness and tissue composition of the RT after OCD treatments,provide effective evaluation of repairing conditions,and they are of great importance on the OCD post-op follow-up.
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