Research Study About Lumbar Facet Joint Degeneration Of Elderly Patients With Low Back Pain Due To Deficiency Of Liver And Kidney

Objective: Based on the theory of "liver governing tendon,kidney governing bone",the histomorphological changes of lumbar facet articular cartilage and the expressions of interleukin-1a(IL-1a)and matrix metalloproteinase-13(MMP-13)in elderly patients with low back pain due to liver and kidney deficiency have been studied.The relationship between the constitution of liver and kidney deficiency and lumbar facet joint degeneration was revealed.Methods : From Month 2017 to October 2018,30 patients with non-liver-kidney deficiency(under 35 years old)were enrolled in the contrast group and 45 patients with liver-kidney deficiency(60 or over 60 years old)were enrolled in the experimental group,referring to the diagnostic criteria of low back pain and TCM symptoms.The CT、MRI changes of lumbar facet joints were observed before operation and scored according to Kalichman and Weishaupt classification criteria.The cartilage tissues of lumbar facet joints of the two groups were collected as experimental specimens during operation,gross naked eye changes were observed and Brittberg classification criteria were scored.The cartilage tissues of the facet joints were immediately washed with sterile saline and put into sterile test tubes,and 10% of them were poured into sterile test tubes.The neutral formalin solution was fixed completely for 24 hours and then sent to the laboratory for decalcification,embedding and sectioning.The histomorphological changes of articular cartilage were observed under HE staining light microscopy and the Mankin’s score of pathological sections was obtained.Immunohistochemistry(ABC)was used to detect the positive expression of IL-1a and MMP-13 in articular cartilage.Image-Pro Plus 6.0 was used to analyze the positive staining area of visual field,and the mean of IOD was calculated.Results:1.Lumbar CT MRI examination: There was no degenerative change of lumbar facet joints in the control group,but the experimental group had obvious degeneration,narrowing or disappearance of joint space,peripheral bone hyperplasia,hypertrophy and other imaging changes compared with the control group.The Kalichman and Weishaupt grading standard scores of lumbar facet joints in the experimental group is obvious higher than those in the control group,with significant difference(P<0.01).2.Gross morphology observation: The lumbar facet articular cartilage of the control group was normal in general morphology,no abnormal color,texture and luster.The experimental group had obvious degenerative changes,such as yellowing,hardening and subchondral osteosclerosis.The Brittberg grading standard score of the gross morphology of the facet articular cartilage of the experimental group is obvious higher than that of the control group,with significant difference(P<0.01);3.Cartilage HE staining observation: The control group can clearly see the surface of cartilage and subchondral bone is neat,chondrocyte distribution is uniform,tidal line is obvious,clearly visible,and other phenomena,while the experimental group can see the edge of cartilage is rough and irregular,most of chondrocyte is missing,cell distribution and arrangement is relatively disordered,size is different,and deep soft can be seen dimly.The Mankin’s score of pathological section of articular cartilage in the experimental group is obvious higher than that of the control group,with significant difference(P<0.01);4.Immunohistochemical staining results showed that the mean of IOD of IL-1a and MMP-13 immunopositive expression in articular cartilage of the experimental group is obvious higher than that of the control group((P<0.01);5.The correlation analysis of inflammatory factors of IL-1a and MMP-13 in the experimental group(r = 0.583,P< 0.05),showed that there was a positive correlation between IL-1a and MMP-13.Conclusions: 1.Patients with liver and kidney deficiency have obvious degeneration of lumbar facet joints,and its imaging and pathological changes may be similar to other joint degeneration;2.Liver and kidney deficiency constitution significantly affects lumbar facet joint degeneration;3.IL-1α,MMP-13 may be the target of low back pain,liver and kidney deficiency,and kidney main bone.There is a positive correlation between IL-1α and MMP-13,which may accelerate the degeneration of lumbar facet joints and participate in the mechanism of facet joint degeneration.