Effects Of Distraction Technique By Minimally Invasive On Articular Cartilage Of Knee Osteoarthritis Goat And Preliminary Clinical Observation

Object:Part I:In vivo, the establishment of the goat knee osteoarthritis model to observe the impact of minimally invasive distraction technique of articular cartilage morphology and serum MMP-1and CTX-II concentration indicators to explore minimally invasive distractionthe technical mechanisms of effective treatment of knee osteoarthritis, and provide a theoretical basis for the minimally invasive distraction clinical treatment of osteoarthritis.Part Ⅱ:preliminary clinical observation, the application of minimally invasive distraction technique with traditional Chinese medicine named "osteoarthritis I" to treat ankle osteoarthritis which are caused by equinovarus, Baird-Jackson score、the VSA pain scores and AOFAS score were observed in patients before and after treatment. Made an objective evaluation of treatment to provide a basis for further clinical applications.Methods:PartⅠ1.Knee osteoarthritis animal pathological model and animal grouping:32goats were randomly divided into model group which contains25goats and the Sham operation group which contain7goats, the model group using the method of the knee joint cavity injection of papain to the establishment of experimental animals with knee osteoarthritis model, six weeks after finishing injection, the model group and sham group were randomly selected one goat to sacrifice. Taking the goat articular cartilage and synovial tissue to observe to make sure the model is successful. After the success of setting model,the model group24goats were randomly divided into model control group, Fl pull tension group, F2pull tension group, F3pull tension group, each group has6goats. F1, F2, F3group were given pull force of F1, F2, F3, installing the external fixator and locking hinge rod. The sham operation group, model control group were not to wear external fixator. Each animal might live in a separate cage, freedom of movement. Intramuscular injection of aqueous penicillin3d (40million units per day), managed by hand.2.Material, specimen pretreatment and targets detection:Normal rearing30goats under the same conditions, eight weeks after installing the external fixator, sacrifice the experimental animals and open the left knee join to observe the general situation of the joint synovial tissue and cartilage. Stripping cartilage of the tibial plateau, femoral condyle and patellofemoral joints of the left knee and removing the synovial membrane to fix in4%paraformaldehyde.Useing EDTA for decalcification and producing slice with HE.3.The statistical processing:the experimental data with the x±S SPSS16.0software for analysis.Part Ⅱ1.Case selection:Select the patients of Fuji an Provincial People’s Hospital and all of them suffered ankle arthritis which caused by clubfoot deformity.2. The observation method:Patients were value the VSA pain score, Baird-Jackson score, the AOFAS score before surgery, using minimally invasive distraction technique correction of ankle deformity and reduce uneven force of the ankle articular cartilage. Two day after surgery,patients take traditional Chinese medicine named "osteoarthritis I".we investigated patients2week,l month,2monthes,4months after surgery.The survey include the VSA pain score, Baird-Jackson score, the AOFAS score.3. statistical processing:the experimental data with the x±S SPSS16.0software for analysisResults:Part I:1. sham operation group are normal gait, the model control group of goats limp serious, All groups with external fixator have some of the improvements in gait compared with the model group. Fl group have an more obvious improvement in gait than other groups.2.In model control group, inflammation of the knee joint synovitis and degeneration of articular cartilage are very obvious. In all groups with external fixator, the pathological changes in the morphology observation was lighter than the model group.pathological changes of F1group is lightest.3. Mankin’s score of articular cartilage of all model group are different degrees of increase and have a significant difference ((P<0.01) compared with the sham group, F1group increased to a lesser extent.4. After the model of each group of serum MMP-1, the CTX-Ⅱ levels were reduced, compare with the model group, F2group and F3group. serum MMP-1and CTX-Iilevels of the F1group are lowest and there are significant differences (P<0.05).Part ⅡPatients using minimally invasive stretch technology combined with the treatment of traditional Chinese medicine named "osteoarthritis Ⅰ" pain eased significantly improved ankle function than before treatment.Conclusion:1.In this study, the method of intra-articular injection of papain successfully simulated with knee osteoarthritis to establish the experimental pathology model.2. Minimally invasive distraction techniques may reduce the articular surface pressure, balance the force of the articular surface while maintaining moderate stress of the articular surface, reduce of expression of MMP-1and CTX-Ⅱ, thereby reduce the destruction of the articular cartilage and delay knee arthritis in the development process.3.Minimally invasive distraction technique can effectively relieve ankle pain andimprove ankle function of ankle osteoarthritis which are caused by equinovarus.