针刀干预对膝骨关节炎兔股四头肌肌腱拉伸力学的影响
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摘要
目的:观察针刀干预对膝骨关节炎(KOA)兔行为学、形态学及拉伸力学的影响,探讨针刀治疗KOA的生物力学效应。方法:24只新西兰雄兔随机分为4组:正常组、模型组、电针组、针刀组,每组各6只。模型组以改良Videman左后肢伸直位固定制动固定6周建立兔KOA模型。电针组电针左侧梁丘、血海、内膝眼、外膝眼,每周3次,治疗3周。针刀组以针刀松解左侧股四头肌肌腱,每周1次,治疗3周。分别于造模措施解除1周后和治疗结束1周后应用Lequesne MG膝关节评估法进行行为学检测,治疗结束1周后进行HE染色和力学测试。结果:行为学治疗前观察显示:在局部疼痛、步态反应、关节活动和关节肿胀方面,正常组与模型组比较差异有统计学意义(P<0.05),而模型组、电针组和针刀组之间差异无统计学意义(P>0.05)。治疗后结果显示:与正常组相比,模型组、电针组和针刀组在局部疼痛、步态反应、关节活动和关节肿胀上差异均有统计学意义(P<0.05);在局部疼痛上,电针组较模型组降低,差异无统计学意义(P>0.05),针刀组与模型组比较差异有统计学意义(P<0.05),电针组和针刀组之间比较差异无统计学意义(P>0.05);在步态改变上,模型组与电针组比较差异有统计学意义(P<0.05);针刀组与模型组比较差异无统计学意义(P>0.05);在关节活动度方面,电针组、针刀组与模型组相比,差异均有统计学意义(P<0.05);在关节肿胀上,电针组和针刀组分别与模型组比较,差异均有统计学意义(P<0.01),而电针组和针刀组之间比较差异无统计学意义(P>0.05)。力学方面:与空白组相比,模型组的极限载荷显著降低(P<0.01),电针组极限载荷有下降趋势(P>0.05),针刀组极限载荷有上升趋势(P>0.05);与模型组比较,电针组极限载荷升高(P<0.05),针刀组极限载荷显著升高(P<0.01);与电针组相比,针刀组极限载荷有上升趋势(P>0.05)。与空白组比较,模型组的最大位移显著降低(P<0.01),电针组和针刀组最大位移均有下降趋势(P>0.05),与模型组比较,电针组最大位移有升高趋势(P>0.05),针刀组最大位移显著升高(P<0.05),与电针组相比,针刀组最大位移有上升趋势(P>0.05)。在刚度方面各组数据间均无统计学意义(P>0.05)。结论:针刀干预可使行为学及形态学发生明显改变,可显著改善股四头肌肌腱拉伸力学特性,并发挥其生物力学效应从而达到治疗KOA的目的。
Objective :To observe the effects of acupotomy intervention on the behavior, morphology and tensile mechanics of knee osteoarthritis(KOA) rabbits,and to explore the biomechanical effects of acupotomy on KOA. Methods:Twentyfour New Zealand male rabbits were randomly divided into four groups :normal group,model group,electroacupuncture group and needle-knife group,with 6 rabbits in each group. In each model group, rabbit KOA model was established by fixing Videman's left hind limb in straight position for 6 weeks. In the electroacupuncture group,rats were treated left on Liang Qiu(梁丘),Xue Hai(血海),Nei Xi Yan(内膝眼)and Wai Xi Yan(外膝眼) 3 times a week for 3 weeks. In the acupotomology group,the left quadriceps femoris tendon was released with acupotomology,and the treatment was once a week for 3 weeks. Behavioral tests were performed using Lequesne MG knee joint evaluation method one week after the end of modeling and one week after the end of treatment, and HE staining and mechanical tests were performed one week after the end of treatment. Results: Behavioral observation before treatment showed that there were significant differences in local pain,gait response,joint activity and joint swelling between the normal group and the model group(P<0.05), while there was no significant difference among the model group, electro-acupuncture group and needle-knife group(P>0.05). After treatment, the results showed that there were significant differences in local pain, gait response, joint activity and joint swelling among model group, electroacupuncture group and needle-knife group compared with normal group(P<0.05); In local pain,the electro-acupuncture group was lower than the model group,and there was no significant difference(P>0.05); there was significant difference between needle knife group and model group(P<0.05);there was no significant difference between electro-acupuncture group and needleknife group(P>0.05). In gait change, there was significant difference between model group and electro-acupuncture group(P<0.05); there was no significant difference between needle-knife group and model group(P>0.05). In joint activity, there was significant difference between electro-acupuncture group and model group(P<0.05). In joint swelling, compared with model group,there was significant difference on electro-acupuncture group and electro-knife group(P<0.01),but there was no significant difference between the electro-acupuncture group and the needle-knife group(P>0.05). Mechanics : Compared with the blank group, the ultimate load of the model group decreased significantly(P<0.01),the ultimate load of the electro-acupuncture group decreased(P>0.05),and the ultimate load of the needle-knife group increased(P>0.05). Compared with the model group, the ultimate load of the electro-acupuncture group increased significantly(P<0.05),and the ultimate load of the needleknife group increased significantly(P<0.01). Compared with the electro-acupuncture group,the ultimate load of the needleknife group increased(P>0.05). Compared with the blank group,the maximum displacement of the model group decreased significantly(P<0.01),and the maximum displacement of the electro-acupuncture group and the needle-knife group decreased(P>0.05). Compared with the model group,the maximum displacement of the electro-acupuncture group increased(P>0.05),and the maximum displacement of the needle-knife group increased significantly(P<0.05). Compared with the electro-acupuncture group,the maximum displacement of the needle-knife group increased(P>0.05). There was no significant difference in stiffness among groups(P>0.05). Conclusion : Acupotomy intervention can significantly change the behavior and morphology, significantly improve the mechanical properties of quadriceps femoris tendon stretch, and exert its biomechanical effects to achieve the purpose of treating KOA.
Objective :To observe the effects of acupotomy intervention on the behavior, morphology and tensile mechanics of knee osteoarthritis(KOA) rabbits,and to explore the biomechanical effects of acupotomy on KOA. Methods:Twentyfour New Zealand male rabbits were randomly divided into four groups :normal group,model group,electroacupuncture group and needle-knife group,with 6 rabbits in each group. In each model group, rabbit KOA model was established by fixing Videman's left hind limb in straight position for 6 weeks. In the electroacupuncture group,rats were treated left on Liang Qiu(梁丘),Xue Hai(血海),Nei Xi Yan(内膝眼)and Wai Xi Yan(外膝眼) 3 times a week for 3 weeks. In the acupotomology group,the left quadriceps femoris tendon was released with acupotomology,and the treatment was once a week for 3 weeks. Behavioral tests were performed using Lequesne MG knee joint evaluation method one week after the end of modeling and one week after the end of treatment, and HE staining and mechanical tests were performed one week after the end of treatment. Results: Behavioral observation before treatment showed that there were significant differences in local pain,gait response,joint activity and joint swelling between the normal group and the model group(P<0.05), while there was no significant difference among the model group, electro-acupuncture group and needle-knife group(P>0.05). After treatment, the results showed that there were significant differences in local pain, gait response, joint activity and joint swelling among model group, electroacupuncture group and needle-knife group compared with normal group(P<0.05); In local pain,the electro-acupuncture group was lower than the model group,and there was no significant difference(P>0.05); there was significant difference between needle knife group and model group(P<0.05);there was no significant difference between electro-acupuncture group and needleknife group(P>0.05). In gait change, there was significant difference between model group and electro-acupuncture group(P<0.05); there was no significant difference between needle-knife group and model group(P>0.05). In joint activity, there was significant difference between electro-acupuncture group and model group(P<0.05). In joint swelling, compared with model group,there was significant difference on electro-acupuncture group and electro-knife group(P<0.01),but there was no significant difference between the electro-acupuncture group and the needle-knife group(P>0.05). Mechanics : Compared with the blank group, the ultimate load of the model group decreased significantly(P<0.01),the ultimate load of the electro-acupuncture group decreased(P>0.05),and the ultimate load of the needle-knife group increased(P>0.05). Compared with the model group, the ultimate load of the electro-acupuncture group increased significantly(P<0.05),and the ultimate load of the needleknife group increased significantly(P<0.01). Compared with the electro-acupuncture group,the ultimate load of the needleknife group increased(P>0.05). Compared with the blank group,the maximum displacement of the model group decreased significantly(P<0.01),and the maximum displacement of the electro-acupuncture group and the needle-knife group decreased(P>0.05). Compared with the model group,the maximum displacement of the electro-acupuncture group increased(P>0.05),and the maximum displacement of the needle-knife group increased significantly(P<0.05). Compared with the electro-acupuncture group,the maximum displacement of the needle-knife group increased(P>0.05). There was no significant difference in stiffness among groups(P>0.05). Conclusion : Acupotomy intervention can significantly change the behavior and morphology, significantly improve the mechanical properties of quadriceps femoris tendon stretch, and exert its biomechanical effects to achieve the purpose of treating KOA.
引文
[1]王翔,刘顺怡,石瑛,等.针刀松解术治疗膝骨关节炎的临床观察[J].中国骨伤,2016,29(4):345-349.WANG X,LIU SY,SHI Y,et al.Clinical observation on knee osteoarthritis treated by needle knife loosening[J].Zhongguo Gu Shang/China J Orthop Trauma,2016,29(4):345-349.Chinese with abstract in English.
[2]付达尔丽,郭长青,金晓飞.针刀干预对膝骨关节炎家兔模型内侧副韧带拉伸特性的影响[J].世界中医药,2014,9(7):912-915.FU DEL,GUO CQ,LIU JF.Effect of needle knife intervention on the tensile properties of medial collateral ligament in rabbit model of knee osteoarthritis[J].Shi Jie Zhong Yi Yao,2014,9(7):912-915.Chinese.
[3]Videman T.Experimental osteoarthritis in the rabbit:comparison of different periods of repeated immobilization[J].Acta Orthop Scand,1982,53(3):339-347.
[4]Wright T.Biomechanical factors in osteoarthritis:the effects of joint instability[J].HSS J,2012,8(1):15-17.
[5]Leong DJ,Sun HB.Mechanical loading:potential preventive and therapeutic strategy for osteoarthritis[J].J Am Acad Orthop Surg,2014,22(7):465-466.
[6]李哲,白玉,闫冬,等.膝三针、艾灸结合超激光照射治疗膝骨关节炎对下肢生物力学相关参数变化的影响[J].针灸临床杂志,2018,34(1):33-36.LI Z,BAI Y,YAN D,et al.Effect of moxibustion combined with ultra laser irradiation on biomechanical parameters of lower limbs in the treatment of knee osteoarthritis[J].Zhen Jiu Lin Chuang Za Zhi,2018,34(1):33-36.Chinese.
[7]郭长青,张丽萍.针刀干预对膝骨关节炎兔髌韧带拉伸、蠕变及应力松弛等生物力学特性的影响[J].中国科学:生命科学,2016,46(8):976-982.GUO CQ,ZHANG LP.The effect of needle knife intervention on the biomechanical properties of knee osteoarthritis rabbits such as patellar ligament tension,creep and stress relaxation[J].Zhongguo Ke Xue:Sheng Min Ke Xue,2016,46(8):976-982.Chinese.
[8]周帅,张伟,王彤,等.针刀疗法对膝骨关节炎兔胫骨前肌表面肌电与肌腱生物力学行为的影响[J].北京中医药大学学报,2018,41(8):675-680.ZHOU S,ZHANG W,WANG T,et al.Effect of acupotomy on surface EMG and tendon biomechanical behavior of tibial anterior muscle in rabbits with knee osteoarthritis[J].Bei Jing Zhong Yi Yao Da Xue Xue Bao,2018,41(8):675-680.Chinese.
[9]张栋,王庆甫,石鑫超,等.膝骨关节炎肌骨超声与X线片表现的比较与分析[J].中国骨伤,2016,29(5):429-433.ZHANG D,WANG QF,SHI XC,et al.Comparison and analysis of ultrasound and X ray findings of muscle and bone in knee osteoarthritis[J].Zhongguo Gu Shang/China J Orthop Trauma,2016,29(5):429-433.Chinese with abstract in English.
[10]Mills K,Hunt MA,Leigh R,et al.A systematic review and meta analysis of lower limb neuromuscular alterations associated with knee osteoarthritis during level walking[J].Clin Biomech(Bristol,Avon),2013,28(7):713-724.
[11]Thomas AC,Sowers M,Karvonen Gutierrez C,et al.Lack of quadriceps dysfunction in women with early knee osteoarthritis[J].J Orthop Res,2010,28(5):595-599.
[12]Henriksen M,Christensen R,Danneskiold Samsoe B,et al.Changes in lower extremity muscle mass and muscle strength after weight loss in obesepatients with knee osteoarthritis:a prospective cohort study[J].Arthritis Rheum,2012,64(2):438-442.
[13]Pal S,Besier TF,Draper CE,et al.Patellar tilt correlates with vastus lateralis:vastus medialis activation ratio in maltrackingpatellofemoral pain patients[J].J Orthop Res,2012,30(6):927-933.
[14]Pan J,Stehling C,Muller Hocker C,et al.Vastus lateralis/vastus medialis cross sectional area ratio impacts presence and degree of knee joint abnormalities and cartilage T2 determined with 3TMRI an analysis from the incidencecohort of the osteoarthritis initiative[J].Osteoarthritis Cartilage,2011,19(1):65-73.
[15]Schwartz AG,Lipner JH,Pasteris JD,et al.Muscle loading is necessary for the formation of a functional tendon enthesis[J].Bone,2013,55(1):44-51.
[16]Izu Y,Ansorge HL,Zhang G,et al.Dysfunctional tendon collagen fibrillogenesis in collagenⅥnull mice[J].Matrix Biol,2011,30(1):53-61.
[2]付达尔丽,郭长青,金晓飞.针刀干预对膝骨关节炎家兔模型内侧副韧带拉伸特性的影响[J].世界中医药,2014,9(7):912-915.FU DEL,GUO CQ,LIU JF.Effect of needle knife intervention on the tensile properties of medial collateral ligament in rabbit model of knee osteoarthritis[J].Shi Jie Zhong Yi Yao,2014,9(7):912-915.Chinese.
[3]Videman T.Experimental osteoarthritis in the rabbit:comparison of different periods of repeated immobilization[J].Acta Orthop Scand,1982,53(3):339-347.
[4]Wright T.Biomechanical factors in osteoarthritis:the effects of joint instability[J].HSS J,2012,8(1):15-17.
[5]Leong DJ,Sun HB.Mechanical loading:potential preventive and therapeutic strategy for osteoarthritis[J].J Am Acad Orthop Surg,2014,22(7):465-466.
[6]李哲,白玉,闫冬,等.膝三针、艾灸结合超激光照射治疗膝骨关节炎对下肢生物力学相关参数变化的影响[J].针灸临床杂志,2018,34(1):33-36.LI Z,BAI Y,YAN D,et al.Effect of moxibustion combined with ultra laser irradiation on biomechanical parameters of lower limbs in the treatment of knee osteoarthritis[J].Zhen Jiu Lin Chuang Za Zhi,2018,34(1):33-36.Chinese.
[7]郭长青,张丽萍.针刀干预对膝骨关节炎兔髌韧带拉伸、蠕变及应力松弛等生物力学特性的影响[J].中国科学:生命科学,2016,46(8):976-982.GUO CQ,ZHANG LP.The effect of needle knife intervention on the biomechanical properties of knee osteoarthritis rabbits such as patellar ligament tension,creep and stress relaxation[J].Zhongguo Ke Xue:Sheng Min Ke Xue,2016,46(8):976-982.Chinese.
[8]周帅,张伟,王彤,等.针刀疗法对膝骨关节炎兔胫骨前肌表面肌电与肌腱生物力学行为的影响[J].北京中医药大学学报,2018,41(8):675-680.ZHOU S,ZHANG W,WANG T,et al.Effect of acupotomy on surface EMG and tendon biomechanical behavior of tibial anterior muscle in rabbits with knee osteoarthritis[J].Bei Jing Zhong Yi Yao Da Xue Xue Bao,2018,41(8):675-680.Chinese.
[9]张栋,王庆甫,石鑫超,等.膝骨关节炎肌骨超声与X线片表现的比较与分析[J].中国骨伤,2016,29(5):429-433.ZHANG D,WANG QF,SHI XC,et al.Comparison and analysis of ultrasound and X ray findings of muscle and bone in knee osteoarthritis[J].Zhongguo Gu Shang/China J Orthop Trauma,2016,29(5):429-433.Chinese with abstract in English.
[10]Mills K,Hunt MA,Leigh R,et al.A systematic review and meta analysis of lower limb neuromuscular alterations associated with knee osteoarthritis during level walking[J].Clin Biomech(Bristol,Avon),2013,28(7):713-724.
[11]Thomas AC,Sowers M,Karvonen Gutierrez C,et al.Lack of quadriceps dysfunction in women with early knee osteoarthritis[J].J Orthop Res,2010,28(5):595-599.
[12]Henriksen M,Christensen R,Danneskiold Samsoe B,et al.Changes in lower extremity muscle mass and muscle strength after weight loss in obesepatients with knee osteoarthritis:a prospective cohort study[J].Arthritis Rheum,2012,64(2):438-442.
[13]Pal S,Besier TF,Draper CE,et al.Patellar tilt correlates with vastus lateralis:vastus medialis activation ratio in maltrackingpatellofemoral pain patients[J].J Orthop Res,2012,30(6):927-933.
[14]Pan J,Stehling C,Muller Hocker C,et al.Vastus lateralis/vastus medialis cross sectional area ratio impacts presence and degree of knee joint abnormalities and cartilage T2 determined with 3TMRI an analysis from the incidencecohort of the osteoarthritis initiative[J].Osteoarthritis Cartilage,2011,19(1):65-73.
[15]Schwartz AG,Lipner JH,Pasteris JD,et al.Muscle loading is necessary for the formation of a functional tendon enthesis[J].Bone,2013,55(1):44-51.
[16]Izu Y,Ansorge HL,Zhang G,et al.Dysfunctional tendon collagen fibrillogenesis in collagenⅥnull mice[J].Matrix Biol,2011,30(1):53-61.