Effect of acupotomy intervention on the morphology and ultrastructure of rectus femoris muscle in rabbits with knee osteoarthritis / 中国骨伤

OBJECTIVE@#To observe the effect of acupotomy on the morphology and ultrastructure of rectus femoris muscle in rabbits with knee osteoarthritis and to reveal the possible therapeutic mechanism involved in the effect of acupotomology on the treatment of knee osteoarthritis(KOA).@*METHODS@#Twenty-four male New Zealand rabbits aged 6 months and weighed (2.0±0.5) kg were randomly divided into blank group, model group and acupotomy group, 8 rabbits in each group. KOA model was established by modified Videman method with left hind limb extended plaster immobility for 6 weeks. In acupotomy group, the transfascial focal points of quadriceps femoris muscle were released by acupotomy under the guidance of Jingjin theory for 4 times and once a week, and the treatment points include Hedingci, Binwaixia, Binneixia. Blank group and model group were fed normally without intervention. One week after the end of the intervention, the pennation angle(PA), muscle thickness(MT), cross-sectional area(CSA) and strain ratio(SR) of rectus femoris were measured by ultrasound. HE staining was used to observe the changes of the tissue morphology, the number of muscle fibers and the average area of muscle fibers. The myofibril of rectus femoris, sarcomere and myofilament were observed by transmission electron microscope.@*RESULTS@#The PA of rectus femoris muscle in the blank group was (9.05±0.21)°. The MT was(1.09±0.09) cm and the CSA was(1.30±0.01) cm2. The PA of rectus femoris muscle in the model group was (3.06±0.15)°. The MT was (0.71±0.02) cm and the CSA was(0.77±0.02) cm2. The PA of rectus femoris muscle in the acupotomy group was (6.94±0.28)°. The MT was (0.80±0.05) cm and the CSA was(0.94±0.03) cm2. The muscle PA, MT and CSA of rectus femoris in the model group were significantly smaller than those in the blank group (P<0.05). Those in acupotomy group were significantly increased compared with those in model group (P<0.05). The SR of rectus femoris muscle was 1.19±0.02 in the blank group, 3.50±0.05 in the model group and 1.99±0.07 in the acupotomy group. The elastic SR of the model group was significantly higher than that of the blank group (P<0.05). These in acupotomy group was significantly lower than that in model group(P<0.05). The results of HE staining showed:in blank group, the fascicles of rectus femoris were arranged neatly, the number of beam of muscle fibers within the fixed visual field was 94.38±3.50 and the average CSA was(0.75±0.22) mm2. In model group, the fascicles of rectus femoris with different sizes were disorganized with a small amount of inflammatory cell infiltration, the number of beam of muscle fibers within the fixed visual field was 196.63±2.62 and the average CSA was(0.26±0.03) mm2. Compared to the blank group, a significant increase in the number of muscle fibers in the fixed field in the model group (P<0.05) and the average CSA decreased significantly(P<0.05). In acupotomy group, the rectus femoris fascicles in the acupotomy group tended to be arranged in a more orderly manner, with the inflammatory cells decreased, the number of beam of muscle fibers within the fixed visual field was 132.88±4.61 and the average CSA was(0.70±0.07) mm2. Compared to the model group, a significant decrease in the number of muscle fibers in the fixed field in the model group(P<0.05) and the average CSA increased significantly(P<0.05). The results of transmission electron microscope showed:compared with the blank group, the overall arrangement of the myofibrils of the rectus femoris in the model group was less structured. There was fracture between the muscle fibers and the sarcomere, the myofilaments were disordered, and the fracture of the Z line was discontinuous. Compared with the model group, the myofibrillar texture of rectus femoris in acupotomy group was clearer, and the Z line was more continuous.@*CONCLUSION@#Based on the jingjin theory, the release of quadriceps femoris by acupotomy can effectively improve the morphology and structure of rectus femoris, and promote the repair and reconstruction of chronic skeletal muscle injury in rabbits with KOA, which may be one of the mechanisms of acupotomy in the treatment of KOA.

Ultrasound anatomy and needle-knife insertion approach of common tendon lesions in knee osteoarthritis based on meridian sinew theory / 中国针灸

OBJECTIVE@#To explore the ultrasonic anatomical characteristics and needle-knife insertion approach of common tendon lesions in knee osteoarthritis (KOA), so as to provide the references for accurate release of KOA by needle- knife along tendon lesions based on meridian sinew theory.@*METHODS@#Sixty patients with one-knee KOA were selected. High-frequency musculoskeletal ultrasound was used to collect sonograms at the anatomical positions of "Hedingci" "Binwaixia" "Binneixia" and "Yinlingshang". The anatomic levels were marked on the sonograms. The anatomic levels and sonographic features of lesions were compared and analyzed, and the relevant data of needle-knife simulation approach was measured.@*RESULTS@#The "Hedingci" lesions were mainly located at the attachment of quadriceps tendon to patella and suprapatellar bursa. The "Binwaixia" and "Binneixia" lesions were mainly located at the attachment of retinaculum patellae laterale and retinaculum patellae mediale to patella and infrapatellar fat pad. The "Yinlingshang" lesions were mainly located at the attachment of goose foot tendon to medial tibial condyle and bursa of goose foot. With "Hedingci" as an example, when the needle-knife entry point was 1 cm above the patella, the attachment of quadriceps tendon to patella was released, and the average depth of needle-knife was (3.60±0.10) cm, and the needle body was perpendicular to the skin. The average depth of needle-knife for releasing suprapatellar bursa was (2.35±0.17) cm, and the needle body was 45° towards head.@*CONCLUSION@#The musculoskeletal ultrasound could clearly show the local detailed anatomical level, ultrasonic characteristics and anatomical level of common tendon lesions of KOA, and could improve the accuracy of needle-knife along tendon lesions with non-direct vision, which has important reference value for needle-knife medical standardization and standardized operation.

Treatment of Clunial Nerve Entrapment Syndrome with Needle Knife Based on Principle of "Staging, Segmenting and Layering" / 中国中医药信息杂志

Treatment of clunial nerve entrapment syndrome with needle knife has the advantages of quick efficacy and easy application. However, because of the surgeons' lack of knowledge of the disease and the operation of different proficiency, there are differences in the treatment effects. This article introduced the guidance principle of"staging, segmenting and layering", which can improve the efficacy during treatment and be beneficial to the clinical application of all levels of clinical doctors.

Effects of Pilose antler polypeptide on apoptosis of chondrocyte and related cytokines in experimental knee osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To explore the effects of Pilose antler polypeptide on apoptosis of chondrocyte and related cytokines in experimental knee osteoarthritis.</p><p><b>METHODS</b>Totally 64 New Zealand White rabbits of 6 months old were randomly divided into 2 groups:normal group(n=8)and model group (n=56). Model group was surgically induced into knee osteoarthritis model by method of Hulth. After successful modeling,the rabbits of model group were further divided into 2 groups: Pilose antler polypeptide-treatment group (n=24) and control group (n=24). Pilose antler polypeptide-treatment group received 0.5 ml intraarticular injection of Pilose antler polypeptide dilution liquid once per 2 days for 30 days while control group received 0.5 ml intra-articular injection of physiological saline. On days 7, 15 and 30 after intervention, articular cartilage samples and synovial fluid were collected respectively. The morphological changes of articular cartilage under optical microscope and the structural change of chondrocyte were observed by transmission electron microscopy. The levels of interleukin-1beta and tumor necrosis factor-alpha in synovial fluid was detected by Enzyme-linked Immunosorbent Assay.</p><p><b>RESULTS</b>Along with the extending of time, articular cartilage degenerated gradually and chondrocytes apoptosis increased significantly. On days 7,15 and 30 after intervention, the chondrocyte apoptosis index of the Pilose antler polypeptide-treatment group were (20.30 +/- 1.23), (28.60 +/- 2.37), (37.10 +/- 1.82) and those of control group were (31.50 +/- 2.44), (34.40 +/- 1.77), (42.30 +/- 2.33). There were significant differences between them (P<0.05). At the same time, the chondrocyte apoptosis index of the Pilose antler polypeptide-treatment group were lower than those of control group,which had a statistical significance (P<0.05). On days 7,15 and 30 after intervention, the levels of interleukin-1beta in synovia fluid of Pilose antler polypeptide-treatment group were (15.81 +/- 1.26), (12.59 +/- 1.42), (9.57 +/- 0.92) microg/L and the level of tumor necrosis factor-alpha were (48.47 +/- 2.64), (43.46 +/- 1.33), (40.96 +/- 1.05) microg/L, with statistical differences(P<0.05). The levels of interleukin-1beta in synovia fluid of control group were (18.92 +/- 1.83), (20.25 +/- 2.76), (22.13 +/- 2.24) microg/L and the levels of tumor necrosis factor-alpha were (57.92 +/- 2.12), (60.25 +/- 1.48), (63.35 +/- 2.15) microg/L. At the same period,the levels of interleukin-1beta and tumor necrosis factor-alpha were lower than those of the control group,which had a statistical significance (P<0.05).</p><p><b>CONCLUSION</b>Pilose antler polypeptide can inhibit chondrocytes apoptosis, decrease the levels of interleukin-1beta and tumor necrosis factor-alpha and delay the degeneration of articular cartilage to some extent.</p>

Effects of pilose antler polypeptide on the glycosaminoglycan and type II collagen in experimental knee osteoarthritis / 中国骨伤

<p><b>OBJECTIVE</b>To observe the influence of Pilose antler polypeptide on the glycosaminoglycan and type II collagen in the articular cartilage in experimental knee osteoarthritis.</p><p><b>METHODS</b>Totally 64 New Zealand white rabbits of 6 months old were randomly divided into 2 groups:normal group (n = 8) and model group (n = 56). Model group was surgically induced into osteoarthritis model by method of Hulth. After successful modeling, the rabbits of model group were further divided into 2 groups: Pilose antler polypeptide-treatment group and control group, 24 rabbits in each group. Pilose antler polypeptide-treatment group received 0.5 ml intra-articular injection of Pilose antler polypeptide dilution liquid once in per 2 days for 30 days, while control group received 0.5 ml intra-articular injection of physiological saline. On days 7, 15 and 30 after intervention, articular cartilage samples were collected respectively. The content of glycosaminoglycan in articular cartilage was observed by toluidine blue staining and the expression of type II collagen in cartilage matrix was detected by immunohistochemical staining.</p><p><b>RESULTS</b>Along with the prolonging of time, the content of glycosaminoglycan and type II collagen in cartilage matrix of the Pilose antler polypeptide-treatment group and control group decreased gradually. On days 7, 15 and 30 after intervention, integrated optical density of the type II collagen positive area in cartilage matrix of the Pilose antler polypeptide-treatment group were (312.06 +/- 14.12), (273.31 +/- 12.42) and (248.34 +/- 10.41), which had statistically significant differences. Integrated optical density of the type II collagen positive area in cartilage matrix of the control group were (253.47 +/- 15.53), (215.67 +/- 9.72) and (160.01 +/- 13.23), which had statistically significant differences. At the same period, integrated optical density of the type II collagen positive area in cartilage matrix of the Pilose antler polypeptide-treatment group was higher than that of control group, which had statistically significant difference.</p><p><b>CONCLUSION</b>Pilose antler polypeptide can inhibit reduction of the glycosaminoglycan and type II collagen in cartilage matrix and delay the degeneration of articular cartilage.</p>

Study on correlation between the pathological changes under arthroscopy and the cytokine levels in the knee osteoarthritis of the Blood Stasis type / 中国骨伤

<p><b>OBJECTIVE</b>To explore the correlation between cytokine levels and the pathological changes under arthroscopy in knee osteoarthritis of Blood Stasis type.</p><p><b>METHODS</b>From 2009.2 to 2010.3, 90 patients with knee osteoarthritis were reviewed. Among the patients, 17 patients were male and 73 patients were female, ranging in age from 40 to 70 years, averaged 57.2 years, the duration of the disease ranged from 1 month to 10 years, with a mean of 3.4 years. Thirty-one patients had osteoarthritis in left knee, and 59 patients in right knee. The patients had the syndrome of blood stasis. All the patients had pain and morning stiffness; most patients had joint interlocking; and all the patients didn't have joint swelling. The synovial fluid was collected before surgery, and ELISA was used to detect the contents of interleukin-1beta and transforming growth factor-beta1. At the same time, the pathological changes of the joint were observed under the arthroscopy. Based on the above datum analysis, the severity of knee osteoarthritis of blood stasis type was studied, and the correlation between different types of pathological changes under arthroscopy and cytokine levels was analyzed.</p><p><b>RESULTS</b>The contents of IL-1beta and TGF-beta1 in synovial fluid were (28.18 +/- 5.57) pg/ml and (51.69 +/- 6.56) pg/ml respectively. The level of IL-1beta of grade III-IV cartilage degeneration was (30.65 +/- 3.48) pg/ml, which was significantly higher than (20.55 +/- 3.50) pg/ml of grade I-II cartilage degeneration group; the level of TGF-beta1 of grade I-II cartilage degeneration was (58.18 +/- 3.98) pg/ml,which was significantly higher than (49.59 +/- 5.83) pg/ml of grade II-IV cartilage degeneration group. IL-1beta and cartilage degeneration was positively correlated, the correlation coefficient was 0.744; TGF-beta1 and cartilage degeneration was negatively correlated, the correlation coefficient was -0.563. The level of IL-1beta of grade II-III synovial hyperplasia was (33.48 +/- 2.95) pg/ml, which was significantly higher than (25.40 +/- 4.50) pg/ml of grade I synovial hyperplasia group; IL-beta was positively correlated with synovial hyperplasia, the cor- relation coefficient was 0.801. The levels of IL-1beta of grade I osteophyte formation was (34.18 +/- 2.69) pg/ml, which was significantly higher than (25.74 +/- 4.48) pg/ml of grade 0 osteophyte formation group; the level of TGF-beta 1 of grade 0 osteophyte formation was (53.11 +/- 6.78) pg/ml, which was higher than (48.21 +/- 4.47) pg/ml of grade I osteophyte formation group. IL-1beta was positively correlated with osteophyte formation, the correlation coefficient was 0.762; TGF-beta1 was negatively correlated with osteophyte formation, the correlation coefficient was - 0.340.</p><p><b>CONCLUSION</b>All the patients with knee osteoarthritis identified as blood stasis syndrome have pathological changes such as articular cartilage degeneration and synovial hyperplasia. The level of IL-1beta has important reference value to estimate the severity of cartilage degeneration, synovial hyperplasia and osteophyte proliferation.</p>