| ObjectiveExploring the application of MRI diffusion-weighted imaging (DWI) technology and cartilage biological marker of synovial fluid detection method, with gross observation in operation and histopathological results, we comprehensively analyze articular cartilage lesions condition of ONFH (ARCO, Ⅲ stage). This study is to compare the cartilage activity and function between different groups of ONFH (ARCO, Ⅲ stage), analyze the key clinical factors affecting the cartilage status and further to determine the correlation between cartilage lesions of ONFH (ARCO Ⅲ stage) and TCM syndrome types. It is contribute to reveal the material basis of Chinese medicine syndrome and provide the oretical and clinical evidence to select the appropriate patients, formulate reasonable surgery program to retain the femoral head, use syndrome differentiation theory, play the overall advantages of Chinese medicine, improve the efficacy of ONFH.Methods1the study of MRI diffusion-weighted imaging on articular cartilage of ONFH32patients (47hips) of ONFH and10(10hips) negative patients were imaged by Philips Achieva1.5T MR scanner. The scan sequences included T1WI, T2WI, PDWI and DWI. After image post-processing, the ADC mean value of region of interest (ROI) was measured.2the study of synovial fluid of CTX-II of ONFHSynovialfluid liquid (2～5ml) of38ONFH patients (43hips) and6(4hips,2knees) negative patients were extracted in the operation. Within2hour, specimens from the supernatant after centrifugation were put in the Eppendorf tube, quick frozen, stored in-80℃deep hypothermic refrigerator. Synovial fluid CTX-Ⅱ concentration was measured by the double antibody sandwich enzyme-linked immunosorbent assay.3the study of articular cartilage histopathological of ONFHOne cartilage (1×1cm) from36patients (44hips) of ONFH and8(6hips,2knees) negative control patients were taken in the operation. HE staining, Safranin0staining and type II collagen immunohistochemical staining were performed. All specimens were scored according to the degree of cartilage damage by Mankin articular cartilage score. Immunohistochemical staining of collagen type Ⅱ was analyzed by Image-Pro Plus image analysis software (Version6.0) and Pathological Photo Management System (Version3.0)We observed patients general information, collapse extent, pain duration, etiology and TCM syndrome type and analyzed the relationship between above factors and cartilage ADCav, CTX-Ⅱ concentration, Mankin's articular cartilage score and collagen type Ⅱ expression. Measurement data was presented as mean±standard deviation (x±s) and dealed with SPSS19.0software package. Any two groups were compared with one-way ANOVA, correlation analysis based on the data type with Pearson or Spearman rank correlation analysis, consistency test using the weighted Kappa coefficient, influencing factors were analyzed with multiple logistic regression analysis. Differences were considered significant at P<0.05. Results1the study of MR I diffusion-weighted imaging on articular cartilage of ONFH(1) articular cartilage ADC value in comparison①Collapse ExtentONFH groups cartilage ADC value was significantly higher than the negative group. There was not significant difference (P=0.459) between stage Ⅱ group and the negative group. There was statistically significant difference (P <0.01) between Stage Ⅲ groups and the negative group, respectively. The differences between stage II group and stage III groups respectively, were statistically significant (P<0.05)②Pain Duration<6months group ADC value was lower than6-11months group and≥12months group, and the differences were statistically significant (P<0.05). There was not significant difference (P>0.05) between6-11months group and≥12months group. ③EtiologyThere was not statistically significant difference (P>0.05) between any two groups.④TCM Syndrome TypesADC value in blood stasis and qi stagnation type and phlegm and stasis accumulation type was lower than kidney deficiency and blood stasis type, and the difference was statistically significant (P<0.01). There was not significant difference (P>0.05) between blood stasis and qi stagnation type and phlegm and stasis accumulation type.(2) correlation analysis of articular cartilage ADCav value and impact factorsSpearman rank correlation coefficients were0.807,0.622,0.720(P<0.01),-0.247(P=0.094>0.01) between ONFH articular cartilage ADCav value and collapse extent, pain duration, syndrome types and etiology, respectively.2the study of synovial fluid CTX-Ⅱ of ONFH(1) synovial fluid CTX-Ⅱ content in comparison①Collapse ExtentONFH groups synovial fluid CTX-II content was significantly higher than the negative group. There was not significant difference (P=0.109) between stage IIIA group and the negative group. The differences between stageⅢB group, stage IIIC group and negative group respectively, were statistically significant (P<0.01). There was statistically significant difference (P <0.05) between any two groups of stage Ⅲ.②Pain DurationThere was not significant difference (P=0.09) between<6months group and the negative group. CTX-II content in6-11months group and≥12months group was higher than the negative group, and the difference was statistically significant (P<0.01).<6months group was lower than6-11months group and≥12months group, and the differences were statistically significant (P<0.05). There was not significant difference (P>0.05)between6-11months group and≥12months group.③EtiologyThere was not statistically significant difference (P>0.05) between any two groups.④TCM Syndrome TypesThere was not significant difference (P=0.192) between blood stasis and qi stagnation type and the negative group. CTX-Ⅱ content in phlegm and stasis accumulation type and kidney deficiency and blood stasis type was higher than negative group, and the difference was statistically significant (P<0.01) Blood stasis and qi stagnation type was lower than phlegm and stasis accumulation type and kidney deficiency and blood stasis type, and the differences were statistically significant (P<0.05). There was not significant difference (P>0.05) between phlegm and stasis accumulation type and kidney deficiency and blood stasis type.(2) correlation analysis of synovial fluid CTX-Ⅱ content and impact factorsSpearman rank correlation coefficients were0.943,0.595,0.618(P<0.01),0.112(P=0.476>0.01)between ONFH synovial fluid CTX-Ⅱ content and collapse extent, pain duration, syndrome types and etiology, respectively.3the study of articular cartilage histopathological of ONFH(1) articular cartilage Mankin score in comparison①Collapse ExtentONFH groups articular cartilage Mankin score were significantly higher than the negative group, and the differences Were statistically significant (P<0.01). Between any two groups of ONFH, the difference was statistically significant (P<0.05)②Pain DurationBetween any two groups, the difference was statistically significant (P <0.05).③EtiologyThere was not statistically significant difference (P>0.05) between any two groups.④TCM Syndrome TypesBlood stasis and qi stagnation type Mankin score was lower than phlegm and stasis accumulation type and kidney deficiency and blood stasis type, and the differences were statistically significant (P<0.05). There was not significant difference (P>0.05) between phlegm and stasis accumulation type and kidney deficiency and blood stasis type.(2) articular cartilage type Ⅱ collagen expression in comparison①Collapse ExtentONFH groups mean density and positive units value were lower than the negative group, and the differences were statistically significant (P<0.01). Between any two groups of ONFH, the difference was statistically significant (P<0.05)②Pain DurationDifferences of mean density between any two groups were statistically significant (P<0.05). Positive units value in<6months group was higher than6-11months group and≥12months group, and the differences were statistically significant (P<0.05). There was not significant difference (P>0.05) between6-11months group and≥12months group.③EtiologyThere was not statistically significant difference (P>0.05) between any two groups.④TCM Syndrome TypesMean density of blood stasis and qi stagnation type was higher than phlegm and stasis accumulation type and kidney deficiency and blood stasis type, and the differences were statistically significant (P<0.05). Difference of positive units value between any two groups was statistically significant (P<0.05).(3) correlation analysis of articular cartilage Mankin score and impact factorsSpearman rank correlation coefficients were0.662,0.680,0.770(P<0.01),-0.241(P=0.114>0.01) between ONFH articular cartilage Mankin score and collapse extent, pain duration, syndrome types and etiology, respectively.(4) correlation of articular cartilage type II collagen expression and impact factors①Mean DensitySpearman rank correlation coefficients were-0.613,-0.671,-0.751(P <0.01),0.247(P=0.106>0.01) between ONFH type II collagen immunohistochemical mean density and collapse extent, pain duration, syndrome types and etiology, respectively.②Positive Units ValueSpearman rank correlation coefficients were-0.669,-0.657,-0.780(P <0.01),0.275(P=0.071>0.01) between ONFH type II collagen Immunohistochemical positive units value and collapse extent, pain duration, syndrome types and etiology, respectively.(5) consistency of generally pathological grade and Mankin pathological gradeSpearman rank correlation coefficient was0.894(P=0.000<0.01) between articular cartilage generally pathological grade and Mankin pathological grade. The consistency test showed that the weighted Kappa coefficient was0.78(P<0.05).(6) correlation of articular cartilage ADC value and Mankin pathological gradeSpearman rank correlation coefficient was0.887(P<0.01) between articular cartilage ADC value and Mankin pathological grade.(7) correlation of synovial fluid CTX-Ⅱ content and Mankin pathological gradeSpearman rank correlation coefficient was0.537(P<0.01)between synovial fluid CTX-Ⅱ content and Mankin pathological grade.(8) multiple Logistic regression analysis of articular cartilage Mankin pathological gradeIf ONFH collaps in a light extent, pain in a short time, or in blood stasis and qi stagnation type, the probability of articular cartilage Mankin pathological grade to be mild or moderate was greater than the severer.Conclusion1The study preliminarily confirmed that ONFH collapse<2mm, pain duration <6months, the cartilage lesions were in a lesser extent. With the collapse extent severer and pain time longer, cartilage lesions were gradually worsened.2There were correlation between the ONFH cartilage lesion status and collapse extent, pain duration and age, wheres, no correlation with etiology.3There was correlation between ONFH cartilage lesion and TCM syndrome types. In brief, cartilage lesion in blood stasis and qi stagnation type was to a lesser extent, however, the phlegm and stasis accumulation type and kidney deficiency and blood stasis type were to a severer extent.4ONFH cartilage lesion status can be assessed by collapse extent, pain duration and age. And the assessment can provide a guidance for the treatment of osteonecrosis of femoral head. |
PDF Full Text Request