| 张丽,李传根,许明军.体外冲击波联合电热针治疗膝骨关节炎的研究[J].中国康复,2025,40(2):67-71 |
| 体外冲击波联合电热针治疗膝骨关节炎的研究 |
| Multimodal ultrasound technique to evaluate the effect of extracorporeal shock wave combined with electrothermal acupuncture on cartilage protection in knee osteoarthritis |
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| DOI：10.3870/zgkf.2025.02.001 |
| 中文关键词: 膝骨关节炎 体外冲击波 电热针 超声多模态技术 软骨保护 |
| 英文关键词: knee osteoarthritis extracorporeal shock wave electrothermal acupuncture ultrasonic multimodal technology cartilage protection |
| 基金项目: |
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| 摘要点击次数: 706 |
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| 中文摘要: |
| 目的：研究体外冲击波联合电热针干预对膝骨关节炎（KOA）大鼠模型的治疗效果。方法：选取43只无特定病原体（SPF）级健康雄性SD大鼠，其中33只大鼠用于制作KOA模型，将建模成功后的30只大鼠分为模型对照组、体外冲击波治疗（ESWT）组、联合治疗组，10只/组。另将10只未建模大鼠列为正常对照组。正常对照组及模型对照组不进行干预；ESWT组在造模24h后开始进行EWST干预，1次/周，连续3周；联合治疗组进行ESWT联合电热针干预，ESWT干预方法与ESWT组相同，电热针为隔天1次，20min/次，共20次。干预前后分别检测各组大鼠的肿胀足体积及足底压痛阈值，采用超声多模态技术检测膝关节超声弹性应变率比值及达峰时间，用酶联免疫吸附法（ELISA）检测关节液中白细胞介素6（IL-6）、白细胞介素1β（IL-1β）、肿瘤坏死因子-α（TNF-α）水平，苏木素-伊红（HE）染色法检测膝关节组织病理变化，免疫印迹法（WB）检测关节软骨中基质金属蛋白酶3（MMP-3）、基质金属蛋白酶9（MMP-9）表达水平。结果：与正常对照组比较，模型对照组足肿胀程度、膝关节超声弹性应变率比值、关节液IL-6、IL-1β 、TNF-α、MMP-3、MMP-9蛋白均升高，足底压痛阈值降低，达峰时间缩短（均P<0.05）；与模型对照组比较，ESWT组和联合治疗组足肿胀程度、膝关节超声弹性应变率、关节液IL-6、IL-1β 、TNF-α、MMP-3、MMP-9蛋白水平均降低，足底压痛阈值升高、达峰时间延长（均P<0.05），且联合治疗组足肿胀程度、膝关节超声弹性应变率比值、关节液中IL-6、IL-1β 、TNF-α、MMP-3、MMP-9蛋白均低于ESWT组（均P<0.05），足底压痛阈值、达峰时间高于ESWT组（均P<0.05）。HE染色结果显示，正常对照组大鼠软骨结构完好；模型对照组大鼠软骨损伤及炎症浸润明显；ESWT组和联合治疗组大鼠软骨结构较模型对照组有所改善，表面趋于光滑、完整、清晰。结论：体外冲击波联合电热针对大鼠KOA具有较好的治疗作用，具有潜在的临床应用价值。 |
| 英文摘要: |
| Objective: To explore the effect of ultrasonic multimodal technique in evaluating the protection of cartilage by extracorporeal shock wave therapy (ESWT) combined with electrothermal acupuncture in knee osteoarthritis (KOA). Methods: A total of 43 healthy male SD rats with SPF grade were selected, 33 of which were used to establish KOA model. The 30 rats after successful modeling were divided into model control group, ESWT group, combined treatment group, 10 rats/group, and the rest 10 rats served as normal control group. Normal control group and model control group were not treated. The ESWT group received EWST intervention once a week for 3 consecutive weeks 24 h after modeling. The combined treatment group received ESWT combined with electrothermal acupuncture, and the intervention method of ESWT was the same as that of ESWT group, with electrothermal acupuncture once every other day, 20 min/ time, a total of 20 times. The degree of foot swelling and the threshold of plantar tenderness were detected before and after the intervention, and the ultrasonic elastic strain rate and peak time of knee joint were detected by ultrasonic multimodal technique. The levels of interleukin-6 (IL-6), IL-1β and tumor necrosis factor-α (TNF-α) in joint fluid were detected by enzyme-linked immunosorbent assay (ELISA), and the his-topathologic changes of knee joint were detected by hematoxylin-eosin (HE) staining. The expression levels of matrix metalloproteinase 3 (MMP-3) and MMP-9 in articular cartilage were detected by Western blotting. Results: Compared with the normal control group, the swelling degree of foot, the ultrasonic elastic strain rate, serum IL-6, IL-1β, TNF-α, MMP-3 and MMP-9 proteins were increased in the model group, and the pain threshold and time to peak were decreased (P<0.05). Compared with model group, foot swelling degree, ultrasonic elastic strain rate, serum IL-6, IL-1β, TNF-α, MMP-3 and MMP-9 proteins were decreased in ESWT group, and pain threshold and time to peak were increased (P<0.05). Compared with ESWT group, the degree of foot swelling, the ultrasonic elastic strain rate and IL-6, IL-1β, TNF-α, MMP-3 and MMP-9 proteins in joint fluid were decreased in combined group, and the pain threshold and time to peak were increased (P<0.05). HE staining showed that the cartilage structure of the normal control group was intact. In the model group, the cartilage injury and inflammatory infiltration were severe. The cartilage structure of rats in all treatment groups was improved, and the surface tended to be smooth, complete and clear, among which the improvement of the combined group was the most significant. Conclusion: ESWT combined with electrothermal acupuncture has a good effect in the treatment of knee osteoarthritis, and it is found that the combined treatment has a good effect on cartilage protection through ultrasonic multimodal technology. |
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