膝关节干细胞注射疗法演示文档.ppt
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膝关节腔内注射Sox9转染骨髓间充质干细胞修复膝关节骨关节炎卓群豪;张伟娜;李舰;王红卫;郑峰;应彬彬【摘要】BACKGROUND:Bone marrow mesenchymal stem cel s are considered to have good proliferation and differentiation potentials. Sox9 is a transcription factor that is essential for chondrogenesis and has been termed as a“master regulator”of the chondrocyte phenotype. OBJECTIVE:To study the therapeutic effects of Sox9-transfected bone marrow mesenchymal stem cel s on knee osteoarthritis. METHODS:The bone marrow mesenchymal stem cel s were transfected with Lenti-Sox9-EGFP in vitro. The model of murine knee osteoarthritis was established by cutting off the anterior cruciate ligament. Thirty model mice were randomly divided into three groups, as normal saline group, bone mesenchymal stem cel group and Sox9-transfected bone mesenchymal stem cel group. 0.1 mL of normal saline, 0.1 mL of normal saline containing non-transfected bone marrow mesenchymal cel s (non-transfected group), or 0.1 mL of normal saline containing Sox9-transfected bone marrow mesenchymal cel s (Sox9-transfected group) was injected into the knee joint cavity of mice in the corresponding group, respectively. After 4, 8, 12 weeks, the repair of articular cartilage lesions was evaluated by toluidine blue and immunohistochemical staining. RESULTS AND CONCLUSION:The lesions of articular cartilage were more serious in the normal saline group, compared with the other two groups, and the difference became moreobvious over time. Damaged articular cartilage was improved in the non-transfected group, but the improvement was less than that in the Sox9-transfected group. Immunohistochemistry staining revealed that in theSox9-transfected group, the positive type II col agen expression was stronger than that in the other two groups, but this positive expression was decreased over time in al the three groups. These results suggest that Sox9-transfected bone marrow mesenchymal stem cel s promote the repair of damaged cartilage in mice with knee osteoarthritis.%背景:相关研究认为,骨髓间充质干细胞具有良好的增殖及分化能力,Sox9转录因子在软骨形成及维持软骨细胞表型方面起关键作用。
膝关节注射治疗动画演示关节是骨间及骨突间的连接部分,其生物力学功能主要是承受压缩、牵拉、剪切、扭转等不同类型的负荷,并在此基础上为骨的活动提供一定范围的生理活动。
膝关节及关节周围病变可引起疼痛。
关节炎症常表现为疼痛、软组织肿胀僵硬,除引起本身关节破坏外,还可以引起关节周围的肌肉萎缩。
关节腔注射治疗是限制关节损害进一步加剧的主要治疗措施之一。
关节及关节周围注射长效类固醇药物能有效缓解关节炎症。
透明质酸钠注射则具有慢效缓解症状及改善骨关节炎病情的价值。
操作方法及程序1.膝前痛点注射(1)患者取仰卧屈膝,膝下垫枕使关节屈曲(髌尖注射时取膝关节伸直位)(2)进针点:根据不同病变选取,如侧副韧带起止点附着部、交叉韧带(髌韧带正中)、半月板(内、外膝眼)、髌上滑囊(髌骨上)、脂肪垫(髌韧带两侧)、内外关节间隙等(3)经进针点快速进针达病变处,向肌腱、韧带的起止点方向注射,或注射至病变的滑囊、脂肪垫,每点注射药液量5ml2.膝后痛点注射(1)取俯卧位,膝前垫枕(2)进针点:根据压痛部位选取。
多取在构成腘窝的诸肌与其肌腱的移行处或止点,如股二头肌止点即腓骨头,半膜肌止点即胫骨内侧髁下缘,腓肠肌内外侧头止点即股骨内外上髁(3)经进针点快速进针达病变处,向肌腱、韧带的起止点方向注射,或注射至病变的滑囊、脂肪垫,每点注射药液量5ml3.膝关节腔注射(1)取俯卧位,膝前垫枕(2)进针点:膝前进针点可取内外膝眼或髌上囊入路(即髌骨外上缘外),膝后进针点取腘窝中点上(3)用7号8cm长针,经进针点垂直皮面快速进针,遇关节囊时稍有韧感,突破关节囊有落空感,注液注气无阻力,如关节腔内有积液,可先抽出后再注射药液。
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