目的：观察针刀松解法对膝骨关节炎(KOA)兔软骨基质金属蛋白酶-3(MMP-3)和Ⅱ型胶原(Col-Ⅱ)的影响,探讨针刀治疗KOA的机制。方法将40只清洁级6月龄健康新西兰兔随机取10只为空白组,剩余30只统一造模,关节制动方法制造KOA模型,造模成功后将30只兔随机分为模型组、针刀组和电针组,每组10只。针刀组以膝关节内外侧副韧带及髌韧带为松解对象,以纵疏、横剥法进行针刀松解,每星期1次,共治疗3次；电针组取阴陵泉、阳陵泉、内膝眼、犊鼻穴,电针频率2～100 Hz,强度为3 mA,每次电针20 min,每星期治疗3次,共治疗3星期。光镜观察软骨形态改变,Western blot法检测膝关节软骨Col-Ⅱ、MMP-3蛋白表达水平。结果 HE染色模型组家兔膝关节滑膜存在不同程度增生、水肿,光镜下见模型组关节软骨呈明显退行性变。电针组和针刀组软骨组织损伤减轻,且有修复趋势。针刀组兔膝关节软骨破坏程度明显减轻。针刀组Col-Ⅱ蛋白表达较模型组明显升高(P＜0.01)；针刀组 Col-Ⅱ蛋白表达与电针组比较,差异具有统计学意义(P＜0.05)；模型组 Col-Ⅱ蛋白表达水平降低,与其他各组比较差异均有统计学意义(P＜0.05)。模型组 MMP-3蛋白表达较空白组明显升高(P＜0.01)；针刀组MMP-3蛋白表达较空白组降低,但无统计学意义(P＞0.05)；针刀组MMP-3蛋白表达与模型组和电针组比较,差异均具有统计学意义(P＜0.01,P＜0.05)。结论针刀松解治疗KOA兔,能够使软骨MMP-3水平下降,Col-Ⅱ表达水平升高,从而阻抑软骨退变,起到治疗作用。%Objective To investigate the effect of acupotomy lysis on the expressions of cartilage matrix metalloproteinase-3 (MMP-3) and typeⅡ collagen (Col-Ⅱ) in rabbits with knee osteoarthritis (KOA).Methods Of 40 6-month-old healthy New Zealand rabbits of clean grade, 10 were randomly selected as a blank group and the other 30 were used for model making. A KOA model was made by joint immobilization. After successful model making, the 30 rabbits were randomized into model, acupotomy and electroacupuncture groups, 10 rabbits each. The acupotomy group received acupotomy lysis of knee lateral collateral ligaments and patellar ligament by longitudinal loosening and transverse stripping, once a week for a total of three times. The electroacupuncture group was given electroacupuncture at points Yinlingquan, Yanglingquan, media Xiyan and Dubi, at a frequency of 2-100 Hz and an intensity of 3 mA, 20 min thrice a week for a total of three weeks. Morphological changes in the cartilage were observed by optical microscopy. The expressions of Col-Ⅱ and MMP-3 in knee cartilage were determined by Western blotting. Results HE staining showed different degrees of hyperplasia and edema of knee joint synovium in the model group of rabbits. Optical microscopy showed an obvious degenerative change in the articular cartilage in the model group. Injury to the cartilage tissue was reduced and had a tendency to be repaired in the electroacupuncture and acupotomy groups. Knee cartilage destruction was significantly reduced in the acupotomy group of rabbits. Col-Ⅱ expression was higher in the acupotomy group than in the model group (P<0.01). There was a statistically significant difference in Col-Ⅱ expression between the acupotomy and electro- acupuncture groups (P<0.05). Col-Ⅱ expression was low in the model group and there was a statistically significant difference compared with the other groups (P<0.05). MMP-3 expression was significantly higher in the model group than in the blank group (P<0.01). MMP-3 expression was lower in the acupotomy group than in the blank group (P<0.01) but there was no statistically significant difference (P>0.05). There was a statistically significant difference in MMP-3 expression between the acupotomy group and the model or electroacupuncture group (P<0.01,P<0.05).Conclusions Acupotomy lysis can reduce cartilage MMP-3 level and increase Col-Ⅱ expression to prevent cartilage degeneration and produce a therapeutic effect in the treatment of KOA rabbits.
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