Acute effect of bipolar radiofrequency energy on human knee articular cartilage★

Abstract

AIM： To evaluate the therapeutic effect of bipolar radiofrequency energy in fibrillated cartilage.

METHODS：The experiment was carried out in the laboratory of the Department of Orthopaedics, Second Affiliated Hospital, Suzhou University from August 2005 to December 2006. ①The fibrillated cartilage of twenty-two femoral condyles of eleven knees from 9 cases after total knee arthroplasty were enrolled. With Atlas DNR operation system produced by American Jiexi Shiye Co., Ltd. and 3.5 mm Right Angle radiofrequency head, the energy was composed of 0 grade, 2 grade and 6 grade. ②The cartilage with outerbridge classification Ⅱ or Ⅲ partial-thickness lesions were divided into three districts: district one: sham operation group; district two: treatment group using radiofrequency energy of grade two; district three: treatment group using radiofrequency energy of grade six. Lavaged by saline of room temperature with equal speed, the radiofrequency energy of grades two and six was performed until smooth surface of samples and slight change of color were produced. The treating mode was same in shame operation group, although radiofrequency energy was shut. ③The samples were sent for histological observation after being fixed in 40 g/L formalin. Another two cartilage samples of outerbridge Ⅱ lesions were selected to be treated by radiofrequency energy of grade six or sham operation, respectively, and then sent for analyzed by scan electron microscope (SEM).

RESULT:①Gross inspection: the cartilage surface of sham operation group was pale and roughness; smooth surface was acquired after treatment. No significant difference appeared between grade two and grade six group. ②HE staining observation: accidented surface with fibrillar fragment was found in sham operation. Smooth surface with chondrocytes variably filling the lacunae was observed after treatment, no histological differences among the sites treated by different settings. Masson staining found significant fibrilar surface of cartilage in the sham operation group, and deep blue stain was found under fibrillar surface, while shallow in basilar part. Smooth surface of cartilage appeared after treatment. No obvious effect was found by collagen staining. No difference was found in Masson staining after treatment of different grade. ③SEM: A rough surface with fibrillar fragment was presented in partial-thickness lesions district. The fiber was melt and surface became smooth without fribrillar fragment after treatment.

CONCLUSION：After fibrillated articular cartilage received radiofrequency energy, its surface and matrix are improved satisfactorily.

摘要
目的：了解双极射频能量对纤维化软骨的治疗效应。
方法：实验于2005－08/2006－12在苏州大学附属第二医院骨科实验室完成。①选用全膝置换术后的股骨髁软骨共9例11膝，内外髁分成不同样本，共计22份。采用美国杰西实业有限公司的Atlas等离子手术系统，3.5 mm Right Angle射频头，能量设置分别为：0级、2级、6级。②选择股骨髁表面软骨Ⅱ级或Ⅲ级病变区域，将其分成3个区：1区：假手术组，2区：2级射频能量治疗组，3区：6级射频能量治疗组。在室温生理盐水匀速持续灌洗状态下，分别用2，6级射频能量治疗，直至大体观察表面平整，色泽轻度改变。假手术组不开射频，只是模拟射频治疗。③术后将样本分别置于40 g/L甲醛溶液中固定进行组织学检查。另取二处Ⅱ级病变区域，选择一块作6级射频治疗，另一块假手术处理，处理后送作扫描电镜检查。
结果：①股骨髁表面软骨大体观察：可见假手术组关节软骨表面苍白，纤维毛糙；治疗区关节软骨表面光滑，平整。在2级能量作用区和6级能量作用区并没有发现外观上的明显差异。②组织学观察：苏木精-伊红染色见假手术组软骨表面凹凸不平，有纤维碎片形成。治疗区软骨表面平滑，软骨陷窝间或呈空泡状，不同能量设置的切片观察结果相似。Masson染色发现假手术组软骨表面纤维化明显，在纤维化的软骨表面下可以见到蓝染加深，而基底部相对较浅。治疗区软骨表面平整，对胶原染色没有明显影响。不同能量设置的切片观察结果相似。③扫描电镜结果：显示病变软骨表面纤维化明显，纤维碎片形成。治疗后可见胶原纤维融合，表面变平，碎片消失。
结论：纤维化软骨经过射频治疗后，其表面形态及基质得到了良好的改善。
关键词：导管消融术；软骨，关节；纤维化

茅泳涛，董启榕.双极射频能量对人膝关节软骨的急性效应[J].中国组织工程研究与临床康复，2007，11(5):868-871
[www.zglckf.com/zglckf/ejournal/upfiles/07-5/5k-868(ps).pdf]