玻璃酸钠、糖皮质激素与生理盐水治疗实验性兔颞颌关节骨关节炎的疗效比较

目的探讨玻璃酸钠治疗不同病因兔颞颌关节(temporomandibular joint,TMJ)骨关节炎的疗效,并与糖皮质激素和生理盐水进行比较。方法39只3月龄新西兰白兔,18只左TMJ注射木瓜蛋白酶造成骨关节炎,18只左TMJ创伤髁突软骨造成骨关节炎,右TMJ为对照侧,3只为健康对照。分别于第1、5、9周开始向关节内注射药物治疗。每种骨关节炎动物随机分成3组,分别接受强的松龙、玻璃酸钠和生理盐水治疗。每周治疗1次,共4次,每次均注射0.2 ml,同一只动物左右侧关节均接受同一种药物。疗程结束后第4周处死动物,病理学检查,计分,进行统计学分析。结果两种方法均能使累及关节造成中等严重骨关节炎,模型制作成功。与生理盐水组相比,强的松龙治疗后病损加重,而用玻璃酸钠治疗各组均可见病变程度减轻及软骨修复。两组差别接近统计学显著差异界值(P=0.06)。健康关节内注射强的松龙或玻璃酸钠仅发生了轻微病变。结论玻璃酸钠对不同病因不同病程的兔颞颌关节骨关节炎均有疗效,糖皮质激素无助于软骨的修复,反而加重骨关节炎病变。

Comparative study on effects of sodium hyaluronate, glucocorticoids and saline on the temporomandibular joint osteoarthritis of rabbits

Objective To explore the effects of sodium hyaluronate on papain induced and traumatic temporomandibular joint(TMJ) osteoarthritis of rabbits in comparison with prednisolone and saline.Methods Thirty-six New Zealand white rabbits were used to make TMJ osteoarthritic model and 3 as healthy controls.In order to make osteoarthritis models,the left TMJs of 18 rabbits were injected papain,and another left TMJs of 18 rabbits were traumaticly.The right TMJs were left as self-control.Three treatments were randomly assigned to the left TMJs of each arthritic group,include: sodium hyaluronate,prednisolone and saline.The treatments were given at first,fifth and ninth week respectively for 4 times,once per week,each time 0.2ml per lower joint compartment with same agent for both sides of each animal.Four weeks after treatment the animals were sacrificed.Pathological examinations were given and pathological scores were recorded for comparison.Results Both trauma and papain injection in the TMJs produced osteoarthritis were moderate severity.Comparative with Saline injection,the joint pathology become more severe after prednisolone injection,while improved after delivering of sodium hyaluronate,reparative process being seen in arthritic condylar cartilage.Deference between two pathological score means reached nearly significant level(P=0.06).Intraarticular injection of prednisolone or sodium hyaluronate into the healthy TMJs brought only about slight pathological changes.Conclusion Sodium hyaluronate shows beneficial effects for whatever cause of TMJ osteoarthritis.Glucocorticoids do not help for repairing articular cartilage,in contrast it would aggravate pathology of TMJ osteoarthritis.