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Collagenase로 유도한 가토의 슬관절염에서 TGF-β1과 키토산-TGF-β1 복합체의 영향
장의찬 ( Eui Chan Chang ),송광섭 ( Kwang Sup Song ),정호중 ( Ho Jung Jung ),박영욱 ( Young Uk Park ),김미경 ( Mi Kyung Kim ) 대한슬관절학회 2006 대한슬관절학회지 Vol.18 No.2
목적: Collagenase type II로 유도한 가토의 슬관절염에서 TGF-β1과 키토산-TGF-β1 복합체의 영향을 알아보고자 하였다. 대상 및 방법: 가토 15마리의 우측 슬관절에 Collagenase를 실험 1일 및 4일째 두 번 주입하여 관절염을 유발한 후 실험 10일째 TGF-β1 (15 ng/mL, 1 mL, 1군), 키토산-TGF-β1 복합체(Chitosan: 5.8 g/mL, TGF-β1: 15 ng/mL, 1 mL, 2군), PBS(1 mL, 3군)을 각각 5마리씩 같은 부위에 주입하여 1주 간격으로 슬관절의 염증 소견 및 절름거림의 정도를 관찰하였다. 실험 4주째 관절연골과 활액막 조직을 얻어 각 군간의 육안적(India ink), 조직학적 소견(H&E, Safranin-O)을 평가(Kikuchi 점수)하였다. 결과: 외양상 염증 소견은 collagenase를 주사 후 1주 후에 가장 심하였으며, 이후로 각 군간 의미있는 차이는 없었으며, 절름거림의 정도는 3군에서 심했다. 육안적 소견은 2군에서 우수하였으며, 이러한 차이는 조직학적 평가에서 더욱 뚜렷하였다(1군: 평균 14±2.7, 2군: 평균 10.3±1.2, 3군: 평균 20.3±3.7) (p<0.05). 결론: Collagenase로 유도한 가토의 슬관절염의 회복에 과정에서 TGF-β1 단독 사용보다 키토산-TGF-β1 복합체의 사용이 효과적인 것으로 생각된다. Purpose; To evaluate the effects of the chitosan-TGF-β1 conjugate and TGF-β1 on osteoarthritic rabbit cartilage induced by collagenase type II. Materials and Methods; Chemical arthritis was induced in right knee of 15 rabbits by injection of collagenase type II (4 mg/mL, 0.25 cc) twice at day 1 and 4, and then each 5 rabbits were treated by intra-articular injection of TGF-β1 (15 ng/mL, 1 mL, group I), chitosan-TGF-β1 conjugate (Chitosan: 5.8 g/mL, TGF-β1: 15 ng/mL, group II) and PBS (1 mL, group III) at 10 days later in the same knees. The appearance of the injected knee joints and lameness were observed weekly. The articular cartilage and synovium obtained at 4 weeks were analysed by gross findings (India ink), histological examinations (H&E, Safrainin O) and evaluation through the Kikuchi score. Result; The osteoarthritic sign about knee joints was the most severe at 1 weeks after the initiation of collagenase injections, but there wasere no difference of 3 groups in osteoarthritic sign and lameness was most severe in group 3. Group 2 showed the most superior results in gross findings using india ink and the these results were more prominent in the evaluation of histological scoring (average scores of each group I:14±2.7, II:10.3±1.2, III:20.3±3.7). Conclusion; These results might suggest that, in the rabbit osteoarthritic knee model induced by collagenase, Chitosan-TGF-β1 conjugate is more effective than only TGF-β1 in inhibiting cartilage degeneration.
자가 골-슬개건-골을 이용한 두 터널 방법 후방 십자 인대 재건술 : 관절경적 재관찰 소견
염재광,정영복,장의찬 대한슬관절학회 1997 대한슬관절학회지 Vol.9 No.1
Authors analyzed the findings of nineteen cases of arthroscopic second-look operations after posterior cruciate ligament(PCL) reconstruction with autogenous bone-patellar tendon-bone(BPTB) and Trevira augmentation by two tunnel technique during the period from Nov, 1993 to Jan. l997 in fifty-one cases, along with the results of reconstruction in terms of clinical knee scoring, radiographical and arthroscopic findings. The results were as follows; Age ranged fmm 20 to 53 years, the average being 32.3 years. Thirteen cases(68%) had associated knee injuries; five medial collateral ligament(MCL) injuries, four lateral collateral ligament(LCL) injuries, two associated injuries of MCL and medial meniscus, one both menisci and one associated injury of anterior cruciate ligament and MCL. The average period from PCL injury to reconstruction was 7 weeks(range, 1 to 52 weeks) and the mean period from PCL reconstruction to second-look operation was 20.3 months(range, 10 to 46 months). The average Mu¨ller's knee score at the last follow-up was 86 points. The radiographical results: The distance of posterior translation of the PCL reconstructed knee compared with the normal side knee in posterior stress roentgenography was average 3.8mm(range, 0 to 11 mm). The position of the femoral bone block on the plane of extended Blumansaat's line, from the anterior end of the line, was average 32%. The level of proximal end of the tibial bone block according to the tibial tunnel orifice into the joint was mean negative 2.6 degrees position. The findings of arthroscopic second-look examination; In 9 cases(47%), the reconstructed ligaments were well covered with synovial tissue and looked like almost normal PCL. There were five cases(26%) of severe fragmentation, three cases(16%) of partial torn fibers of the grafted tendon. And one case showed the thinning of thc grafted tendon compared with the initial diameter at the time of reconstruction and one case showed overgrawth of the synovial membrane which surrounding the grafted tendon. All the Trevira which were augmented at the time of PCL reconstruction were ruptured. Twelve cases(63%) were stable, three cases(16%) were slightly lax and 4 cases(21%) showed laxity of the grafted tendon by the posterior drawer test and probing under arthroscopy. The isometricity which was checked at the time of PCL reconstruction was average 3.4mm. From the ahove results, PCL reconstruction with autogenous BPTB by the two tunnel technique seemed to be a valuable procedure, but there were some cases of unfavorable results. Authors think that a new graft fixation method is needed for resolving the problem mentioned above.
슬관절의 퇴행성 골관절염 환자에 대한 관절경적 수술의 유용성
염재광,정영복,류호성,장의찬 대한슬관절학회 1998 대한슬관절학회지 Vol.10 No.1
The arthroscopic procedure has been one of the useful treatment modalitis in osteoarthritis of the knee, which does not respond to conservative treatment. Authors reviewed the results of 61 cases of 61 patients(18 males and 43 females) that had been treated with arthroscopic procedures including arthroscopic simple lavage, partial menisectomy, removal of the loose bodies, synovectomy and chondroplasty. The purpose of this study is to evaluate indication and effectiveness of arthroscopic surgery for osteoarthritic knee. 1. Seventy-one percent of sixty-one patients had relief of pain and other clinical symptoms after arthroscopic procedures. 2. Sixty-one percent were still good at last follow-up more, than one year. 3. The favorable results were obtained after removal of loose bodies or partial menisectomy in association with osteoarthritic knee compared with the other procedures. And the poor results were obtained in patients with severe degenerative changes and severe cartilage defects of both femoral condyles. 4. The normal-alignment knees had much better results after arthroscopic surgery compared with valgus or varus knees. Our results suggest that arthroscopic surgery can be one of the good alternative treatment methods for osteoarthritic knee and a time-saving procedure before arthroplastic surgery.