Ratlarda deneysel osteokondral defektlerde intraartiküler hyalüronik asid ve ESWT (Extracorporeal Shock Wave Therapy) uygulamalarının karşılaştırılması
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Date
2012
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Düzce Üniversitesi
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info:eu-repo/semantics/openAccess
Abstract
Giriş ve Amaç: Eklem kıkırdağının düşük tamir yeteneği nedeniyle osteokondral defektlerin tedavisi pratikte zor bir konudur ve iyileşme mekanizması çok iyi bilinmemektedir. Ancak tedavi edilmezlerse lezyonların iyileşmesinde yetersizlik görülür. Hyalüronik asidin, in vitro çalışmalarda lökosit fonksiyonlarını azalttığı ve antiinflamatuvar etki gösterdiği, eklem içinde sürtünmeyi azalttığı ve ağrı kesici etkileri gösterilmiştir. Ekstrakorporeal şok dalga tedavisi (ESWT) çeşitli muskuloskeletal sorunların tedavisinde kullanılmaktadır. Etki mekanizması çeşitli büyüme faktörlerinin sentezini artırarak neovaskülarizasyonun artırılması ile mezenşimal kök hücrelerin migrasyon, proliferasyon ve diferansiasyonlarının artırılmasıdır. Bu çalışmada ratlarda deneysel oluşturulan osteokondral defektlerde intraartiküler HA ile ESWT uygulamasının etkinliklerinin karşılaştırılarak, osteokondral defektte ESWT'nin olumlu etkisini ortaya çıkarmak amaçlanmıştır.Gereç ve Yöntemler: Çalışmada her grupta 10 olmak üzere toplam 30 Wistar albino rat kullanılmıştır. Ratların sağ dizlerinde patellofemoral eklemin femoral yüzüne anestezi altında 1,5 mm çapında ve 2 mm derinliğinde silindirik tam kat osteokondral defekt dril ile oluşturulmuştur. 1. grupta (kontrol) ratlara herhangi bir tedavi uygulanmamıştır. 2. grupta (HA grubu) ratların dizlerine bir hafta arayla 3 kez intraartiküler 50 µg HA uygulanmıştır. 3. grupta (ESWT grubu) ratların dizine bir hafta arayla 3 kez ESWT (0,16 mJ/mm2 enerji yoğunluğunda 1000 puls) uygulanmıştır. Tedaviden 4 hafta sonra ratlar sakrifiye edilerek elde edilen preparatlar histopatolojik olarak değerlendirilmiştir.Bulgular: HA ve ESWT uygulanan tedavi gruplarının histopatolojik sonuçları tedavi edilmeyen kontrol grubuyla karşılaştırıldığında istatistiksel olarak anlamlı farklılık vardır. HA ve ESWT gruplarının histopatolojik sonuçları karşılaştırıldığında iki grubun etkinlikleri arasında anlamlı farklılık yoktur.Sonuç: ESWT, osteokondral defektlerin tedavisinde kullanılabilecek noninvaziv, yan etki ve komplikasyonu az, maliyeti düşük, tekrarlanabilir, cerrahi yöntemlere alternatif bir metod olabilir.
ABSTRACTBackground and Aim: Treatment of osteochondral defects is a difficult issue in practice because of a low ability to repair of articular cartilage and healing mechanisms are not well known. However, if they are not treated, it seen that the healing of the lesions is inadequate. In vitro studies, it?s shown that hyaluronic acid has anti-inflammatory effect, inhibits leucocyte function, makes anesthesia and decreases friction in the joint. Extracorporeal Shock Wave Therapy (ESWT) is used for the treatment of various musculoskeletal problems. Mechanism of ESWT enhance neovascularization by increasing the synthesis of various growth factors and increasing migration, proliferation and differentiation of mesenchymal stem cells. In this study, intended to reveal positive effect of ESWT on osteochondral defect by comparison HA injection and ESWT application in the experimental osteochondral defects in rats.Materials and Methods: Ten for each group and totally 30 Wistar albino rats were used in this study. 1.5 mm diameter and 2 mm deep cylindrical full-thickness osteochondral defect was created with drill on the femoral side of the patellofemoral joint of the right knee of rats under anesthesia. The first group (control) rats were not applied to any treatment. 50 µg HA intraarticular applied in knee of rats in 2nd group (HA group) 3 times a week apart. ESWT (0.16 mJ/mm2 1000 pulse energy density) was applied on knee of rats in 3th group (ESWT group) 3 times a week apart. The rats are sacrificed after 4 weeks of treatment and specimens obtained from rats are evaluated histopathologically.Results: Histopathological results of ESWT and HA treatment groups compared to the untreated control group, there is statistically significant differences. HA and the ESWT group compared with histopathologic results do not differ significantly between the two group efficiency.Conclusion: ESWT, which is noninvasive, cost-effective, reproducible, and has less side effects, may be used in the treatment of osteochondral defects as an alternative method for surgery.
ABSTRACTBackground and Aim: Treatment of osteochondral defects is a difficult issue in practice because of a low ability to repair of articular cartilage and healing mechanisms are not well known. However, if they are not treated, it seen that the healing of the lesions is inadequate. In vitro studies, it?s shown that hyaluronic acid has anti-inflammatory effect, inhibits leucocyte function, makes anesthesia and decreases friction in the joint. Extracorporeal Shock Wave Therapy (ESWT) is used for the treatment of various musculoskeletal problems. Mechanism of ESWT enhance neovascularization by increasing the synthesis of various growth factors and increasing migration, proliferation and differentiation of mesenchymal stem cells. In this study, intended to reveal positive effect of ESWT on osteochondral defect by comparison HA injection and ESWT application in the experimental osteochondral defects in rats.Materials and Methods: Ten for each group and totally 30 Wistar albino rats were used in this study. 1.5 mm diameter and 2 mm deep cylindrical full-thickness osteochondral defect was created with drill on the femoral side of the patellofemoral joint of the right knee of rats under anesthesia. The first group (control) rats were not applied to any treatment. 50 µg HA intraarticular applied in knee of rats in 2nd group (HA group) 3 times a week apart. ESWT (0.16 mJ/mm2 1000 pulse energy density) was applied on knee of rats in 3th group (ESWT group) 3 times a week apart. The rats are sacrificed after 4 weeks of treatment and specimens obtained from rats are evaluated histopathologically.Results: Histopathological results of ESWT and HA treatment groups compared to the untreated control group, there is statistically significant differences. HA and the ESWT group compared with histopathologic results do not differ significantly between the two group efficiency.Conclusion: ESWT, which is noninvasive, cost-effective, reproducible, and has less side effects, may be used in the treatment of osteochondral defects as an alternative method for surgery.
Description
YÖK Tez No: 311302
Keywords
Ortopedi ve Travmatoloji, Orthopedics and Traumatology, ESWL, ESWL, Eklemler, Joints, Hiyaluronik asit, Hyaluronic acid, Kıkırdak, Cartilage, Litotripsi, Lithotripsy, Osteokondrom, Osteochondroma, Sıçanlar, Rats, Şok-travmatik, Shock-traumatic, ESWT, osteokondral defekt, hyalüronik asit, şok dalgası, rat, ESWT, osteochondral defect, hyaluronic acid, shock wave, rats
