[Correlation of clinical joint function with histopathological features of knee joint fibrosis].

• DOI: 10.3760/cma.j.cn112151-20220302-00141
• Publication Date: 2022-12-08
• Authors: Xin Chen; L H Gong; Xiang Shao; Yixuan Sun; Yi S. Ding
• Keywords: Arthrofibrosis; Grading (engineering)

Objective: To investigate the correlation between joint function and histologic grading after total knee arthroplasty, to aid in early diagnosis prognostication of arthrofibrosis. Methods: A 29 patients including 22 females 7 males were enrolled retrospectively from October 2015 2020. These had a mean age 63 years (range 41 79 years) underwent revision Jishuitan Hospital due contraction or loss range motion. Histologic assessment was carried out by utilizing immunohistochemistry (IHC) Masson staining evaluate fibrosis inflammation samples. Results: By light microscopy, stage arthrofibrosis showed massive proliferation myofibroblasts fibroblasts with SMA expression IHC. In late arthrofibrosis, hyaline degeneration occured extensive hyperplasia fibrosis-related tissue. The samples appeared blue staining. Lymphocytes perivascular distribution. tissue mostly grade 3 (26 samples) assessment, moderate (25 ALVAL score, 1 (23 lymphocyte grading. Fibrosis an overwhelming motion (ROM) joint. score highly correlated WOMAC score. There also direct inflammatory cell infiltration pain. good predictive value replacement surgery. Conclusions: is closely values for prognosis surgery.目的： 探讨人工膝关节置换术后关节纤维化患者病理组织学分级与关节功能的相关性，为关节纤维化的早期组织学诊断及预后预测提供依据。 方法： 回顾性分析2015年10月至2020年10月于北京积水潭医院行人工膝关节置换术，由于术后关节纤维化导致的关节屈曲或者伸直活动受限而行关节翻修术的病例，共29例，女性22例，男性7例。年龄41~79岁，平均63岁。进行组织学观察及无菌性淋巴细胞为主型血管炎相关病变（Aseptic Lymphocytic Vasculitis Associated Lesion，ALVAL）评分，对纤维化及炎性细胞进行分级评估，并辅助免疫组织化学染色及特殊染色。 结果： 镜下关节纤维化的早期病理改变为肌纤维母细胞及纤维母细胞增生，后期广泛纤维组织增生伴玻璃样变性。免疫组织化学显示平滑肌肌动蛋白阳性，Masson染色显示蓝色。淋巴细胞散在分布或灶状聚集。组织学评分显示纤维化以3级居多（26例），淋巴细胞分级以1级居多（23例），ALVAL评分以中度多见（25例）。纤维化评分和关节活动度呈现极高的相关度。ALVAL评分与西安大略和麦克马斯特大学关节炎指数（Western Ontario McMaster Universities Arthritis Index，WOMAC）评分有较高的相关性。炎性细胞浸润程度与患者的疼痛程度评分直接相关。纤维化联合ALVAL评分对于关节置换术后关节功能具有较好的预测效果。 结论： 人工膝关节置换术后关节纤维化患者的组织学分级评估与关节功能密切相关，并能对关节置换术后的关节功能具有较好的预测作用。.