血清软骨寡聚基质蛋白水平与膝骨关节炎发生发展的关系研究

目的 分析血清软骨寡聚基质蛋白(cartilage oligomeric matrix protein, COMP)水平与膝骨关节炎(knee osteoarthritis, KOA)发生发展的相关性。方法 选取2012年4月至2019年3月期间在上海交通大学医学院附属新华医院崇明分院骨科收治的双侧KOA患者255例(KOA组)作为研究对象，另选取同期来院体检的健康志愿者100例作为对照组。KOA组男168例，女87例；年龄28～85岁，平均年龄(59.77±11.01)岁。对照组男67例，女33例；年龄20～86岁，平均年龄(58.96±12.42)岁。采用酶联免疫吸附法检测血清COMP水平。采用Kellgren-Lawrence(K/L)分级、西安大略和麦克马斯特大学(the Western Ontario and McMaster Universities, WOMAC)骨关节炎指数及Lequesne指数评估KOA疾病严重程度。结果 KOA组患者血清COMP水平显著高于对照组(P<0.001)。经受试者工作特征曲线分析，血清COMP诊断KOA的曲线下面积为0.789。血清C...     

中国广东地区膝骨关节炎患者与健康人群肠道菌群差异性分析

目的比较中国广东地区骨关节炎(osteoarthritis,OA)患者与健康人群肠道菌群的宏基因组,初步分析其差异性及差异特征。方法选取我院从2017年6～12月收集的29名健康人群,66例膝OA患者粪便样本,其中膝OA患者根据K-L分型分为轻度OA组17例,重度OA组49例。检测前进行对基线比较。样本提取DNA后,使用Simpson多样性指数分析群落多样性,使用LEf Se分析对群落关键物种进行筛选;差异物种GO分析及Pathway分析进行差异性菌群代谢功能预测。结果 3组在身高、年龄及体重上没明显差异(P0.05); Simpson多样性指数分析表明轻度OA患者与健康人群肠道菌群多样性无显著差异,重度OA患者肠道微生物多样性显著低于健康人群。LEf Se分析发现,寡养单胞菌属(Stenotrphomonas)、黄单胞菌属(Xanthomonadacease)等18种菌群在膝骨关节炎患者人群中显著高丰度,毛螺旋菌属(Lachnospiraceae)、瘤胃球菌属(Ruminococcus)等6种菌群在膝骨关节炎患者人群中显著低丰度。寡养单胞菌属、黄单胞菌属两类菌群可以显著区分轻重型膝骨关节炎。差异物种GO分析提示寡养单胞菌属、黄单胞菌属等菌群的显著升高,对代谢类疾病、感染性疾病、心血管类疾病、免疫性疾病的发病具有增加的趋势。结论广东地区膝骨关节炎患者肠道菌群丰度和某些菌群与健康人群有显著差异,寡养单胞菌属、黄单胞菌属两类菌群可以显著区分轻重型膝骨关节炎。     

关节炎患者血管内皮生长因子的检测及其临床意义

目的通过对类风湿关节炎(rheumatoid arthritis,RA)和骨关节炎(osteoarthritis,OA)患者血清及关节液的血管内皮生长因子(vascular endothelial growth factor,VEGF)的检测,探讨VEGF在两种疾病中的鉴别意义。方法采用酶联免疫吸附试验方法检测RA组(40例)、OA组(40例)血清及关节液中VEGF的含量。结果 RA组血清VEGF含量(94.41±43.32)ng/L,明显高于OA组(35.60±17.08)ng/L,差异有统计学意义(t=7.987,P0.001);RA组关节液VEGF含量(188.26±90.76)ng/L,明显高于OA组(69.72±30.42)ng/L,差异有统计学意义(t=7.832,P0.001);关节液中VEGF和血清中VEGF含量之间存在相关性(r=0.714,P0.001)。结论 VEGF在RA患者体内高表达,可作为RA与OA鉴别的参考指标。     

骨质疏松合并骨关节炎患者血清中Wnt通路调节因子研究

目的 探讨骨质疏松(osteoporosis,OP)合并骨关节炎（osteoarthritis,OA）患者血清中β-catenin、Dickkopf-1（DKK-1）和Matrix metalloproteinase-9（MMP-9)的表达模式及其与临床参数的相关性。 方法 选取2017年1月至2018年3月在本院就诊的肌肉骨骼疾病患者158例,根据其症状分为OP（58例）、OA（52例）和OP＋OA（48例）,另外选取40例健康个体作为对照组。所有受试者血清中的β-catenin、DKK-1和MMP-9表达量采用酶联免疫吸附方法（enzyme-linked immuno-sorbent assay,ELISA）进行检测。用Pearson相关性分析方法来检测这三种因子的表达量和临床参数：红细胞沉降率(erythrocyte sedimentation rate,ESR) 、C-反应蛋白(C-reactive protein,CRP) 、骨密度（bone mineral density,BMD）,分析三者之间的关系。 结果 各组参与者在年龄上和体质量指数上无明显差别（P=0.356,P=0.438)。各组骨骼疾病患者（OP、OA和OP＋OA）在性别比例上均约为1：2。与健康组相比,OP＋OA组患者血清中的β-catenin含量明显下降（P=0.024),而DKK-1（P=0.013)和MMP-9（P=0.003) 的表达水平显著升高,这种表达模式和OP组患者的表达模式相似。在OP＋OA组中β-catenin含量比OP组明显升高（P=0.047),但比OA组明显降低（P=0.018);而DKK-1和MMP-9含量与OP组（P=0.041/0.007)和OA组（P=0.006/0.002)相比明显升高。Pearson相关分析显示OP+OA组患者血清β-catenin和DKK-1与临床参数ESR/CRP存在相关性（r =0.713/0.621,r =0.462/0.321);β-catenin和腰椎BMD/股骨颈BMD存在正相关（r =0.425/0.545),但DKK-1与腰椎BMD/股骨颈BMD 呈负相关（r = -0.376/-0.315);MMP-9仅和腰椎BMD/股骨颈BMD存在弱负相关性（r = -0.525/-0.324)。 结论 OA+OP组血清β-catenin、DKK-1和MMP-9的表达不是OP组与OA组相关产物的简单混合。β-catenin/DKK-1/MMP-9与OP/OA临床参数的相关性表明这些因子表达的变化可作为临床炎症程度和骨质量诊断的参考。     

全膝关节磁共振成像积分对膝骨关节炎诊断价值的探讨

目的:探讨全膝关节磁共振成像积分(WORMS)对膝骨关节炎(KOA)患者的诊断价值。方法:回顾性分析2009年11月至2011年1月门诊及住院KOA伴膝关节积液患者70例,男12例,女58例;年龄46～75岁,平均(59.66±9.93)岁。用WOMAC量表进行临床症状评估,用K-L分级及全膝关节磁共振成像积分(WORMS)进行放射学评估,同时应用ELISA法检测患者关节液中COMP及CTX-Ⅱ的浓度。并对上述指标进行相关性分析及多重线性回归分析。结果:WOMAC评分及WORMS分别为(57.50±8.20)和(64.54±16.45)分,CTX-Ⅱ及COMP含量分别为2.42ng/ml和4.56ng/ml。选择WORMS四分位数中轻和严重2组,比较2组COMP差异有统计学意义(Z=2.04,P=0.039),而CTX-Ⅱ差异则无统计学意义(Z=0.79,P=0.427)。相关性分析发现WORMS与WOMAC评分、K-L分级呈正相关(r=0.777,P<0.01;r=0.716,P<0.01),K-L分级与WOMAC评分也呈正相关(r=0.692,P<0.01)。WORMS中关节软骨积分、骨赘积分、滑膜炎积分分别与WOMAC评分、K-L分级及COMP亦呈正相关(r=0.771,P<0.01;r=0.509,P<0.01;r=0.917,P<0.01)。以WOMAC评分为应变量,年龄、性别、K-L分级、WORMS、COMP和CTX-Ⅱ为自变量进行逐步回归(F=20.327,P<0.01),KOA病情主要受WORMS、K-L分级影响(P=0.015,P=0.025)。结论:WORMS对膝骨关节炎的诊断有较高的参考价值。WORMS高时,关节液中COMP含量升高。膝骨关节炎的临床症状主要受WORMS、K-L分级影响。     

原发性膝骨关节炎合并高血压的临床研究

目的探讨原发性膝骨关节炎(osteoarthritis,OA)合并高血压的患病情况和临床特点。方法回顾性分析膝OA行人工关节置换术后患者104例,按有无合并高血压分为高血压病膝OA组61例和单纯膝OA组43例,比较两组患者的临床资料。结果合并高血压病的膝骨关节炎组膝关节功能评分显著低于不伴有高血压的患者(P=0.001,t=-6.345),女性患者更明显(P=0.001,t=-7.558);伴高血压病的膝骨关节炎患者肥胖率明显大于不伴高血压者(P=0.001,χ~2=14.785);伴高血压的女性膝骨关节炎患者骨质疏松比例明显高于没有高血压者(P=0.016,Z=5.823)。结论高血压可能通过力学因素和代谢性炎症因素促进原发性膝OA的发生和发展,其中对女性膝关节功能的影响更加明显。     

Toll样受体4与白细胞介素1β在膝骨关节炎中的表达意义

目的探讨骨关节炎(OA)患者血清、膝关节液中Toll样受体4(TLR-4)、白细胞介素1β(IL-1β)表达变化规律及临床意义。方法选取内江市第二人民医院骨科2011年6月至2013年6月收治的112例膝关节OA患者作为OA组,均符合中华医学会骨科分会2007版OA诊疗指南中关于膝关节炎的诊断标准,排除长期伴有高血压,冠心病,糖尿病,免疫性疾病,既往有膝关节外伤史,膝关节感染史,代谢性骨病,骨肿瘤史;并以同期在该院体检的120例健康患者为健康对照组,检测比较两组血清、膝OA中TLR-4,IL-1β水平。两组间差异比较采用t检验;多组间差异比较采用单因素方差分析和SNK检验;相关分析采用Pearson相关性或Spearman秩相关进行分析。结果 OA患者血清TLR-4和IL-1β分别为(13.0±4.0)ng/L、(7.5±3.5)ng/L,明显高于健康对照组(8.8±2.1)ng/L与(4.5±3.4)ng/L,组间差异均有统计学意义(t=9.869,6.657;P0.05);膝关节液中TLR-4和IL-1β分别为(15.0±3.1)ng/L、(9.0±3.2)ng/L,高于健康对照组的(12.0±3.1)ng/L,(7.1±3.8)ng/L,组间差异均有统计学意义(t=7.255,4.032;P0.05)。OA患者血清TLR-4、IL-1β与关节液中浓度呈明显相关性,血清和关节液中IL-1β、TLR-4水平与OA的严重程度均存在明显正相关,组间差异均有统计学意义(F=26.303,19.863,20.732,7.778,P均0.05)。结论 TLR-4、IL-1β在OA患者关节液中含量明显升高,且与病情严重程度成正比,可用于OA的早期诊断和病情评估。     

软骨代谢标志物COMP对骨关节炎软骨改变的反应

目的研究血清中软骨寡聚基质蛋白（cartilage oligomeric matrixprotein，COMP）水平与骨关节炎病变严重程度的关系。方法采用ELISA方法测定正常对照组和22例骨关节炎患者血清中及关节液中的COMP水平。结果骨关节炎患者血清中COMP水平明显高于正常组水平，有统计学差异。结论血清中COMP水平与骨关节炎病变严重程度相关，测定骨关节炎患者血中COMP水平对进一步研究OA发病机理及早期发现骨关节炎并采取有效防治策略，监测防治效果具有极其重要的意义。     

骨关节炎患者血清及关节液中白细胞介素-17表达及其意义

目的检测膝骨关节炎(osteoarthritis,OA)患者血清及关节液中自细胞介素-17(interleukin-17)的表达并评估其与OA严重程度的相关性。方法收集100例原发性膝OA患者血清及关节液标本,并以50例健康志愿者血清标本作为对照。OA严重程度及分级分别采用Lequesne指数和K-L分级系统。酶联免疫吸附法分别检测血清及关节液中IL-17浓度,并分析其与OA严重程度的相关性。结果 OA组患者血清中IL-17浓度[(5.292±1.470)pg/ml]明显高于对照组[(4.173±0.640)pg/ml],差异有统计学意义(P0.05)。K-L4级或3级OA患者关节液IL-17的浓度明显高于2级OA患者,差异有统计学意义(P0.05)。4级OA患者关节液IL-17的浓度[(6.161±1.120)pg/ml]明显高于3级OA患者[(4.474±0.816)pg/ml],差异有统计学意义(PO.05)。关节液IL-17浓度与Lequesne指数呈正相关(r=0.6232,P0.05);血清IL-17浓度与Lequesne指数之间无明显相关。结论 IL-17在OA患者血清及关节液中的表达明显升高,关节液中IL-17的水平与OA严重程度之间明显相关,提示IL-17的失衡表达在OA的发病机制中具有一定作用。     

血清和关节液中钙结合蛋白（S100A12)的水平与膝关节骨关节炎严重程度的相关性分析

目的探讨患者关节液和血清中钙结合蛋白(S100A12)浓度和膝关节骨性关节炎严重程度相关性,以评估它在骨性关节炎(osteoarthritis,OA)发病中的作用。方法 40例骨性关节炎(OA组)与40例需关节镜手术的半月板、韧带损伤的患者及行髓内钉固定的股骨及胫骨骨折患者(对照组);对两组患者静脉采血及取关节液,采用ELISA法测S100A12含量;采用Kellgren-Lawrence(K-L)标准对膝关节X线片进行评估分级。结果 OA组的血清中S100A12水平(35.10±26.43)ng/ml显著高于对照组含量(22.13±15.67)ng/ml,有统计学差异(P=0.026);OA组关节液S100A12含量(14.09±8.08)ng/ml显著高于对照组关节液中的含量(9.30±6.85)ng/ml(P=0.02)。OA组血清中的S100A12水平显著高于关节滑液中的水平(P0.01)。关节液中的S100A12含量和血液中的S100A12水平显著正相关(r=0.42,P=0.02),但相关关系并不密切。OA组关节滑液中S100A12与K-L分级成正相关(r=0.65,P0.01)。血清中的S100A12与K-L分级关联不显著(r=0.29,P=0.24)。结论 S100A12在OA患者的血液及关节液中都有表达;关节液的S100A12表达与患者骨关节炎严重程度成正相关;检测关节液中的S100A12有助于骨性关节炎的早期诊断,提示病变严重程度,为临床治疗提供参考。     

膝骨关节炎影像学分级同胫股及髌股关节轴线角相关性分析

目的:探讨膝骨关节炎影像学分级与胫股及髌股关节轴线角的相关性。方法:回顾性分析2018年9月至2020年12月行立位双下肢X线及膝关节侧位片检查的中老年KOA患者739例(1 026膝)。其中K-L0级患者63例(95膝);K-L 1级100例患者(130膝);K-L 2级161例患者(226膝);K-L 3级187例患者(256膝);K-L 4级228例患者(319膝)。依据膝关节中心和髋关节中心与踝关节中心连线的相对位置将患膝分为内翻组844膝及外翻组182膝。根据Install-Salvati法将患膝重新分为高位髌骨(髌骨高度>1.2 mm)347膝、中位髌骨(髌骨高度0.8～1.2 mm)561例、低位髌骨(髌骨高度<0.8 mm)118膝3组。测量并比较各组股骨下角,胫骨上角,股骨颈干角,股骨胫骨角,关节间隙角,髋-膝-踝角,髌骨股骨角及髌骨高度。结果:(1)在内翻型KOA组中,不同K-L分级患者的髋-膝-踝角、胫股角、股骨下角、胫骨上角、关节间隙角、股骨颈干角比较,差异有统计学意义(P<0.05)。髋-膝-踝角、胫股角、股骨下角、胫骨上角、关节间隙角与K-...     

Serum levels of cartilage oligomeric matrix protein (COMP) correlate with radiographic progression of knee osteoarthritis

OBJECTIVE: To evaluate the prognostic utility of serum COMP level measured with a new sandwich ELISA, by correlating COMP level with outcome measures of osteoarthritis (OA) progression. DESIGN: Patients (N=48) had symptomatic primary knee OA of Kellgren-Lawrence (K-L) grade I-III and met ACR criteria. These patients were evaluated prospectively as part of a double-blind drug trial of 3 years' duration and represented the placebo arm of the study. Serum COMP levels were measured by sandwich ELISA with monoclonal antibodies 16-F12 and 17-C10 at baseline and at study end and levels were correlated with changes in (1) joint space width (JSW), (2) K-L grade, (3) Lequesne, and (4) WOMAC indices, over 3 years. RESULTS: The change in JSW over 3 years, summed for both knees, correlated positively with serum COMP level at baseline as well as at study end. Patients were sorted by level of progression based upon a change in K-L grade summed for both knees over 3 years; patients who progressed by two K-L grades were shown to have had significantly higher COMP levels at baseline as well as at study end. Baseline and study end COMP levels did not correlate with the change of Lequesne or WOMAC indices. Baseline COMP levels correlated strongly with end serum COMP levels. CONCLUSION: Serum COMP has the potential to be a prognostic marker of disease progression. High COMP levels, persisting over the 3-year study period in the patients with radiographic progression, indicated differences in disease activity detectable throughout the entire follow-up interval.     

Serum cartilage oligomeric matrix protein (COMP) in knee osteoarthritis: A novel diagnostic and prognostic biomarker

A case–control study was conducted to estimate the association of cartilage oligomeric matrix protein (COMP) with knee osteoarthritis (OA) and to examine the potential utility of COMP as a diagnostic and prognostic biomarker in early knee OA. The COMP levels were estimated in the blood sera of 150 subjects belonging to study group (n = 100) and control one (n = 50). Patients with confirmed clinical isolated knee OA diagnosed through American College of Rheumatology criteria were included and were without any other cause of knee pain. ELISA was used to determine the levels of COMP, interleukin‐1β (IL‐1β) and tumor necrosis factor‐α (TNF‐α). The median (range) serum COMP levels were observed to be 1117.21 ng/ml (125.03–4209.75 ng/ml) in OA patients and 338.62 ng/ml (118–589 ng/ml) in control subjects with p < 0.001. The COMP levels of study group were negatively correlated (correlation factor ?0.88) with disease duration and positively correlated with age, BMI, pain score and IL‐1β with correlation factors 0.86, 0.63, 0.76, and 0.79, respectively with p < 0.001. Gender differentiation was found in study group with 52% higher COMP level in males as compared to that of females. There was no significant correlation of COMP levels with radiological grading, erythrocyte sedimentation rate (ESR), hemoglobin (Hb), and TNF‐α. The serum COMP levels may be used as a diagnostic OA marker along with prognostic value in determining the patients at risk of rapidly progressing this debilitating joint disease. The serum COMP level remains significantly high in first 3 years of disease duration. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:999–1006, 2013

     

高能量激光联合针对性手功能训练治疗1-2级拇腕掌关节骨性关节炎的疗效观察

目的：观察高能量激光(high-intensity laser therapy,HILT)联合针对性手功能训练对1-2级拇腕掌关节(carpometacarpal,CMC)骨性关节炎(osteoarthritis,OA)的疼痛和侧捏力的影响。方法：选择2020年4月至2022年4月诊断为1-2级CMC OA的患者42例,年龄58~80(68.90±7.58)岁,均为女性,分为观察组和对照组,各21例。观察组患者接受HILT及手功能训练4周,对照组患者接受超短波治疗及矫形器制动4周。分别在干预前、干预后即刻以及干预后12周采用疼痛视觉模拟评分(visual analogue scale,VAS)比较疼痛程度,采用测力计观测拇指侧捏力并比较手指功能恢复情况。结果：干预后即刻及干预后12周,两组患者VAS及拇指侧捏力均较治疗前改善(P<0.05)。但与对照组比较,观察组VAS减轻程度更大(干预后立即t=3.37,P<0.05,干预后12周t=9.05,P<0.05),拇指侧捏力平均值高于对照组(干预后立即t=-2.55,P<0.05,干预后12周t=-9.51,P<0.05)。结论：高能量激光联合针对性手功能训练较传统方法更能有效改善1-2级拇腕掌关节骨关节炎的疼痛和侧捏力。     

消瘀散外敷配合导引治疗颈椎病临床观察

目的：探讨消瘀散外敷配合导引治疗颈椎病的临床疗效,为颈椎病的治疗寻找新途径。方法：从2007年5月至2008年4月,共治疗颈椎病患者63例,按随机数字表单双数随机分为两组,治疗组33例,男21例,女12例,年龄20～49岁,平均（30．60±7．89）岁,用消瘀散外敷配合导引治疗;对照组30例,男16例,女14例,年龄20～49岁,平均（32．43±8．00）岁,用扶他林缓释片治疗。治疗前后对患者颈部疼痛、压痛和颈椎活动度进行观察。结果：治疗组治疗前后各项指标比较（疼痛、压痛、活动度）,差异均有统计学意义（P〈0．001）。对照组治疗前后各项指标比较（疼痛、压痛、活动度）,差异均有统计学意义（P〈0．001）。两种治疗方法均能改善颈部疼痛、压痛和颈椎活动度。结论：消瘀散外敷配合导引治疗颈椎病,能明显改善颈部疼痛、压痛和颈椎活动障碍,纠正颈椎动力性平衡失调。     

类风湿关节炎及骨关节炎血清和滑液中一氧化氮的测定

目的 研究一氧化氮（ＮＯ）在类风湿性关节炎（ＲＡ）及骨关节炎（ＯＡ）病变中的作用。方法 采用亚硝酸盐间接法测定了４０例ＲＡ、２０例ＯＡ患者表及滑液ＮＯ的含量变化,并与年龄相匹配的健康人相比较。结果 ＲＡ患者血清及滑液ＮＯ的浓度呈正ｒ＝０．４１７,Ｐ〈０．０５）。ＲＡ和ＯＡ患者血清ＮＯ浓度均低于滑液中的,但显著高行正常对照组血清ＮＯ浓度;ＲＡ患者滑液ＮＯ浓度高于血清中,且明显高于ＯＡ组滑液ＮＯ浓度。     

归挤拍打正骨手法治疗产后耻骨联合分离病例对照研究

目的:观察归挤拍打正骨手法治疗产后耻骨联合分离的临床疗效。方法 :2015年6月至2017年3月纳入产后耻骨联合分离患者80例,分为治疗组和对照组,每组40例。治疗组生育年龄26~40(30.61±5.94)岁,新生儿体重3.20~4.52(3.59±0.13)kg;对照组生育年龄22~37(27.51±4.57)岁,新生儿体重3.0~5.8(3.81±0.63)kg。治疗组采用归挤拍打正骨手法,每周手法治疗1次,3周为1个疗程。对照组采用骨盆绑带制动治疗,每天骨盆固定绑带制动不少于8 h,3周为1个疗程。在病例筛选入组的当天以及治疗后1、2、3周和1个月进行临床观察,对两组VAS疼痛评分、Oswestry功能障碍指数评分(ODI)、耻骨联合分离距离进行评价。结果 :耻骨联合VAS评分与治疗前比较,治疗组治疗1周开始差异有统计学意义(P=0.013),对照组治疗1个月差异有统计学意义(P=0.042);治疗组治疗后均小于对照组(P0.05)。ODI评分与治疗前比较,治疗组治疗1周开始差异有统计学意义(P=0.009),对照组治疗1个月差异有统计学意义(P=0.013),治疗组治疗后均小于治疗前(P0.05)。耻骨联合距离值与治疗前比较,治疗组治疗后明显减小(P0.05),对照组治疗后差异无统计学意义(P0.05),两组比较,第1周(P=0.042)、第3周(P=0.005)差异有统计学意义。结论:归挤拍打正骨手法能快速恢复耻骨联合分离距离,减轻局部疼痛和改善腰骶部功能,优于骨盆绑带固定治疗。     

基于Caprini风险评估模型的干预策略对全膝关节置换术后静脉血栓栓塞症的预防效果观察

目的：探讨基于Caprini血栓风险评估模型的干预策略对全膝关节置换术（total knee replacement,TKA）后静脉血栓栓塞症（venous thromboembolism,VTE）的预防效果。方法：自2017年5月至2021年12月收治257例TKA患者,以2019年5月是否引进Caprini血栓风险评估模型为界分为传统常规干预策略（对照组121例）和基于Caprini血栓风险评估模型的干预策略（观察组136例）。对照组男79例,女42例;年龄50~78（63.10±11.86）岁;体质量指数（body mass index,BMI）19~32（25.21±4.95） kg/m²;左侧55例,右侧66例。观察组男81例,女55例;年龄50~78（64.35±10.54）岁;BMI 19~32（24.43±5.18） kg/m²;左侧87例,右侧49例。比较两组患者术后VTE发生率,疼痛视觉模拟评分（visual analogue scale,VAS）,美国特种外科医院（Hospital for Special Surgery,HSS）膝关节评分,患肢肿胀情况,血流平均速度（mean velocity,Vm）,峰值速度（peak velocity,PV）,D-二聚体（D-dimer,D-D）及凝血酶原时间（prothrombin time,PT）和并发症发生率。结果：观察组VTE发生率为1.47%（2/136）,对照组VTE发生率为9.09%（11/121）,两组比较差异有统计意义（χ²=6.976,P=0.008）。术后7 d,观察组VAS、HSS评分及患肢周径差值均明显优于对照组（P<0.05）。术后7 d,两组血流Vm和PV水平均明显升高（P<0.001）,且观察组血流Vm、PV水平高于对照组（P<0.001）。术后7 d,观察组血清D-D水平明显低于对照组,PT水平明显高于对照组（P<0.05）。两组并发症发生率比较,差异有统计意义（χ²=4.488,P=0.034）。结论：基于Caprini血栓风险评估模型的干预策略可有效降低TKA患者VTE发生率及并发症发生率,改善患肢肿胀、血流动力学及凝血功能状态,有助于膝关节功能恢复。     

Clinical and radiological features of lumbar degenerative spondylolisthesis who complicates osteoarthritis of the knee

Background dataCorrelation between lumbar degenerative disease and degenerative disorders of the knee joint have often been reported, however, detailed research concerning lumbar degenerative spondylolisthesis (DS) who complicates osteoarthritis of the knee (KOA) are scarce.MethodsA total of 184 consecutive surgically treated DS patients were identified, and divided into two groups: DS patients who complicate KOA (KOA group) and DS patients without KOA (non-KOA group). DS was defined as grade 1 or more, according to Meyerding's classification, and KOA was defined as grade 3 or more according to Kellgren–Lawrence classification. Clinical and the radiological differences of DS patients between KOA group and non-KOA group were investigated in order to clarify the features of DS patients who complicate KOA. Statistical significance using student's t-test and multivariate logistic regression analysis was performed to identify independent predictors of complicating KOA in DS.ResultsKOA group and non-KOA group consisted of 57 and 127 patients, respectively, with both group predominantly of female patients. Clinical features of KOA group were significantly high in age and body mass index (BMI), and more likely to complicate circulatory system disorders than non-KOA group. Radiological features of KOA group were significantly high in frequency of double adjacent level spondylolisthesis, Pelvic incidence (PI), Pelvic tilt (PT), and PI–LL. Multivariate logistic regression analysis identified coexistence of circulatory system disorders (OR 2.251, p = 0.024) and PI–LL (OR 1.04, p < 0.001) to be an independent predictors of complicating KOA in DS patients.ConclusionsOlder age and overweighted female patients coexistence of circulatory system disorders, containing double adjacent level spondylolisthesis with high PI, PT, and PI–LL were the characteristics of DS patients who complicate KOA, particularly coexistence of circulatory system disorders and significantly high lumbo-pelvic sagittal mismatch were the most significant factors above all.