膝关节外翻畸形的人工全膝关节置换术

目的探讨膝关节外翻畸形患者行人工全膝关节置换术(TKA)的手术方法和临床效果。方法对1996年1月至2004年8月74例87个膝关节外翻畸形TKA手术进行回顾分析。患者男11例,女63例,平均年龄63岁(26~80岁);股胫角(股骨和胫骨解剖轴线的夹角)平均为21·59°(12°~40°);应用后稳定型假体,采用髌旁内侧入路、常规截骨加单纯外侧软组织松解方法。随访检查膝关节活动度、X线外翻角度及KSS评分以评价手术效果。结果术后评价随访时间33·8个月(5个月~9年),根据膝关节活动度数及KSS评分评估关节功能情况。膝关节平均活动度为112·4°(80°~130°),KSS评分平均为81·7分(71~93分),比术前提高了59分;功能评分平均为86·3分,比术前提高了59·8分。所有膝关节在行TKA后外翻畸形基本得到矫正,随访时外翻度数(股胫角)平均为8·7°(0°~11°),较术前有明显改善。随访时1例患者有膝关节轻度不稳症状,1例术前严重髌脱位患者术后髌骨存在半脱位,其余正常。结论对于膝关节外翻畸形患者,采用髌旁内侧入路、常规截骨加单纯外侧软组织松解以及安装后稳定型假体的方法,可取得比较满意的临床效果。     

金属蛋白酶诱导因子表达增加在人工关节无菌性松动中的作用及意义

目的研究松动人工关节假体界膜中细胞外基质金属蛋白酶诱导因子(EMMPRIN)的表达,探讨其在人工关节无菌性松动发生发展中的作用。方法16例无菌性松动人工髋关节界膜标本采用免疫组织化学染色和反转录一多聚酶联免疫反应(RT-PCR)法,观察界膜中EMMPRIN的蛋白及mRNA表达。8例股骨颈骨折后髋关节滑膜做为对照。结果在界膜内衬层、内衬层下的巨噬细胞、成纤维细胞内及血管周围发现免疫反应强阳性的EMMPRIN表达。界膜组EMMPRIN的表达量明显高于正常滑膜组(Z=-3．252,P=0．001)。14例界膜标本EMMPRINmRNA的表达阳性。结论界膜中过度表达的EMMPRIN通过上调基质金属蛋白酶(MMPs)促进假体周围的骨破坏。选择性地抑制EMMPRIN生物活性,可能是防治人工关节无菌性松动的新途径。     

膝关节内肿物的关节镜检查和手术

目的探讨膝关节内肿物的关节镜手术适应证。方法合并关节绞锁症状的膝关节内肿物6例,经CT和或MRI检查,确定肿物位于关节内,遂行关节镜检查和手术。结果诊断分别为腱鞘巨细胞瘤、炎性假瘤、剥脱性骨软骨炎、腱鞘纤维瘤、畸胎瘤和蜡样骨瘤。术后随访1～20个月,症状改善。结论按照肿物来源,可将膝关节内肿物的关节镜检查适应证分为三类:1源于滑膜病变合并关节紊乱者;2怀疑骨骼病变,但有无法解释的关节内症状者;3曾经手术切除的腘窝良性肿瘤,复发症状以关节内症状为主,不接受开放手术者。以上三种情况,经CT和或MRI检查,如肿物位于关节内,可行关节镜检查以进一步诊断。经关节镜检查证实肿物确位于关节内,边界清楚,直径小于5cm者,可行关节镜下肿物切除术。     

Genistein Inhibit Cytokines or Growth Factor-Induced Proliferation and Transformation Phenotype in Fibroblast-Like Synoviocytes of Rheumatoid Arthritis

The purpose of this research is to study the effect of genistein on cytokines or growth factor-induced proliferation and transformation phenotype of rheumatoid arthritis fibroblast-like synoviocytes (RA-FLS). RA-FLS were primarily cultured. With respective stimulation of IL-1β, TNF-α, and EGF, genistein was applied to elucidate its effect on synoviocytes’ growth number, cell proliferation assay, cell cycle using cell counts, ³H-TdR incorporation and flow cytometry, the colony numbers under anchorage-independent condition, and the expression of MMP-2 and MMP-9 in synovial fibroblasts. EGF, IL-1β, and TNF-α increased ³H incorporation in RA-FLS, respectively. EGF augmented clone numbers of RA-FLS under anchorage-independent condition and not IL-1β and TNF-α. Genistein had an inhibitory role on cell number and ³H-TdR incorporation of RA-FLS stimulated with IL-1β, TNF-α and EGF; genistein arrested the cell cycle at G₁ restriction point; genistein decreased colony numbers under anchorage-independent condition stimulated by EGF in serum condition. IL-1β or TNF-α increased expression of MMP-9 and MMP-2 in rheumatoid synoviocytes; EGF stimulated expression of MMP-9 but not of MMP-2; genistein suppressed production of MMP-9 more than MMP-2 induced by IL-1β or TNF-α; rMMP-9, rMMP-2, or their inhibitors had no effect on the ³H-TdR incorporation of synovial cells. Erk1/2 inhibitor (PD098 059) had obvious inhibitory effect on the ³H incorporation induced by TNF-α or IL-1β; inhibitors of JNK (SP600 125) had no significant effect on the ³H incorporation. While pretreatment with PD098059 had no marked inhibitory effect on MMP-9 expression induced by TNF-α or IL-1β, SP600125 decreased significantly the MMP-9 expression induced by TNF-α or IL-1β. Neither PD098059 nor SP600 125 could inhibit the MMP-2 expression induced by TNF-α or IL-1β. Genistein inhibited IL-1β, TNF-α or EGF-induced proliferation and MMP-9 expression in fibroblast-like synoviocytes of rheumatoid arthritis; the proliferation of RA-FLS was mediated by Erk1/2 but not JNK activation, while JNK activation was involved in the signal transduction pathway leading to MMP-9 expression in rheumatoid synoviocytes.     

Autoantibodies in d-penicillamine-induced myasthenia gravis: A comparison with idiopathic myasthenia and rheumatoid arthritis

The distribution of autoantibodies was studied in patients with rheumatoid arthritis (RA) treated by d-penicillamine and who developed myasthenia gravis (MG). The anti-human acetylcholine receptor (AChR) antibodies were specifically associated with clinical symptoms of MG without any difference in the pattern of specificities in idiopathic (id-MG) or in induced MG (DPen-MG). Conversely, anti-nuclear antibodies were elevated in DPen-MG sera compared to id-MG sera (P < 0.001) but were also compared to patients with RA treated by d-penicillamine (or thiopronine) and who did not develop MG. Anti-denatured DNA antibodies were enhanced in sera from treated patients, whether they had presented or not a MG disease. Anti-histone antibodies were associated with RA. These observations suggest that the immunological imbalance in RA patients, can be increased by a drug treatment which may trigger the appearance of a second autoimmune disease such as MG, where anti-AChR antibodies are associated with anti-nuclear antibodies.     

膝内翻患者下肢对线的X线分析

目的分析骨性关节炎膝内翻的成因以及关节置换手术的矫正效果.方法对100例145个骨性关节炎膝内翻关节置换手术前后的负重位X线片进行测量,分别测量关节面夹角、胫骨平台角和胫内翻角度.结果全部膝内翻患者内翻角度平均为9.2°±3.1°(5°～30°),其中关节周围软组织失衡占内翻总角度比例为53.2%,而胫骨机械性内翻角度只占总内翻角度的22.8%,胫骨平台关节面磨损及胫骨平台倾斜占总内翻角度的24%.术后测量表明,平均胫骨平台截骨矫正度数为4.3°,占膝内翻矫正度数的27.9%.通过软组织平衡方法矫正的度数为10.7°,占膝内翻矫正度数的72.1%.结论骨性关节炎膝内翻角度的组成有两方面骨结构性内翻和软组织失衡性内翻.其中软组织失衡性内翻大于骨结构性内翻.因此在膝内翻全膝关节置换术中,软组织松解与平衡与切骨同等重要.     

大骨节病的治疗方法及研究进展

大骨节病是一种好发于儿童和青少年,以骺软骨、骺板软骨和关节软骨多发对称性变性、坏死以及继发性退行性变为主要病变的慢性、地方性、变形性骨关节病,累及我国多个地区。患者主要表现为关节疼痛、增粗、变形、活动受限,肌肉萎缩,严重者出现短指、短肢甚至矮小畸形。目前尚无大骨节病特效治疗方法,常用的治疗方法包括非甾体抗炎药、保护软骨组织药物、中医中药治疗以及关节镜手术、关节置换术等。文中就大骨节病的治疗方法及研究进展做一综述,旨在为大骨节病的治疗提供更为全面的参考依据。     

股骨头圆韧带生物学特征及临床研究进展

股骨头圆韧带是连接人体髋臼内下缘和股骨头的韧带,其内走行圆韧带动脉,以往观点认为股骨头圆韧带是人体胚胎发育的残余,在成人髋关节中并不具有任何生物学作用。但深入研究发现,股骨头圆韧带是一种强韧的关节内韧带,具有较重要的生理学功能。本文就股骨头圆韧带的生物学特点及其在先天性髋关节发育不良中的重要功能进行综述。