miR-21对骨质疏松小鼠骨髓基质细胞增殖的影响

目的探讨miR-21对骨质疏松小鼠骨髓基质细胞(BMSCs)增殖的影响。方法采用双侧卵巢切除法构建骨质疏松小鼠模型(VOX),分离、培养、纯化小鼠BMSCs并采用si PORT Neo FX转染pre-miR-21、pre-miR-negative control(pre-miR-NC)、antmiR-21、ant-miR-negative control(ant-miR-NC)并进行RT-PCR验证,MTT法检测小鼠BMSCs增殖情况、茜素红与碱性磷酸酶染色法检测小鼠BMSCs成骨能力、Western-blotting检测细胞增殖、成骨分化相关蛋白水平。结果骨质疏松症小鼠BMSCs中miR-21相对表达水平低于Ctrl组(P0.05),OVX-pre-miR-21组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均高于OVX-pre-miR-NC组(P0.05),OVX-premiR-NC组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均显著低于Ctrl-pre-miR-NC(P0.05); OVX-ant-miR-21组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均显著低于OVX-ant-miR-NC组(P0.05),OVX-ant-miR-NC组BMSCs中miR-21相对表达水平、细胞增殖、PCNA水平、Ki-67水平、ALP染色程度、ALP活性、茜素红染色程度、Runx2水平、Osterix水平均显著低于Ctrl-ant-miR-NC(P0.05)。结论提高miR-21表达水平可促进骨质疏松小鼠BMSCs增殖能力与成骨分化能力。     

补肾活血汤联合手法复位小夹板固定治疗老年肱骨近端骨折患者的临床效果

目的:探讨补肾活血汤联合手法复位小夹板固定治疗老年肱骨近端骨折患者的疗效及对肢体功能的影响。方法:选择2018年5月—2020年1月我院收治的老年肱骨近端骨折患者84例,随机分为对照组和观察组,各42例。对照组采用手法复位小夹板固定治疗,观察组在对照组基础上联合补肾活血汤治疗,治疗4周后对患者效果进行评估,比较两组骨折愈合效果、肢体功能、骨折愈合时间、视觉模拟疼痛(VAS)评分、肩关节评分系统Constant-Murley(C-M)评分及治疗预后。结果:治疗4周后,观察组的优良率为92.86%,高于对照组71.43%;观察组的旋前度(88.68±7.56)°、背伸度(89.41±2.43)°、桡偏角度(15.39±2.15)°、掌屈度(42.35±4.61)°及旋后度(80.45±5.98)°均大于对照组[旋前度(81.32±6.42)°、背伸度(68.98±2.35)°、桡偏角度(12.19±2.05)°、掌屈度(45.72±5.32)°及旋后度(84.36±6.01)°],差异有统计学意义(P<0.05);观察组治疗2周、4周后的VAS评分分别为(3.11±0.38)分、(1.09±0.21)分,骨折愈合时间为(6.49±0.63)周,均低(短)于对照组2周、4周的VAS评分[(4.59±0.43)分、(3.21±0.33)分]及骨折愈合时间[(9.64±0.81)],差异有统计学意义(P<0.05);观察组治疗4周后的畸形愈合、骨折不愈、股骨头坏死、感染及跛行发生率均低于对照组(P<0.05)。结论:补肾活血汤联合手法复位小夹板固定用于老年肱骨近端骨折患者中能提高骨折愈合率,改善患者肢体功能,缩短骨折愈合时间,减轻患者疼痛,改善预后,值得推广应用。     

当归通痹汤联合中药热敷治疗膝关节骨性关节炎的疗效及对IL-1β、MMP-3和TNF-α水平的影响

目的:探讨当归通痹汤联合中药热敷治疗膝关节骨性关节炎的疗效及对白细胞介素(IL)-1β、基质金属酶(MMP)-3和肿瘤坏死因子(TNF)-α水平的影响。方法:选取我院收治的膝关节骨性关节炎患者140例,随机分为两组各70例。对照组给予中药热敷治疗,治疗组在对照组基础上给予当归通痹汤,对比两组治疗后的临床疗效、VAS评分、WOMAC指数和ADL评分,以及IL-1β、MMP-3和TNF-α水平。结果:治疗后,治疗组的总有效率为94.29%,高于对照组的81.43%,差异有统计学意义(P<0.05);两组ADL评分明显升高,WOMAC指数、VAS评分明显降低(P<0.05);且治疗组比对照组明显改善(P<0.05);两组患者治疗后的IL-1β、MMP-3和TNF-α水平均显著低于治疗前(P<0.05);且治疗组低于对照组,差异有统计学意义(P<0.05)。两组患者不良反应发生率差异无统计学意义(P>0.05)。结论:膝关节骨性关节炎患者采用当归通痹汤联合中药热敷治疗,具有较好的临床疗效,能够改善患者膝关节功能,值得在临床上推广应用。     

中医活血补骨汤用于骨质疏松性肱骨近端骨折患者临床价值研究

目的:探讨骨质疏松性肱骨近端骨折术,给予患者中医活血补骨汤+阿仑膦酸钠治疗对患者术后康复效果产生的影响。方法:选取2019年1月—2020年1月本院收治66例骨质疏松性肱骨近端骨折患者通过随机数字表分作两组。对照组(33例)术后给予阿仑膦酸钠片进行治疗,观察组(33例)给予阿仑膦酸钠片+活血补骨汤治疗。观察患者治疗后病情恢复时间、疼痛程度、肩关节功能恢复及骨代谢改善情况及并发症发生情况。结果:治疗后与对照组相比,观察肿胀消退、住院天数及骨痂出现、骨折愈合天数均显著更短(t=6.153、5.861、14.163、17.958,均P0.05);对比对照组,治疗后1、3、6、12个月观察组NPIS评分均显著更低(t=4.335、10.673、21.542、30.315,均P0.05);治疗后观察组肩关节功能恢复优良率为93.94%(31/33),相比对照组的75.76%(25/33)显著更高,并发症总发生率为3.03%(1/33),相比对照组的18.18%(6/33)显著更低(χ~2=4.243、3.995,均P0.05);治疗后相比对照组,观察组PTH、BALP、β-CTX水平均显著更低,OC则显著更高(t=9.897、3.858、8.942、26.732,均P0.05)。结论:骨质疏松性肱骨近端骨折患者接受术后治疗后再使用阿仑膦酸钠+活血补骨汤进行辅助治疗,术后恢复速度更快,减轻患者术后疼痛,提高肩关节功能恢复效果,促进患者骨代谢获得良好改善,减少术后并发症,有助于患者术后获得更理想总体康复效果。     

Cause for revision differs between a short and standard length stem at 5 year follow-up

BackgroundThe purpose of this study was to compare the 5 year radiographic and clinical outcomes of anatomic total shoulder arthroplasties (TSA) performed with either a standard length (SL) or short stem. The hypothesis was there would be no difference in radiographic or clinical outcomes based on stem length.MethodsA multicenter retrospective review was performed of primary TSAs performed with a press-fit humeral component. Fifty SL and 72 short stems were available for review, of which 43 SL and 60 short stems had minimum 5 year follow-up. Functional outcome was assessed according to range of motion (ROM), visual analog scale (VAS) American Shoulder and Elbow Surgeons (ASES), and Single Assessment Numeric Evaluation (SANE) scores. Radiographs were reviewed for signs of humeral component loosening and stress shielding.ResultsAt final follow-up there were no differences in ROM, or ASES or SANE scores between groups (P>.05). Postoperative VAS scores were lower in the SL compared to the short stems (0.8 vs. 1.6; P = .053). All-cause revision was similar between the SL and short stems (16% vs. 22.2%; P = .395). Among SL stems there were no revisions for humeral loosening and none were considered radiographically at risk. Six short stems were revised for loosening (8.3%; P =.036 vs. SL). An additional 5 short stems were considered to be radiographically at risk for loosening for a total revision or at risk rate of 15.3% (P = .003 vs. SL).ConclusionThere is no difference in functional outcome at mid-term follow-up of TSA based on stem length with a grit-blasted humeral component. Revision for loosening and radiographic risk for loosening may be higher with a short stem compared a standard length humeral stem placed with press-fit fixation using grit blasting.Level of evidenceLevel III; Retrospective Comparative Study.     

Revision to reverse total shoulder arthroplasty: do short stem and stemless implants reduce the operative burden compared to convertible stems?

BackgroundRevision of prior hemiarthroplasty (HA) or total shoulder arthroplasty (TSA) to reverse shoulder arthroplasty (RSA) is a technically challenging procedure with high complication rates. The purpose of this study was to compare intraoperative complications between convertible humeral stems and nonconvertible humeral stems stratified by stem length for conversion of TSA or HA to RSA.Materials and methodsA multicenter retrospective analysis of patients undergoing revision of a primary TSA or HA to RSA was conducted. Patients were divided into 2 groups based on convertible or nonconvertible humeral stem design from the index surgery. The primary outcome measures were the following intraoperative variables and complications: total operative time, blood loss, intraoperative fracture, overall complication rate, and blood transfusions. Rates were compared between groups and analyzed according to primary stem length for the nonconvertible group.ResultsA total of 279 patients were included in the study, 70 with convertible stems and 209 with nonconvertible stems. About 70% of convertible stems were successfully retained. Operative time was similar between the 2 groups overall. Patients with nonconvertible stems had higher intraoperative blood loss (P = .0001), higher overall complication rate (P = .009), and greater risk of intraoperative fracture (P = .002). Revising stemless and short stems to RSA had significantly reduced operative time compared to standard length stems (97 and 116 minutes vs. 141 minutes, P < .0001 and P = .035, respectively). When revising stemless implants, there was a significantly lower rate of intraoperative fracture (3.6%) compared to short stems (24%, P = .004) and standard stems (23.4%, P = .001). When revising stemless implants to RSA, there was shorter operative time (P= .0001) and similarly low rate of intraoperative fracture (P= .820) compared to convertible stems.ConclusionIn revision of anatomic TSA to RSA, convertible stems lead to lower blood loss and intraoperative fracture rate compared to nonconvertible stems when broadly including all stem types. However, differences appear to be based on stem type. Among nonconvertible stems, revision of short stem and stemless implants are associated with reduced operative time compared to standard length stems. Revision of stemless implants to RSA is associated with the shortest operative time of all implant types as well as a similar rate of intraoperative fracture compared to convertible stems.Level of EvidenceLevel III; Retrospective Cohort Comparative Study     

Inclination correction is associated with improved clinical outcomes in anatomic total shoulder arthroplasty

BackgroundWhile retroversion of the glenoid in anatomic total shoulder arthroplasty (TSA) has been increasingly studied, the effect of glenoid inclination on clinical outcomes has received less attention. The goal of this study was to examine the influence of pre- and postoperative inclination on clinical outcomes after anatomic TSA.MethodsPatients undergoing primary anatomic TSA with minimum 2-year outcomes were included from a multicenter prospectively maintained database of shoulder arthroplasties from 2015 to 2017. Preoperative and postoperative radiographs were independently evaluated to assess native glenoid inclination and postoperative prosthetic glenoid inclination using the previously described TSA angle. A receiver-operator characteristic (ROC) curve analysis was performed to determine if a significant threshold existed for preoperative inclination, postoperative inclination, or amount of inclination correction. A linear regression analysis assessing the correlation between each of these measurements and the postoperative Constant score was performed. For final analysis, means and standard deviations of the Constant scores for patients above and below the calculated inclination thresholds for each group were compared using SPSS.ResultsSeventy-two anatomic TSAs with minimum 2-year follow-up were included. ROC analysis determined a significant threshold of 10 degrees of postoperative inclination for prediction of the 2 year postoperative Constant score (AUC = 0.682), P= .010. This finding was additionally supported in the linear regression analysis, where postoperative inclination was significantly associated with the postoperative Constant score (P= .046). Patients below the postoperative inclination threshold of 10 degrees had significantly improved Constant scores compared to those above the threshold (mean 65.3, P= .005; Table 2). Two degrees of inclination correction was predictive of the 2 year postoperative Constant score (AUC = 0.754; P< .001; sensitivity 68%, specificity 74%). Inclination correction was significantly associated with postoperative Constant score (P= 0.003). Patients above the inclination correction threshold of 2 degrees had significantly improved Constant scores (mean 75.4) compared to those below the threshold (mean 65.9, P= .003).ConclusionsWhen appropriately corrected, preoperative inclination over 10 degrees does not appear to significantly influence postoperative outcome of anatomic TSA. There is a significant association between postoperative inclination and 2 year Constant scores. Inclination correction is particularly associated with postoperative Constant score. These results encourage the need for future studies with detailed analysis as to how to best predict and correct inclination to produce favorable and durable outcomes after anatomic TSA.Level of EvidenceLevel III; Retrospective Comparative Study     

A Case of Large Calcifying Fibroma of Tendo-achilles Managed by En-block Resection and Tendon Reconstruction

Calcifying aponeurotic fibroma is a rare benign fibrous tumor with typical radiological and histopathological features seen in young children and adolescents. It commonly involves the extremities and is characterized by a very high chance of local recurrence. A complete excision of the tumor is considered to be the treatment of choice. We report a case of the tumor involving the substance of achilles tendon and extending up till its insertion in the calcaneum. To the best of our knowledge, this is the largest reported case of calcifying fibroma, with the tumor measuring 10 cm in its largest diameter. The tumor was excised in toto followed by reconstruction of the tendon defect with V-Y plasty of the native tendon and supplemented with semitendinosus and gracilis graft. There was no evidence of recurrence during the follow up period of 1 year.