关节镜下射频汽化治疗膝骨关节炎的临床研究

目的探讨关节镜下射频汽化技术在膝骨关节炎中的临床应用价值。方法对60例膝关节炎患者使用射频汽化仪做镜下半月板部分切除、成形,软骨成形、滑膜切除、髌外侧支持带松解等。结果60例,按IKeuchi膝关节功能评定标准:优45例,良8例,一般7例。结论射频汽化具有低温冷凝、皱缩、汽化、切割及止血等特点。使得手术操作简便易行,组织创伤小,副反应轻,有利于早期功能恢复。     

蜂毒和风痛宁穴位注射治疗骨关节炎468例

目的　探索骨关节炎新的有效治疗途径。方法　运用纯中药制剂蜂毒注射液和风痛宁注射液穴位注射治疗本病 ,并与局封治疗作对照比较。结果　治疗组总有效率为 92 .5 2 % ,对照组为 77.0 0 % ,两组比较有显著差异 (P<0 .0 5 ) ,且两组副作用、复发时间均有显著差异 (P<0 .0 5 )。结论　蜂毒和风痛宁穴位注射治疗本病疗效优于局封治疗 ,且能减少副作用 ,延长复发时间。     

银杏叶提取物对白介素-1β损伤关节软骨细胞一氧化氮体系的影响

目的:观察银杏叶提取物对白介素-1β损伤的关节软骨细胞的作用及对细胞内一氧化氮体系的影响。方法:在无菌环境下消化得到3月龄雌性新西兰白兔膝关节软骨细胞,实验用细胞为第2代软骨细胞。软骨细胞与IL-1β(5μg/L)、IL-1β(5μg/L)+地塞米松(10-7、10-6、10-5mmol/L)、IL-1β(5μg/L)+银杏叶提取物(40mg、80mg、160mg/L)共同孵育,分别在72h后MTT法检测软骨细胞的增殖受到的影响;24h后测定受损伤软骨细胞培养液中的NOi、NOS,逆转录扩增(RT-PCR)检测iNOSmRNA。结果:MTT法显示IL-1β对软骨细胞的增殖有明显的抑制作用;地塞米松同银杏叶提取物均有对抗IL-1β的效应;地塞米松和EGb均能显著减少iNOSmRNAi、NOS、NO的生成(P<0.01);EGb761的这种效应有剂量依赖性。结论:银杏叶提取物通过抑制软骨细胞内的NO生成以保护IL-1β损伤的膝关节软骨细胞。     

Midterm results of mobile-bearing knee replacements

We examined the clinical and radiographic results of 93 patients affected by knee arthritis or osteonecrosis subjected to unilateral cementless mobile-bearing total knee arthroplasty with the LCS prothesis (Depuy/Johnson & Johnson). The mean follow-up was 9.5 years (range, 7–12 years). Clinical evaluation was performed using the Knee Society rating system, while radiographic evaluation was done according to the Knee Society roentgenographic system. At the latest follow-up, the mean knee score was 87 points: the functional score improved from 40 to 90. Radiolucent lines were small and not progressive. The implant survival at 12 years was 88%. Six knees (7%) required revision for implant-related problems. We conclude that the mobile-bearing prosthesis is a successful device even at long-term follow-up.     

Flavocoxid is as effective as naproxen for managing the signs and symptoms of osteoarthritis of the knee in humans: a short-term randomized,double-blind pilot study

Flavocoxid (Limbrel), a proprietary mixture of flavonoid molecules (baicalin and catechin), was tested against a traditional nonsteroidal anti-inflammatory drug, naproxen, for the management of the signs and symptoms of moderate osteoarthritis (OA) in humans. Discomfort and global disease activity were used as the primary end points, and safety assessments were also taken for both treatments as a secondary endpoint. In this double-blind study, 103 subjects were randomly assigned to receive either flavocoxid [500 mg twice daily (BID)] or naproxen (500 mg BID) in a 1-month onset of action trial. Outcome measures included the short Western Ontario and McMaster University Osteoarthritis Index, subject Visual Analogue Scale for discomfort and global response, and investigator Visual Analogue Scale for global response and fecal occult blood. Both flavocoxid and naproxen showed significant reduction in the signs and symptoms of knee OA (P ≤ .001). There were no statistically detectable differences between the flavocoxid and naproxen groups with respect to any of the outcome variables. Similarly, there were no statistically detectable differences between the groups with respect to any adverse event, although there was a trend toward a higher incidence of edema and nonspecific musculoskeletal discomfort in the naproxen group. In this short-term pilot study, flavocoxid was as effective as naproxen in controlling the signs and symptoms of OA of the knee and would present a safe and effective option for those individuals on traditional nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors. A low incidence of adverse events was reported for both groups.     

胫骨髁间嵴增生在膝关节退行性变诊断中的临床价值探讨

本研究分３组，典型膝关节退行性变组（简称退变组）５０例，早期膝关节退行性变组（简称早退组）１５例，对照组３０例。分别测量每组Ｘ线片的内、外侧胫骨髁间嵴角与内、外侧嵴高平台比值。经统计学处理，两指标所测值在退变组与对照组及早退组与对照组之间有显著性差异（Ｐ＜０．０５），而退变组与早退组之间则无显著性差异（Ｐ＞０．０５）。结果表明：胫骨髁间嵴硬化变尖不仅是膝关节退行性变的特征性表现之一，而且是其早期Ｘ线征象。     

Histological comparison of patellar cartilage degeneration between chondromalacia in youth and osteoarthritis in aging

The histological findings of the patellar cartilage were compared between cases of chondromalacia, which occurs predominantly in young persons (22 patients, average age 19.8 years) and cases of osteoarthritis, which is common among the elderly (21 patients, average age 65.4 years). The histological findings of cartilage in the chondromalacia were characterized by increased density and vigorous fibrous metaplasia of chondrocytes. These findings may be considered to represent a reactive change in the chondrocyte. Cartilage degeneration in osteoarthritis, by contrast, is regressive and presents a clearly different histological picture from that of chondromalacia patellae. We conclude that chondromalacia does not easily lead to osteoarthritis. On the other hand, the cartilage was characteristically softened, as observed by gross inspection, and showed rarefaction of the cartilage matrix. It should be noted that the change was not observed in aging, but showed a pattern of cartilage degeneration peculiar to young patients with chondromalacia patellae.     

细胞因子与骨性关节炎软骨退变的研究现状

骨性关节炎是最常见关节疾患之一,是导致中老年残疾的最常见原因,严重危害着中老年人的生活质量。骨性关节炎的主要病理是软骨的改变,软骨细胞分解和合成活动的平衡有助于维持软骨细胞外基质结构和功能的完整性,而软骨细胞的这种平衡受到细胞因子制约,本文就近年来细胞因子与OA软骨退变之间的研究现状综述。