屈曲挛缩畸形膝关节置换的软组织平衡

目的：探讨屈曲挛缩畸形的膝关节行关节置换的方法,重点关注术中膝关节周围软组织平衡的方法。技巧及术后疗效。方法：自2010年6月～2012年6月共收治晚期膝关节疾病合并屈曲挛缩畸形患者156例,213膝,采取人工膝关节置换进行治疗,分别记录术前术后膝关节畸形程度,HSS评分,活动范围。并进行比较。本组病例平均年龄60．2岁（44～81岁）,女92例136膝,男64例77膝。膝骨性关节炎85例,类风湿性关节炎58例,创伤性关节炎13例。膝关节活动范围平均52．6°（33．5°～94．1°）。本组病例轻度屈曲畸形：83例117膝,中度屈曲畸形：58例76膝,重度屈曲畸形：15例20膝。平均屈曲畸形程度：45．8°。每例患者均进行术前及术后1年HSS评分进行疗效评价。结果：所有病例获得随访,屈曲挛缩畸形均得到改善,膝关节HSS评分由术前20．7分提高到术后平均73．6分。膝关节活动范围术前平均52．6°提高到术后平均92．7°。结论：晚期膝关节病所致的屈曲挛缩畸形的膝关节行膝关节置换术,除了在术中注意准确截骨外,应着重注意软组织松解,调整力线。     

MAPK信号通路在骨关节炎发病机制中的研究进展

丝裂原活化蛋白激酶（mitogen—activated proteinkinase,MAPK）真核细胞信号传递的重要途径之一,在调节控制细胞结构和功能活动中发挥关键作用。在真核生物中MAPK信号通路包括p38、ERK、JNK、ERK5等多个亚家族。随着研究的不断深入,发现p38、ERK、JNK信号转导途径的活化与骨关节炎（osteoarthritis,OA）软骨损伤密切相关,诱导软骨细胞产生基质金属蛋白酶,加速关节软骨病理性降解,并参与软骨细胞增殖、凋亡与分化等一系列反应,明确MAPK信号通路在OA中的发生发展机制已成为研究的新热点。     

脂蛋白基因在早期骨关节炎软骨下骨的表达

目的：研究早期骨关节炎软骨下骨脂蛋白相关的基因表达改变情况。方法：大鼠分为实验组（15只）和对照组（15只）.实验组切除右膝内侧半月板及内侧副韧带,对照组仅切开关节囊。于术后1、2、4周取右膝关节标本,采用全基因表达谱芯片技术研究软骨下骨全基因表达,利用差异基因分析的方法分析脂蛋白相关的基因表达改变情况。结果：软骨下骨Apoa5表达于建模术后1周上调,术后2周下调;Apoc2表达于术后2周上调;Apol3表达于术后1周上调,术后4周下调;Lrp1于术后1、2周下调;Lrp5于术后2周下调;Gpihbp1、Lpl、Tfpi、Vldlr表达于术后1周均上调;Lrpap1、RGD1309808于术后4周均下调。结论：脂蛋白相关基因的表达改变在早期膝关节骨关节炎的软骨下骨变化中可能起了重要作用。     

The Prevalence of Osteoarthritis of the Intact Hip and Knee Among Traumatic Leg Amputees

Struyf PA, van Heugten CM, Hitters MW, Smeets RJ. The prevalence of osteoarthritis of the intact hip and knee among traumatic leg amputees.

Objective

To determine the prevalence of osteoarthritis (OA) in the knee and/or hip of the intact leg among traumatic leg amputees compared with the general population and its relationship with amputation level, time since amputation, age, and mobility.

Design

Cross-sectional observational study.

Setting

Outpatient population of 2 Dutch rehabilitation centers.

Participants

Patients (N=78) with a unilateral traumatic transtibial amputation, knee disarticulation, or transfemoral amputation of at least 5 years ago; ability to walk with a prosthesis; older than 18 years of age; and able to understand Dutch. Patients were excluded if they had bilateral amputations, other pathologies of the knee or hip, or central neurologic pathologies.

Interventions

Not applicable.

Main Outcome Measure

The prevalence of OA.

Results

The prevalence of knee OA was 27% (men 28.3%, women 22.2%) and hip OA was 14% (men 15.3%, women 11.1%). This was higher compared with the general population (knee OA men 1.58%, women 1.33%, hip OA men 1.13%, women 0.98%, age adjusted). No significant relationships between the prevalence of OA and level of amputation, time since amputation, mobility, and age were found.

Conclusions

The prevalence of OA is significantly greater for both the knee and hip in the traumatic leg amputee population. No specific risk factors were identified. Although no specific risk factors in this specific population could be identified, it might be relevant to apply commonly known strategies to prevent OA as soon as possible after the amputation.     

关节液中脂联素水平与膝关节骨关节炎严重程度的相关性研究

背景：众所周知,肥胖是引起骨关节炎发生、发展的危险因素之一。肥胖人群容易发生关节炎的原因是超载作用和代谢因素。脂肪组织是一个活跃的器官,它的分泌脂肪细胞因子包括脂联素进入全身循环,参与了骨关节炎的发病。 目的：测量骨关节炎患者血清和关节滑液中脂联素水平,分析其与膝关节骨关节炎严重程度的相关性。 方法：64例膝关节骨关节炎患者（关节炎组）和19例因半月板或韧带损伤患者（对照组,行关节镜检查后排除软骨损伤）被纳入本研究。采用Kellgren-Lawrence（KL）标准对关节炎患者的膝关节前后位X线片进行评估分级。使用酶联免疫吸附试验检测脂联素在对照组和关节炎组患者血清和关节滑液中的表达水平。使用WOMAC量表（Western On-tario and McMaster Universities Arthritis Index）评估患者膝关节功能。 结果：骨关节炎组患者血清中的脂联素水平[（6177.8±991.0）ng/ml]高于对照组[（5793.4±673.3）ng/ml],但差异无统计学意义（P=0.12）。但在骨关节炎组患者,血清中的脂联素浓度[（6177.8±991.0）ng/ml]显著高于关节滑液中的脂联素[（824.3±304.7）ng/ml,P〈0.001）。关节炎患者关节液中脂联素浓度与评估疾病的严重程度呈负相关（r=-0.51,P〈0.001）,但血清脂联素浓度与疾病的严重程度关联不显著（r=-0.17,P=0.18）。血清脂联素水平、滑膜液脂联素水平与MOMAC疼痛评分均不显著相关（r=-0.01和r=-0.13,P＞0.05）。 结论：骨关节炎患者滑膜液中脂联素水平与膝关节炎严重程度呈负相关。检测关节滑液中的脂联素可能有助于早期发现关节炎。     

IL-1β对ATDC5成软骨分化细胞miR-455-3p的影响

目的：检测IL-1β对ATDC5成软骨分化细胞miR-455-3p表达的影响,探索miR-455-3p在骨关节炎中的作用。方法诱导ATDC5细胞成软骨分化后,予10 ng/ml的IL-1β刺激,在刺激4、12、24、48 h时应用实时荧光定量PCR检测miR-455-3p、C/EBPβ和软骨特征性标记物的表达情况;并利用抑制剂IKK-NBD阻断NF-κB通路后,应用实时荧光定量PCR检测IL-1β作用下miR-455-3p的表达水平。结果在IL-1β作用下的ATDC5成软骨分化细胞中miR-455-3p、C/EBPβ和软骨退变标记物（ MMP13、ADAMTS5）均上调,而软骨基质合成标记物（ ACAN、COL2A1、SOX9）则下调,且后期更为明显;而IKK-NBD可抑制IL-1β诱导的miR-455-3p表达。结论 IL-1β可上调ATDC5成软骨分化细胞miR-455-3p的表达水平,且受NF-κB通路的调节。     

肘关节镜下清理术治疗肘关节骨关节炎的早期疗效

目的探讨肘关节镜下清理术治疗肘关节骨关节炎的早期疗效以及术中第一入路的选择。方法2010年5月至2013年5月,我院收治16例肘关节骨关节炎患者,男14例,女2例;年龄22-58岁,平均45岁。右肘15例、左肘1例,均单侧发病。采用侧卧位,以后正中入路作为第一入路,辅以后外侧和近端内、外侧入路行肘关节镜下清理术。分别测量术前、术后肘关节伸直角度、屈曲角度、活动度,应用Mayo肘关节功能评分（Mayo elbow performance score,MEPS）评价疗效。结果所有患者均获随访,切口均甲级愈合,无神经及血管损伤并发症。肘关节伸直角度、屈曲角度、活动度及MEPS值较术前明显改善（P〈0.05）。术后MEPS值结果：优9例,良4例,中3例,优良率达81.25%。结论肘关节镜下清理术治疗肘关节骨关节炎,可以明显增加关节活动度,改善关节功能,早期疗效较好。采用侧卧位,以后正中入路作为第一入路,辅以后外侧和近端内、外侧入路,术中操作方便,安全。     

Robust features of knee osteoarthritis in joint moments are independent of reference frame selection

Background

Changes in lower-limb joint moments are important outcome measures for treatment and prevention of knee osteoarthritis. However, it is known that both the magnitude and amplitude of joint moments are affected by the choice of anatomical reference frame. The purpose of this study was to identify features of joint moment waveforms that, regardless of the choice of reference frame, are different for subjects with knee osteoarthritis as compared to asymptomatic control subjects.

Methods

External joint moments during the stance phase of gait were calculated for 44 subjects with moderate knee osteoarthritis and 44 asymptomatic subjects. Moments were then expressed using four anatomical reference frames: Joint Coordinate System, Plane of Progression, Proximal, and Distal. Principal component analysis was used to extract features of the moment waveforms that differed between control and osteoarthritis groups across all reference frames.

Findings

Principal component analysis revealed that, regardless of the choice of reference frame, subjects with knee osteoarthritis exhibited significantly decreased overall hip adduction moment magnitudes, increased overall knee adduction moment magnitudes, decreased knee internal rotation moment amplitudes, and increased early-stance ankle adduction magnitudes.

Interpretation

The four robust features identified in this study are sensitive to the effect of knee osteoarthritis, but independent of changes in the anatomical reference frame. These features can be solely attributed to the pathogenesis of the disease, and not to the artifact of reference frame selection.     

膝关节骨关节炎经中西医不同疗法的对比研究

目的:比较经不同的药物方案治疗对膝关节骨性关节炎(OAK)患者的疗效,为临床用药提供参考数据。方法:选取2015年1月至2016年12月我院收治确诊为膝关节骨关节炎(Osteoarthritisoftheknee,OAK)的初治患者共103例(132膝)。男性/女性为1.24∶1(57/46)。平均年龄(43.60±10.35)岁。平均病程(20.1±3.4)个月。将全部患者按随机数字表法分为观察1组和观察2组,均经患肢制动、辅以超声下关节腔抽取积液或和关节腔冲洗治疗等。并分别经不同的药物方案治疗,其中观察1组:应用解热镇痛类药布洛芬缓释胶囊(早晚各1次口服,1片/次),盐酸氨基葡萄糖胶囊(1片/次,3次/d)。观察2组:在观察1组治疗基础上额外应用针灸治疗和推拿理疗(隔天1次,3次/周)。疗程均为6周。考察治疗后的疗效和安全性。结果:2组在治疗后2周、4周、6周的膝关节综合评分和治疗后6周临床症状和体征的改善方面,比较的差异均有统计学意义(P0.05)。2组总的不良事件发生率(在观察1组和观察2组分别为9.62%和7.69%)比较的差异无统计学意义(χ~2=0.24,P=0.63,0.05)。结论:在临床上针对膝关节骨关节炎患者采用抗炎镇痛类等西药再联合中医的针灸和推拿按摩疗法,可以获得良好的缓解疼痛的效果,并明显改善患肢膝关节的功能,有助于提高患者的生命质量。