关节腔内注射治疗膝骨关节炎的研究进展

近年应用关节腔内注射药物治疗膝骨关节炎(KOA)一直存在争议。国内外出版过多部指南,对于关节腔内注射药物的推荐强度是不同的,有的甚至相互矛盾,造成广大临床工作者对于这类治疗心存顾虑与疑惑;且缺少国内针对关节腔内注射药物的大样本数据,一定程度上限制了基于国人临床数据产生循证医学指南的可能。随着与国际骨科的接轨,我国学者们越来越重视循证医学指南的产生,在尚缺乏国人临床数据的前提下,试图通过多项专家共识的产生来呼吁更高级别的基础、临床研究的产生,以期更好地服务临床,服务患者。     

应用富血小板血浆混合透明质酸钠治疗膝骨关节炎

目的比较富血小板血浆＋透明质酸钠(PRP＋HA)混合物与单纯使用PRP关节腔内注射治疗Ⅱ期和Ⅲ期膝骨关节炎患者的疗效。 方法选择2014年2月至2014年5月,山东大学附属省立医院和威海市立医院门诊收治的126例Ⅱ、Ⅲ期(Keligren Lawrence分级)膝关节骨关节炎的患者,随机分为PRP＋HA混合物组(63例,63膝)和PRP组(63例,63膝),两组患者性别、年龄、身体质量指数、Keligren Lawrence分级、疼痛视觉模拟评分(VAS)、美国西部安大略与麦克马斯特大学骨关节炎指数(WOMAC)评分分别采用t检验和χ²检验比较。患者接受每周1次的HA＋PRP混合物(2 ml HA＋3.5 ml PRP)关节腔内注射或只注射PRP(3.5 ml)治疗持续3周。在第1、3、6和12个月记录VAS评分和WOMAC评分,采用t检验比较治疗后不同时间点的疗效。 结果两组患者性别、年龄、BMI的差异均无统计学意义(P >0.05),具有可比性。在使用PRP＋HA混合物和单纯PRP治疗的患者中,相比治疗前患者的状态,VAS评分明显降低,膝关节的功能(WOMAC)明显改善。就VAS和WOMAC而言,两组之间差异没有统计学意义(VAS：t＝0.862,P>0.05;WOMAC：t＝1.765,P>0.05);然而,PRP＋HA混合物组有1种能获得更好的功能评分的趋势。两组中没有发现重大不良反应或并发症。 结论PRP＋HA混合物治疗Ⅱ、Ⅲ期膝骨关节炎的患者是安全有效的。     

3D打印技术在肩关节骨性关节炎全肩关节置换术中的应用研究

目的探讨3D打印技术在全肩关节置换术治疗肩关节骨性关节炎的应用价值。 方法2014年5月至2016年5月四川省人民医院骨科收治的肩关节骨关节炎患者12例,其中男4例,女8例;年龄48~81岁,平均（58.5±13.2）岁。累及侧别：左5例,右7例。其中原发性盂肱关节骨关节炎5例,肱骨头缺血性坏死继发盂肱关节骨关节炎4例,创伤性盂肱关节骨关节炎3例。术前应用3D打印技术制备患者双侧肩关节模型,在健侧模型上测定相关解剖学参数,用于假体型号的选择与置入。在患侧模型上观察病变情况,模拟手术过程。记录并与术中情况比较。比较末次随访与术前的肩关节活动度、Constant评分和视觉模拟评分（visual analogue scale,VAS）。采用SPSS 17.0软件对数据进行t检验分析。 结果12例患者均顺利完成人工全肩关节置换术手术,术中选取的假体型号、截骨平面均与模拟手术完全一致。术后影像学资料证实假体组件均按计划精确置入。12例患者术后获随访（16.0±3.8）个月,13~25个月,末次随访Constant评分和VAS与术前对比均有改善,差异具有统计学意义（P <0.05）。末次随访无神经血管损伤,无感染、假体松动,无假体肱骨头上移等严重并发症。 结论3D打印技术用于人工全肩关节置换术治疗原发性和继发性盂肱关节骨关节炎,有助于术前制定手术计划并模拟手术操作,降低手术难度,提高手术质量。     

关节镜治疗老年膝关节骨关节炎合并腘窝囊肿的疗效分析

目的分析膝关节镜下治疗老年骨关节炎合并腘窝囊肿的临床疗效。 方法回顾性分析2013年7月至2015年12月间吉林医药学院附属医院收治的老年膝关节骨关节炎合并腘窝囊肿的患者50例,根据手术方式分为关节镜组（n=25）和开放手术组（n=25）,随访并比较两组患者手术时间、术中出血量、术后恢复率和囊肿复发率情况。 结果所有患者均获得随访,随访时间为8~12个月,平均（10.2±2.1）个月,随访率为100%。关节镜组患者手术时间[（30.2±3.4）min]长于开放手术组[（19.9±2.3）min],术中出血量[（4.5±1.8）ml]少于开放手术组[（38.2±8.1）ml],差异均有统计学意义（t=-12.67,t=20.31,P<0.05）,术后0级恢复率关节镜组为88%,开放手术组为80%,囊肿复发率关节镜组为4.0%,开放手术组为8.0%,差异无统计学意义。 结论关节镜治疗老年膝关节骨关节炎合并腘窝囊肿患者创伤小,术中出血少,但在提高患者术后0级恢复率、降低复发率等方面仍需大样本的研究进行检验。     

Recently highlighted nutraceuticals for preventive management of osteoarthritis

Osteoarthritis(OA) is a chronic degenerative disease of articular cartilage with limited treatment options. This reality encourages clinicians to suggest preventive measures to delay and contain the outbreak of the pathological conditions. Articular cartilage and synovium suffering from OA are characterised by an inflammatory state and by significant oxidative stress,responsible for pain,swelling and loss of mobility in the advanced stages. This review will focus on the ability of olive oil to exert positive effects on the entire joint to reduce pro-inflammatory cytokine release and increase lubricin synthesis,olive leaf extract,since it maintains lubrication by stimulating high molecular weight hyaluronan synthesis in synovial cells,curcumin,which delays the start of pathological cartilage breakdown,sanguinarine,which downregulates catabolic proteases,vitamin D for its capacity to influence the oxidative and proinflammatory environment,and carnosic acid as an inducer of heme oxygenase-1,which helps preserve cartilage degeneration. These molecules,considered as natural dietary supplements,appear like a cuttingedge answer to this tough health problem,playing a major role in controlling homeostatic balance loss and slowing down the pathology progression. Natural or food-derived molecules that are able to exert potential therapeutic effects are known as "nutraceutical",resulting from the combination of the words "nutrition" and "pharmaceutical". These compounds have gained popularity due to their easy availability,which represents a huge advantage for food and pharmaceutical industries. In addition,the chronic nature of OA implies the use of pharmacological compounds with proven longterm safety,especially because current treatments like nonsteroidal anti-inflammatory drugs and analgesicsimprove pain relief but have no effect on degenerative progression and can also cause serious side effects.     

Epidemiology of the locomotive syndrome: The research on osteoarthritis/osteoporosis against disability study 2005–2015

Although locomotive organ disorders are major causes of disability and require support, little information is available regarding their epidemiology. Prevalence and co-existence of locomotive organ disorders including knee osteoarthritis (KOA), lumbar spondylosis (LS), hip osteoarthritis, and osteoporosis have been determined from baseline results of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study. KOA, LS, and hip osteoarthritis overlap in the population, while KOA and LS co-exist in 42.0% of people. Mutual associations between locomotive organ disorders, metabolic syndrome components, and mild cognitive impairment were found using baseline and 3-year follow-up data from the ROAD study. Logistic regression analysis showed that hypertension, impaired glucose tolerance, and mild cognitive impairment increase the risk of KOA. Osteoporosis at L2-4 was significantly influenced by the presence of femoral neck osteoporosis, and vice versa. In turn, excess weight was inversely associated with the occurrence of femoral neck osteoporosis. Finally, data from the 3rd survey (7-year follow-up) were used to calculate the prevalence of the locomotive syndrome using tests proposed by the Japanese Orthopaedic Association for assessing the risk of developing locomotive syndrome. Subsequently, the age-sex prevalence of stage 1 and stage 2 locomotive syndrome was estimated at 69.8% and 25.1%, respectively.     

The MRI-detected osteophyte score is a predictor for undergoing joint replacement in patients with end-stage knee osteoarthritis

Objectives: The aim of this prospective cohort study was to examine whether MRI-detected osteoarthritis (OA)-structural changes at baseline could predict knee OA patients who would undergo total knee arthroplasty (TKA).

Methods: In total, 128 end-stage medial-type knee OA patients were enrolled and followed up for 6 months. MRI using the whole-organ MRI scoring (WORMS) method, radiographic findings, visual analog scale (VAS) for pain and a patient-oriented outcome measure, and the Japanese Knee Osteoarthritis Measure (JKOM) were recorded at baseline. The area under the curve (AUC) was estimated to determine the discriminative value of the prediction models.

Results: While 74 patients (57.8%) did not undergo TKA, the remaining 54 patients (42.2%) underwent TKA during this period. The AUCs of the receiver operating characteristic (ROC) curve for the activities of daily living (ADL) score evaluated by the JKOM ADL score [0.70 (95% CI: 0.60–0.79)] and osteophyte score [0.72 (0.64–0.81)] were 0.70 or greater. The JKOM ADL score (17/40) and the osteophyte score (30/98) showed relative risks (RR) of 2.61 (1.32–5.15) and 3.01 (1.39–6.52) for undergoing TKA, respectively.

Conclusion: The osteophyte score detected by MRI, in addition to ADL score, was found to be an important factor in determining whether the patient should undergo TKA.     

Perfusion of subchondral bone marrow in knee osteoarthritis: A dynamic contrast-enhanced magnetic resonance imaging preliminary study

The role of inflammation in the pathogenesis of osteoarthritis is being given major interest, and inflammation is closely linked with vascularization. It was recently demonstrated that dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) could identify the subchondral bone marrow vascularization changes occurring in osteoarthritis in animals. These changes appeared before cartilage lesions were visible and were correlated with osteoarthritis severity. Thus the opportunity to obtain an objective assessment of bone vascularization in non-invasive conditions in humans might help better understanding osteoarthritis pathophysiology and finding new biomarkers.We hypothesized that, as in animals, DCE-MRI has the ability to identify subchondral bone marrow vascularization changes in human osteoarthritis. We performed knee MRI in 19 patients with advanced knee osteoarthritis. We assessed subchondral bone marrow vascularization in medial and lateral femorotibial compartments with DCE-MRI and graded osteoarthritis lesions on MR images. Statistical analysis assessed intra- and inter-observer agreement, compared DCE-MRI values between the different subchondral zones, and sought for an influence of age, sex, body mass index, and osteoarthritis garde on these values.The intra- and inter-observer agreement for DCE-MRI values were excellent. These values were significantly higher in the femorotibial compartment the most affected by osteoarthritis, both in femur and tibia (p < 0.0001) and were significantly and positively correlated with cartilage lesions (p = 0.02) and bone marrow oedema grade (p < 0.0001) after adjustment.We concluded that, as in animals, subchondral bone marrow vascularization changes assessed with DCE-MRI were correlated with osteoarthritis severity in humans.