Analysis of influencing factors of fear of falling in patients with knee osteoarthritis and construction of nomogram model北大核心

BACKGROUND: Fear of falling will aggravate the instability of the knee joint in patients with knee osteoarthritis, leading to the reduction of activities and the decline of the overall body function. Therefore, screening the factors affecting the fear of falling in patients with knee osteoarthritis and constructing a nomogram model can reduce the injury caused by the fear of falling and provide a reference for the formulation of individualized diagnosis and treatment plans. OBJECTIVE: To explore the influencing factors and conditions of fear of falling in patients with knee osteoarthritis, and to establish a predictive model for the risk of fear of falling in patients with knee osteoarthritis. METHODS: A cross-sectional study method was used to enroll 560 patients with knee osteoarthritis who visited Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from September 2019 to February 2021. Among them, 469 were in the falling fear group and 91 were in the non-falling fear group. The general information of patients, the Western Ontario and McMaster Universities Arthritis Index, and the Hospital Anxiety and Depression Scale scores were analyzed and compared between the two groups to determine the influencing factors of the fear of falling in knee osteoarthritis patients. Receiver operating characteristic curves of the influencing factors were drawn to obtain the Youden’s index with diagnostic value for the fear of falling. The maximum value of the Youden index of each factor was the best diagnostic value (cutoff value) of the knee osteoarthritis fear of falling. A nomogram was drawn to establish the knee predictive model for the fear of falling in patients with knee osteoarthritis. RESULTS AND CONCLUSION: (1) Logistic regression analysis showed that height and male were the protective factors for the fear of falling in patients with knee osteoarthritis, and age, unemployment, Western Ontario and McMaster Universities Arthritis Index stiffness scale score, and anxiety scale score were the risk factors for the fear of falling in patients with knee osteoarthritis. (2) Receiver operating characteristic curve results showed that Western Ontario and McMaster Universities Arthritis Index had a significant diagnostic value for knee osteoarthritis patients (Youden’s index=0.733), followed by age, anxiety, and gender. (3) The results of the nomogram showed that the maximum score of the Western Ontario and McMaster Universities Arthritis Index stiffness scale (8 points) could account for 41.6% of the predictors of knee osteoarthritis fear of falling. (4) It is concluded that there is a high incidence of fear of falling among patients with knee osteoarthritis, and joint stiffness and female gender may be risk factors for fear of falling, while low height may be a protective factor for fear of falling, and there is a need to focus on fear of falling and the management of related factors in clinical treatment interventions. © 2023, Publishing House of Chinese Journal of Tissue Engineering Research. All rights reserved.     

桡骨远端骨折固定方法的研究进展

桡骨远端骨折是上肢最常见的骨折类型之一,是临床骨科的常见病和多发病。桡骨远端骨折分型主要以AO(arbeitsgemeinschaft für osteosynthesefragen)分型为主,已成为国内外临床医师的共识。目前主要治疗方法包括保守治疗和手术治疗。保守治疗主要包括小夹板固定、石膏托外固定及支具固定;手术治疗包括克氏针固定、外固定支架、切开复位内固定术、关节镜下辅助复位固定、骨与骨替代物的移植辅助固定、髓内钉固定术以及人工腕关节置换。而针对不同类型、不同严重程度的桡骨远端骨折可选择的固定方法不一,如何选择最有效的固定方法已成为临床医师亟待解决的问题。     

塞来昔布抑制凝血酶诱导的大鼠软骨细胞退变

背景：骨关节炎患者血清中凝血酶含量显著高于正常人,且凝血酶可以诱导大鼠软骨细胞退变,提示抑制凝血酶功能可能成为治疗骨关节炎的一种方法。塞来昔布为临床治疗骨关节炎的常见药物,是否可以抑制凝血酶的促炎作用而改善大鼠软骨细胞退变尚未可知。目的：探讨塞来昔布对凝血酶诱导软骨细胞退变的影响。方法：使用ELISA试剂盒检测骨关节炎患者与正常人血清中凝血酶含量。体外提取、培养SD乳鼠关节软骨细胞,使用第一代细胞进行实验,将软骨细胞分对照组、凝血酶组和塞来昔布组。显微镜下观察3组细胞形态,并使用Edu试剂盒检测细胞增殖情况;qRT-PCR检测软骨细胞外基质成分(聚集蛋白聚糖、弹性蛋白、软骨寡聚基质蛋白)、炎症因子(白细胞介素1、白细胞介素6、肿瘤坏死因子α)、炎症趋化因子(单核细胞趋化蛋白2、单核细胞趋化蛋白7、粒细胞趋化蛋白6)的表达;免疫荧光法检测Ⅱ型胶原α1的表达;Western Blot检测分解代谢基因如基质金属蛋白酶9、基质金属蛋白酶13和环氧化酶2等蛋白的表达。结果与结论：(1)与正常人相比,骨关节炎患者血清中凝血酶含量显著增高;(2)塞来昔布可明显抑制凝血酶诱导的软骨细胞纤维样形态改变;...     

颈部手法治疗神经根型颈椎病机制研究

颈部旋转扳法是治疗颈椎病非手术治疗的常用技术,临床上该技术不仅改善神经根型颈椎病患者麻木、疼痛症状,同时也提高病人的生活质量和满意度。长期以来,颈部旋转扳法已颇具成效,在全国各地诊治大量门诊患者。但对于其作用机制的研究却相对滞后,本文查阅相关资料,就颈部定点定向扳法作用机制进行梳理。