仰卧位拔伸整复手法治疗椎动脉型颈椎病临床研究

椎动脉型颈椎病（CSA）是由于颈椎间盘组织退行性改变及其继发病理改变累及椎动脉,引起椎动脉痉挛,致使脑干、迷路供血不足而产生的一系列症状和体征。手法治疗是改善CSA较为有效的治疗方法,但治疗手法多样。为评价仰卧位拔伸整复手法治疗CSA的临床疗效,笔者以仰卧位电脑床颌枕带牵引为平行对照,对其疗效进行观察,现总结如下。     

兔骨关节炎关节软骨含水率随时间变化的实验研究

骨关节炎 (ｏｓｔｅｏａｒｔｈｒｉｔｉｓ,ＯＡ)的主要病理改变在关节软骨 ,关节软骨中水占湿重的 80 % ,在关节软骨的生化组成中所占比例最大 ,水与蛋白多糖及胶原相结合共同提供了软骨细胞生物学功能的内环境。在ＯＡ时 ,关节软骨内的各个生化组成部分都在发生“退变” ,本实验观察了兔骨关节炎不同时间点内关节软骨的含水率 ,旨在研究伴随软骨退变程度的加重 ,关节软骨含水率的动态变化情况。1　材料与方法1 1　实验动物48只新西兰大白兔 ,6个月龄 ,雌性 ,体重 (2 5 0± 0 10 )ｋｇ ,由上海中医药大学实验动物中心提供。随机分为模型组…     

Klf4抑制Wnt/β-catenin信号通路调控软骨细胞增殖的研究

目的探讨Klf4基因对大鼠软骨细胞增殖影响及相关机制。方法从出生24 h SD幼鼠的股骨头提取软骨细胞,细胞免疫荧光鉴定Col2a1和Sox9基因的表达。转染慢病毒载体PCDH-GFP-Klf4和辅助质粒PSPAX2及PMD2.0G至293ft细胞中产生慢病毒,48 h后收集病毒上清,用其感染大鼠软骨细胞作为Klf4组,用PCDH-GFP慢病毒感染细胞作为对照组。采用CCK8法检测2组细胞生长增殖变化;采用Western blot方法,分别检测2组细胞中Klf4基因表达、增殖相关基因PCNA和CyclinD1蛋白表达、Wnt/β-catenin信号通路上下游基因表达情况。结果原代培养软骨细胞均强表达Col2a1和Sox9基因。慢病毒PCDH-GFP-Klf4和PCDH-GFP成功感染软骨细胞,Klf4基因在软骨细胞过表达。Klf4组软骨细胞生长明显受到抑制,PCNA和CyclinD1蛋白表达和Wnt/β-catenin信号通路相关基因表达均明显下调。结论过表达Klf4基因可能通过抑制Wnt/β-catenin信号通路相关分子的表达而抑制软骨细胞增殖。     

补肾益精方提高卵巢切除大鼠骨质疏松模型松质骨骨质量的实验研究

目的：探讨补肾益精方对去卵巢大鼠骨质疏松模型松质骨骨质量的影响。方法：40只10月龄Wistar雌性大鼠随机分为正常组、模型组、倍美力组和补肾益精方组,每组10只。正常组仅行假手术,其余3组行卵巢切除术。术后第91天开始给药,连续用药90天,处死动物,取出第2腰椎,测定骨质密度和钙、磷、有机质含量;取出第3腰椎,测定其骨质密度和生物力学性能。应用上述多项指标评价骨质量。结果：补肾益精方能明显提高骨质疏松大鼠腰椎骨的骨质密度和钙、磷、有机质含量,增强椎骨的抗压生物力学性能。结论：补肾益精方能够提高去卵巢大鼠松 质骨的骨质量。     

外洗散熏洗联合双钢板内固定治疗股骨远端C3型骨折的临床研究

目的:探讨采用外洗散熏洗联合双钢板内固定治疗改善股骨远端C3型骨折术后关节功能的临床疗效。方法:将43例C3型股骨远端骨折患者应用随机对照的方法,分为治疗组和对照组,其中治疗组23例,对照组20例。两组在研究期间采用相同的基础治疗方案,并应用内外侧联合入路双钢板内固定治疗,治疗组于术后1周加用外洗散熏洗,对照组于术后1周加用温水熏洗。记录所有患者骨折愈合时间,并行HSS膝关节功能评分,两组资料进行统计分析。结果:X线显示两组患者平均术后6个月骨折愈合。治疗组膝关节功能均明显优于对照组。结论:采用外洗散熏洗能有效改善股骨远端C3型骨折术后患者关节功能。     

化痰除湿祛瘀剂对人骨关节炎软骨细胞凋亡的影响

目的:研究化痰除湿祛瘀剂对人骨关节炎(osteoarthritis,OA)软骨细胞凋亡的影响。方法:(1)在苏州中医院骨伤科协助下,取因外伤急性截肢患者的软骨组织以及全膝关节置换手术OA患者的软骨组织,采用酶消化培养法培养人软骨细胞。采用甲苯胺蓝染色鉴定细胞来源,观察显微镜观察其形态变化。(2)将软骨细胞分成OA软骨细胞组、OA软骨细胞组+化痰除湿祛瘀剂(0.016、0.08、0.4、2、10 mg/mL)组,根据分组情况分别培养24 h或48 h后,应用MTT法比较各组细胞的增殖情况。(3)根据增殖结果将软骨细胞分成OA软骨细胞组、OA软骨细胞组+化痰除湿祛瘀剂(0.05、0.1、2 mg/mL)组,用原位末端标记法(TUNEL)检测各组细胞凋亡情况。结果:(1)成功建立了人骨关节炎软骨细胞有限细胞系,细胞生长状态良好;甲苯胺蓝证明所培养的细胞为来自中胚层的软骨细胞。(2)与对照组比较(24 h+),不同浓度的化痰除湿祛瘀剂对OA软骨细胞活力无影响。与对照组(OD值:0.393±0.010,λ=450 nm)比较(24 h+),化痰除湿祛瘀剂(1 mg/mL,OD值:0.441±0.009)和(2mg/mL,OD值:0.430±0.012)组可明显促进软骨细胞增殖(均P<0.001)。(3)OA软骨细胞经TUNEL标记后的结果显示,对照组的凋亡指数为(42.21±2.67)%,化痰除湿祛瘀剂(0.1 mg/mL,37.14%±4.01%;2 mg/mL,34.21%±5.00%)可明显抑制软骨细胞早期凋亡与对照组比较(P<0.05或P<0.01)。结论:化痰除湿祛瘀剂促进细胞增殖,抑制软骨细胞过度凋亡,这可能是抑制软骨破坏的重要机制之一。     

芪骨胶囊治疗绝经后骨质疏松症的分子机制

目的运用网络药理学的方法探究芪骨胶囊治疗绝经后骨质疏松症(postmenopausal osteoporosis,PMOP)的活性成分与潜在分子机制。方法从BATMAN-TCM数据库中获取芪骨胶囊的主要活性成分及其对应的靶点,在Gene Cards数据库和GEO数据库中筛选PMOP疾病靶点,将药物靶点与疾病靶点取交集,运用Cytoscape软件构建"药物-成分-靶点"网络图,同时将交集靶点导入String在线软件构建蛋白互作网络,筛选出核心靶点进行GO(gene ontology)生物过程及KEGG(Kyoto encyclopedia of genes and genomes)通路富集分析。结果筛选获得67个活性成分,核心活性成分包括24-羟基-11-脱氧甘草次酸、菊油环酮、β-谷甾醇、γ-谷甾醇等;获得交集靶点共57个,其中核心靶点有胰岛素(INS)、白介素-6(IL-6)、胰岛素样生长因子-1(IGF-1)等。核心靶点GO生物过程和KEGG通路富集分析结果显示,GO生物过程主要涉及女性怀孕、多细胞生物过程等,KEGG通路主要涉及雌激素信号通路、卵巢甾体生成、流体剪切应力与动脉粥样硬化、白细胞介素17信号通路等。结论对于芪骨胶囊治疗PMOP的作用机制可能与菊花、黄芪、肉苁蓉中的主要成分如α-蒎烯、菊油环酮、β-谷甾醇等有关,并可能通过雌激素、白细胞介素等信号通路作用于人体INS、IL-6、IGF-1等靶点发挥疗效。     

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.     

石氏手法松解术治疗凝肩症的临床研究

目的:观察石氏手法松解术治疗凝肩症的临床疗效。方法:200例患者按治疗方案的不同分为试验组与对照组,两组均以功能锻炼为基础治疗,其中试验组100例患者采用石氏手法松解术治疗,对照组100例患者由临床医师根据临床实际情况选用相应的治疗措施。结果:试验组97例患者、对照组93例患者获得完整随访。试验组显效率为95.88%,对照组显效率为65.59%,治疗后两组患者的肩关节简式McGill疼痛评分、Constant-Murley肩关节功能评分(CMS)均较治疗前明显改善,试验组较对照组更佳,差异有统计学意义(P<0.05)。结论:石氏手法松解术治疗凝肩症可明显改善患者肩部不适及肩关节功能受限,临床疗效显著。