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。     

成年股骨颈骨折临床特征分析:一项基于医院的回顾性研究

目的分析天津市天津医院股骨颈骨折患者的临床特征。方法收集2016年1月1日至2017年12月31日在天津市天津医院出院的股骨颈骨折患者资料并进行回顾性研究,统计患者的性别、年龄、骨折分型、受伤机制及治疗方法等并进行分析比较。结果共筛选出符合条件的患者2150例,男736例,女1414例,不同年龄段患者男、女分布的差异有统计学意义(χ^2=91.63,P<0.001)。青年(18~44岁)患者中,男性多于女性,中年(45~64岁)、老年(≥65岁)患者中,女性多于男性。骨折类型以移位型为主(75.56%,1646/2150),移位率青年患者最低(55.17%,64/116),老年患者最高(81.91%,1159/1415)。三个年龄段患者的主要受伤机制均为摔倒[青年61.21%(71/116),中年80.29%(497/619),老年91.24%(1291/1415)]。不同年龄段患者治疗方式的差别有统计学意义(χ^2=1057.11,P<0.001),中、青年患者无论骨折是否移位,主要治疗方式均为内固定术;中年无移位患者采用内固定术的比例(86.22%,169/196)高于移位患者(62.88%,266/423)(χ^2=34.93,P<0.001)。老年患者中无移位者多采用内固定术,移位者多采用半髋置换术。陈旧性股骨颈骨折患者年龄(中位年龄74岁)大于新鲜骨折患者(中位年龄70岁)(Z=-2.777,P=0.005)。陈旧性股骨颈骨折患者移位率(92.41%,73/79)高于新鲜股骨颈骨折患者(75.95%,1573/2071)(χ^2=11.48,P=0.001)。陈旧性股骨颈骨折患者多采用全髋置换术,新鲜骨折患者采用内固定术、半髋置换术、全髋置换术比例相差不大,内固定术最多。结论股骨颈骨折老年女性患者最多;移位患者多于无移位患者;青、中、老年患者受伤机制均为摔倒;中、青年患者多采用内固定术治疗,老年患者主要采用关节置换术治疗。     

Immediate weight bearing after plate fixation of fractures of the tibial plateau

BackgroundProximal articular fractures of the tibia are commonly stabilised with internal fixation using plates and screws. There is a lack of evidence and conflicting guidelines as to the most suitable post-operative rehabilitation regime including weight bearing status. There are numerous physiological and socioeconomic benefits of early weight bearing after orthopaedic surgery, but concerns remain around loss of fracture reduction. Therefore, the aim of this study is to investigate whether the weight bearing status after tibial plateau plate fixation is associated with any loss of reduction or articular collapse.MethodsWe retrospectively analysed data from our prospectively collected major trauma centre database. All tibial plateau fractures that required open reduction and internal fixation with plate and screws were included. The immediate post-operative weight bearing status of these patients was recorded. Group I consisted of those patients that were either non-weight bearing or touch weight bearing for the first six post-operative weeks. Group II consisted of patients who were instructed to weight bear fully (as tolerated) immediately after the operation. Radiographs were taken on day one post-operation, at six weeks and at three months and analysed for fracture displacement and joint depression or loss of fixation.ResultsA total of 90 patients were included in the study. Group I (non-weight bearing or touch weight bearing) consisted of 60 patients (67%). Group II (full weight bearing as tolerated) consisted of 30 patients (33%). The follow up radiographs demonstrated no failure of fixation in either study group. One patient from the weight bearing group had >1 mm joint depression (4 mm) identified at the first follow up, which did not progress.ConclusionsThis study shows immediate post-operative full weight bearing does not affect the fixation or cause articular collapse up to three months after surgery and thus we propose that patients should be allowed to weight bear immediately after surgical stabilisation of tibial plateau fractures. This will enable patients to benefit from the positive effects on fracture healing of early weight bearing post-surgery and avoid the complications of non-weight bearing without loss of fixation or articular collapse.     

CRP monitoring in fractured neck of femur. A waste of resource?

AimWe aim to assess post-operative CRP serum values in a cohort of patients who underwent surgical treatment for neck of femur fracture (NOF#), and whether CRP is a valid tool for the assessment of these patients post-operatively.Study Design and MethodsRetrospective analysis was carried out on all NOF#'s admitted for surgical fixation between August 2015 and July 2016 in a district general hospital. Primary analysis included serum CRP levels until day 7 post-operatively, with secondary analysis of any documented evidence of post-operative complications (medical and surgical) within 30 days post-operatively.ResultsA total of 365 patients were surgically treated for NOF#’s over the study period. CRP serum levels peaked over the first two days post-operatively to median (IQ range) of 226 mg/L (158–299 mg/L), decreasing to 67 mg/L (45.5–104 mg/L) by day 7 post-operatively. 116 patients had documented post-operative complications within 30 daysof operation. CRP levels in patients with and without complications showed no statistical significance in day-1, day-2 and day-3 post-operatively. However, a significant difference was demonstrated on day-4 (p = 0.017), day-5 (p = 0.003), day-6 (p = 0.02) and day-7 (p = 0.031).ConclusionsDuring the first three days of the postoperative period we cannot recommend routine CRP serum blood test monitoring in NOF# patients, as it is not diagnostic in the acute inflammatory phase for medical or surgical complications.     

Protein intake and physical function in older adults: A systematic review and meta-analysis

BackgroundThe present study explored cross-sectional and longitudinal associations between protein intake and physical function in older adults.MethodsWe conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated the association between protein intake and measures of physical function in older adults. Cross-sectional, case-control, and longitudinal cohort studies that investigated the association between protein intake and physical function as a primary or secondary outcome in people aged 60 + years were included. Studies published in languages other than English, Italian, Portuguese, or Spanish were excluded. Studies were retrieved from MEDLINE, SCOPUS, EMBASE, CINAHL, AgeLine, and Food Science Source databases through January 31, 2022. A pooled effect size was calculated based on standard mean differences (SMD), MD, log odds ratio (OR) and Z-score..ResultsTwenty-two cross-sectional studies examined a total of 11,332 community-dwellers, hospitalized older adults, and elite senior athletes with a mean age of approximately 75 years. The pooled analysis indicated that a protein intake higher than the recommended dietary allowance (RDA) was significantly associated with higher Short Physical Performance Battery (SPPB) scores (SMD: 0.63, 95% CI: 0.27, 0.99, P-value: 0.0006), faster walking speed, greater lower-limb (SMD: 0.22, 95% CI: 0.04, 0.40, P-value: 0.02) and isometric handgrip strength (Z-score: 0.087, 95% CI: 0.046–0.128, P-value: 0.0001), and better balance (SMD: 0.33, 95% CI: 0.05, 0.62, P-value: 0.02). Nine longitudinal studies investigated 12,424 community-dwelling and native older adults with a mean age of approximately 85 years. A protein intake higher than the current RDA was not associated with lower decline in either isometric handgrip strength (logOR: 0.99, 95% CI: 0.97–1.02, P-value= 0.67) or walking speed (logOR: 0.92, 95% CI: 0.77–1.10, P-value= 0.35).ConclusionsA protein intake higher than the RDA is cross-sectionally associated with better physical performance and greater muscle strength in older adults. However, a high consumption of proteins does not seem to prevent physical function decline over time.     

A comparison of three methods of skin closure following repair of Achilles tendon rupture

Meticulous skin closure is required to avoid wound problems after Achilles tendon surgery. The purpose of our study was to compare postoperative complication rate, operation time, clinical outcome and patient satisfaction with the wound among two topical skin adhesives (2-octyl cyanoacrylate and n-butyl cyanoacrylate) and conventional nylon skin sutures in Achilles tendon repair surgery. We retrospectively reviewed the records 122 consecutive patients (40 patient in nylon skin suture, 43 patients in 2-octyl cyanoacrylate and 39 patients in n-butyl cyanoacrylate) who underwent surgical repair for acute Achilles tendon rupture between 2012 and 2016. The primary outcome measure was the development of complications in the wound. Secondary outcome measures included the operative time, the Achilles Tendon Total Rupture Score (ATRS) and patient satisfaction with the wound. There was no difference in complication rate in the wound (p = 0.694) and in ATRS (p = 0.824) among patients in the three groups. Mean operative time in nylon skin suture group was significantly longer than in the 2-octyl cyanoacrylate group and n-butyl cyanoacrylate group (p = 0.018 and p = 0.002, respectively). Patient satisfaction in the 2-octyl cyanoacrylate and n-butyl cyanoacrylate groups was significantly higher than in the nylon skin suture group (p = 0.015 and 0.018, respectively). The use of 2-octyl cyanoacrylate and n-butyl cyanoacrylate topical skin adhesives for skin closure following repair of Achilles tendon rupture has equivalent effectiveness and safety compared to conventional nylon skin suture, but higher patient satisfaction. Despite its higher cost, these topical skin adhesives are viable alternatives for wound closure in patients who regard cosmetic outcomes as important.     

中药生肌液对体外培养兔骨髓间充质干细胞成骨活性的影响

背景：在临床工作中，外用中药生肌膏能治疗感染开放性骨折引起的骨缺损。其机制可能为生肌膏中作者前期实验从生肌膏的原料生药中提取了生肌液，并证实不同浓度的生肌液对骨髓间充质干细胞的增殖活性影响不同。有效成分促进骨髓间充质干细胞的增殖，并诱导其向成骨细胞转化。目的：观察生肌液对体外培养的兔骨髓间充质干细胞成骨活性的影响。设计：单一样本实验。单位：天津市天津医院骨科研究所。材料：实验于2004—10／2005—12在天津市天津医院骨科研究所细胞工程室完成。骨髓间充质干细胞取自5只3月龄的雄性健康日本大耳白兔。浓度为5×10^2g／L生肌液从生肌象皮膏（由天津市中药饮片厂提供。原料生药当归、生地、龟板、象皮、血余）提取。方法：将25，8．3，5g／L的生肌液作用于兔骨髓间充质干细胞，以不含生肌液的基础培养液为空白对照，以含地塞米松10^-8mol／L，维生素C0．05g／L，β-甘油磷酸钠10mmol／L的基础培养液为标准对照。将不同干预条件下传代后的骨髓间充质干细胞接种在培养板中培养二三周，采用荧光倒置显微镜下观察钙结节形成情况，采用四环素标记及胶原Ⅰ免疫组织化学染色观察细胞的表达情况，取细胞培养液测定胞外及胞内碱性磷酸酶、骨钙素、乳酸脱氢酶含量，将细胞内外碱性磷酸酶、骨钙素、乳酸脱氢酶数量各自加和，计算碱性磷酸酶，乳酸脱氢酶、骨钙素，乳酸脱氢酶值。主要观察指标：培养2，3周兔骨髓间充质干细胞钙结节形成、四环素标记及胶原Ⅰ免疫组织化学染色结果及碱性磷酸酶，乳酸脱氢酶、骨钙素，乳酸脱氢酶值。结果：①细胞钙结节观察结果：除了标准对照细胞外，不同浓度生肌液条件下细胞随培养时间延长，胞体先后出现拉长，聚集生长，随后中心细胞增殖、重叠，细胞之间界限模糊，逐渐形成多个散在的细胞结节，钙沉积逐渐出现，最终形成钙化结节。②四环素标记及胶原Ⅰ免疫组织化学染色：除了基础培养液组外，各实验组四环素标记呈阳性的细胞及钙结节在荧光激发下呈黄绿色，空白对照细胞为阴性；除了标准对照细胞外，不同浓度生肌液条件下细胞胶原Ⅰ免疫组织化学染色呈阳性，棕黄色深染颗粒位于细胞胞浆中。③碱性磷酸酶，乳酸脱氢酶、骨钙素，乳酸脱氢酶检测结果：条件培养后2，3周，25g／L生肌液作用下细胞碱性磷酸酶，乳酸脱氢酶、骨钙素，乳酸脱氢酶比值高于其他条件下两种含量比值，差异具有统计学意义（P〈0．05）。结论：生肌液对体外培养的兔骨髓间充质干细胞的诱导成骨作用肯定，且高浓度时诱导成骨作用较强。     

Proximal femoral fractures: Principles of management and review of literature

PurposeThe purpose of this study was to review the principles involved in the management of proximal femoral fractures as reported in the literature. Methods: A medical literature search in the MEDLINE (PubMed) and Cochrane database was undertaken to review strategies and principles in proximal femoral fracture treatment. Randomized control trials and meta analysis were given preference while case reports/small series were rejected. Results and conclusions: Early anatomical reduction and surgical fixation remains the best option to reduce the risk of complications like non-union and avascular necrosis in treating fracture neck femurs. Cancellous screws continue to be the preferred treatment for fixation of neck femur fractures in younger population until the benefit of using sliding hip screws is validated by large multicentric studies. In the geriatric age group, early prosthetic replacement brings down the mortality and morbidity associated with neck femur fractures. Sliding hip screw (DHS) is the best available option for stable inter trochanteric fractures. The use of intramedullary nails e.g. PFN is beneficial in treating inter trochanteric fractures with comminution and loss of lateral buttress. Intramedullary implants have been proven to have increased success rates in subtrochanteric fractures and should be preferred over extramedullary plate fixation systems.     

Balloon kyphoplasty versus percutaneous vertebroplasty in treating osteoporotic vertebral compression fracture: grading the evidence through a systematic review and meta-analysis

Objective

To assess the safety and efficacy of balloon kyphoplasty (KP) compared with percutaneous vertebroplasty (VP) and provide recommendations for using these procedures to treat osteoporotic vertebral compression fractures (OVCF).

Methods

A systematic search of all studies published through March 2012 was conducted using the MEDLINE, EMBASE, OVID, ScienceDirect and Cochrane CENTRAL databases. The randomized controlled trials (RCTs) and non-randomized controlled trials that compared KP to VP and provided data on safety and clinical effects were identified. Demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies. The evidence quality levels and recommendations were assessed using the GRADE system.

Results

Twelve studies encompassing 1,081 patients met the inclusion criteria. Subgroup meta-analyses were performed according to the study design. In the RCT subgroup, there were significant differences between the two procedures in short-term visual analog scale (VAS), long-term kyphosis angles, operative times and anterior vertebrae heights. In the cohort study subgroup, there were significant differences between the two procedures in short- and long-term VAS, short- and long-term Oswestry Disability Index (ODI), cement leakage rates, short- and long-term kyphosis angles, operative times and anterior vertebrae heights. However, there were no significant differences in long-term VAS or adjacent vertebral fracture rates in the RCT subgroup. There were no significant differences in short- or long-term VAS, short- or long-term ODI, cement leakage rates, adjacent vertebral fracture rates, short- or long-term kyphosis angles or anterior vertebrae heights in the CCT subgroup, and the adjacent vertebral fracture rates did not differ significantly in the cohort study subgroup. The overall GRADE system evidence quality was very low, which lowers our confidence in their recommendations.

Conclusions

KP and VP are both safe and effective surgical procedures for treating OVCF. KP may be superior to VP in patients with large kyphosis angles, vertebral fissures, fractures in the posterior edge of the vertebral body or significant height loss in the fractured vertebrae. Due to the poor quality of the evidence currently available, high-quality RCTs are required.