跑台运动对兔前交叉韧带断裂后膝关节软骨的影响

目的:建立一种可有效用于研究兔前交叉韧带(ACL)断裂后运动对软骨影响的实验运动模型,进而研究早期运动对兔ACL断裂后关节软骨的影响。方法:45只成年新西兰大白兔(4~5月龄,体重2.5~3kg),随机平均分为:I组,假手术自由活动组(Sham组);II组,前交叉韧带切断(ACL transection)自由活动组(ACLT组);III组,前交叉韧带切断跑台运动组(ACLT with exercise,ACLT+Ex组)。运动组在实验跑台上定期运动,运动始于术后第5天,运动强度为5天/周,10分钟/天,跑台速度为0.3英里/小时(约8米/分钟)。分别于术后第2、3、4周每组处死5只兔子,对兔膝关节股骨髁软骨进行印度墨汁染色大体观评分、组织学和二型胶原免疫组化染色并使用国际骨关节炎研究会(OARSI)软骨损伤评分系统进行软骨损伤评估。结果:术后2周,Sham组、ACLT组和ACLT+Ex组未见明显软骨损伤;术后3周、4周,Sham组软骨未见明显损伤退变;ACLT组和ACLT+Ex组均出现软骨损伤,在大体观评分和OARSI分级、分期、总分上分别与Sham组存在显著统计学差异;ACLT组与ACLT+Ex组在大体观评分和OARSI软骨损伤评分上无统计学差异。结论:跑台运动是可用于研究兔ACL断裂后对关节软骨损伤研究的有效实验运动模型;兔ACL断裂后早期出现关节软骨损伤,但与笼养自由活动相比,实验跑台运动对关节软骨损伤进程无影响,表明ACL断裂后早期进行合理运动与康复不会加重膝关节软骨损害。     

内侧副韧带切断合并半月板部分切除对大鼠膝关节软骨、滑膜和细胞因子的影响

目的:观察内侧副韧带切断合并半月板部分切除对大鼠膝关节软骨、滑膜和关节液中细胞因子的影响。方法:20只SD大鼠,行内侧副韧带切断和内侧半月板部分切除术,分别在术后第1、2、3、4和5周各处死4只大鼠并取材;另备4只作为正常对照。组织学观察其关节软骨和滑膜的变化,酶联免疫吸附法(ELISA)测定关节液中细胞因子白细胞介素-1β(IL-1β)和肿瘤坏死因子-α(TNF-α)表达。结果:膝关节内侧副韧带切断和部分半月板切除后,大鼠关节液中IL-1β和TNF-α表达显著增高,TNF-α在术后第1周时、IL-1β在术后第2周时达到峰值,然后逐渐下降,第5周时仍显著高于正常对照水平。术后第1周,关节软骨丢失,软骨层变薄;软骨细胞减少,排列层次紊乱,有簇聚现象;蛋白多糖分泌减少,表面的软骨组织甲苯胺蓝染色失染。第2周,软骨继续退变,表面软骨纤维化,软骨下骨硬化,部分侵入软骨层,蛋白多糖进一步丢失,甲苯胺蓝染色失染严重。从第3周开始,正常的软骨细胞基本消失,呈纤维样变,软骨下骨硬化;髓腔融合、开放、纤维化,呈现晚期骨性关节炎的改变。滑膜细胞从术后第1周开始增生,炎细胞浸润;第2周滑膜炎症加重,并有血管增生;第3周滑膜已出现明显的纤维化改变。结论:内侧副韧带切断伴内侧半月板部分切除后,大鼠膝关节呈现骨性关节炎的改变,关节液中IL-1β和TNF-α表达显著增高。     

色素绒毛结节性滑膜炎膝关节组织的病理学个案研究

目的:研究膝关节色素绒毛结节性滑膜炎关节软骨、滑膜、半月板和前、后交叉韧带的病理学变化。方法:一例膝关节色素绒毛结节性滑膜炎的患者进行关节置换时,选取关节的软骨、滑膜、半月板和前、后交叉韧带组织进行HE染色,观察色素绒毛结节性滑膜炎对上述组织的影响。结果:软骨、滑膜、半月板和前交叉韧带细胞,可吞噬含铁血黄素,导致滑膜细胞增生,绒毛结节形成,软骨细胞和半月板细胞的死亡,软骨、半月板和前交叉韧带组织的退变。     

膝关节退行性骨关节病的MRI表现

目的 :探讨MRI对膝关节退行性骨关节病的诊断价值。方法 :对手术、关节镜或临床证实的 2 1例 2 6个膝关节退行性骨关节病的MRI表现进行回顾性分析。结果 :MRI能较好地显示膝关节病变的关节软骨、半月板、韧带、骨质等改变 ,还能对关节软骨、半月板损伤和退变进行分级 ,明显优于传统X线检查。结论 :MRI检查能清楚显示退行性骨关节病的病变特点和严重程度 ,为临床选择合适的治疗方案提供了依据。     

利用HHGS和OOCHAS评分评价兔前交叉韧带断裂后膝骨关节炎软骨损伤程度的研究

目的:研究两种软骨组织学评分方法 Histologic/Histochemical Grading System(HHGS)和OARSI Osteoarthritis Cartilage Histopathology Assessment System(OOCHAS)对兔前交叉韧带断裂后骨关节炎早期软骨损伤评价的不同,选择更适合早期软骨损伤评价的组织学评分标准。方法:取48只成年新西兰大白兔(2.5~3 kg),切断左膝前交叉韧带建立骨关节炎(OA)模型(实验组),右膝为假手术组(对照组)。分别于术后2、4、6、8周随机处死12只兔子,分别取实验组与对照组胫骨平台负重区软骨行大体观评分、核磁检查、HE和甲苯胺蓝染色,利用HHGS和OOCHAS对组织切片进行软骨损伤评价,并分析两种标准之间的差异。结果:大体观和核磁结果:术后第2周无明显软骨损伤,术后第4周出现早期OA软骨损伤,术后第6和8周出现中晚期OA软骨损伤。组织学评分结果:两种评分标准对实验组术后2、6和8周的软骨损伤程度评价一致,但对术后第4周的评价存在差异,HHGS评分结果显示,12膝中9膝为中期OA软骨损伤,3膝为早期OA软骨损伤;OOCHAS评分显示,1膝为中期OA软骨损伤,11膝为早期OA软骨损伤,配对卡方检验结果:P=0.021,表明两者构成比存在差异。kappa=-0.176(<0.02为一致性差),表明两种方法在评价早期软骨损伤时一致性较差。与HHGS评分相比,OOCHAS评分结果与大体观和核磁检查结果更一致。结论:本动物实验研究表明OOCHAS评分适合前交叉韧带断裂后早期骨关节炎软骨损伤的评价。     

异种异体半月板移植延缓关节软骨退行性变的研究

目的:探讨异种异体半月板移植对延缓关节软骨退变的作用。方法:对15只成年新西兰兔的后肢左、右膝均进行内侧半月板全切。在15只兔的左膝进行猪半月板组织成型后所得的异种异体内侧半月板移植,以其已切除内侧半月板的右膝作为对照。分别于术后6周、12周、24周择期处死动物,观察各组兔膝关节软骨的大体病理表现、组织病理Mankin评分改变,并用Ⅰ、Ⅱ、Ⅲ、Ⅹ型胶原单克隆抗体免疫组织化学染色法观察关节软骨中Ⅰ、Ⅱ、Ⅲ、Ⅹ型胶原的表达情况。结果:兔内侧半月板全切组膝内侧胫骨平台和内侧股骨髁软骨破坏严重,有大量骨赘形成,呈骨性关节炎表现。异种异体半月板移植在短期内对关节软骨具有明显保护作用,但随着术后24周移植半月板被破坏,关节软骨出现退变,但与同期的半月板切除膝相比,关节软骨退变较轻。结论:异种异体半月板移植短期内对关节软骨有保护作用;异种异体半月板移植可延缓关节软骨退行性变。     

自体半腱肌腱重建兔前交叉韧带腱骨愈合和止点形成实验研究

目的:观察应用自体半腱肌腱重建兔前交叉韧带术后12个月内腱骨愈合的组织学变化过程。方法:取新西兰大白兔同侧自体单股半腱肌腱重建前交叉韧带,分别于术后2周,1、2、4、6、12个月取材,采用HE和甲苯胺蓝染色观察骨道内腱骨间愈合和止点形成的组织学变化过程。结果:术后2周,腱组织坏死,腱骨间形成肉芽组织界面,其中的新生组织细胞向坏死腱内长入、替代,术后1个月腱骨间形成Sharpey纤维连接和纤维软骨,术后4个月形成潮线样结构,6个月形成直接止点的四层结构,12个月更加成熟。结论:前交叉韧带重建后腱骨间的愈合是一个由间接止点转化为直接止点的骨源性渐进过程。     

骨性关节炎兔关节软骨、关节液细胞因子IL-1β和TNF-α变化的研究

目的:通过观察骨性关节炎兔关节软骨和关节液中细胞因子的连续动态改变,深入探讨骨性关节炎发生发展的过程和发病机制。方法:15只成年新西兰大白兔(30个膝关节)随机分为2组,实验组(12只,24个膝关节)和对照组(3只,6个膝关节)。采用内侧副韧带切断术和内侧半月板切除术建立骨性关节炎模型,实验组分别在术后第1、2、3、4周处死兔并取材。对照组在第4周处死兔并取材。采用墨汁染色的方法观察软骨损伤情况,使用光镜和扫描电镜观察关节软骨组织学的连续动态变化;采用酶联免疫吸附法测定关节液中白细胞介素-1β(IL-1β)和肿瘤坏死因子α(TNF-α)表达。结果:骨性关节炎模型兔关节软骨损伤随时间延长而加重,光镜和电镜的检查结果均显示关节软骨随时间延长而逐渐被破坏;关节液中IL-1β和TNF-α的表达明显升高,IL-1β表达在2周时达到峰值,TNF-α在1周时明显升高,2周时有所下降,3周时又升高,4周时下降,但仍处于较高水平。结论:在兔骨性关节炎模型中,随着时间延长关节软骨损伤进行性加重,关节液中IL-1β和TNF-α水平呈高表达,但并未随软骨损伤的进行性加重而不断升高。     

关节镜下半腱肌、半膜肌腱联合重建后交叉韧带的疗效分析

后交叉韧带(PCL)是膝关节韧带结构中最强的稳定结构,断裂后可造成关节直向不稳、旋转不稳和侧方不稳,从而影响膝关节功能,并导致膝周其他韧带松弛、半月板损伤和关节软骨退变等病变[1].近年来,PCL重建的研究已成为矫形骨科医师探讨的热点.自2001年3月至2004年4月,笔者在关节镜下联合半腱肌、半膜肌腱重建PCL 46例.现报告如下.     

基质金属蛋白酶-1在创伤性骨关节炎软骨及滑膜中的表达

目的　观察基质金属蛋白酶 - 1(MMP - 1)在兔前交叉韧带切断 (ACLT)创伤性骨关节炎 (OA)软骨及滑膜中的表达和分布 ,探讨MMP - 1表达与创伤性软骨退变之间的关系。　方法大耳白兔 2 0只行单侧ACLT术 ,术后 4周及 8周各处死 10只 ,另选 10只行单侧膝关节切开术作为假手术对照 ,于术后 8周处死。于解剖显微镜下行股骨关节面软骨退变大体评分 ,用免疫组化的方法检测MMP - 1在软骨及滑膜中的表达及分布。　结果　大体评分显示ACLT组软骨退变明显重于对照组 (P <0 .0 1) ,其中 8周组软骨退变程度又明显高于 4周组 (P <0 .0 5 )。MMP - 1主要在软骨表层及中上层、滑膜衬里层表达 ,其表达量随OA进展逐渐增高 (P <0 .0 5 )。OA早期 ,MMP - 1在滑膜中的增长滞后于它在软骨中的增长。　结论　MMP - 1与创伤性OA软骨退变关系密切 ,早期软骨退变主要源于软骨自身代谢改变 ,其后滑膜亦参与软骨退变。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）