沙浴治疗兔膝骨关节炎的实验研究

目的：研究沙浴对兔膝关节骨性关节炎(osteoarthritis OA)关节周围血流、膝关节滑膜及软骨的病理改变的影响，为中老年人膝骨关节炎的沙浴治疗提供依据。方法：青紫兰兔15只，成功建立OA动物模型13只，其中12只随机分成自由活动组(A)，自由活动加沙疗组(B)，健侧关节沙疗对照组(C)。在平均气温32℃情况下，将模型兔下半部分掩埋在干燥的40～50℃的海沙中，1次25～30min，1次／d。观察沙疗后即时的膝关节周围血流情况，以及经过沙疗10d和20d后膝关节滑膜及软骨的病理改变。结果：沙疗后患侧膝关节活动改善，膝关节周围血管内血流明显增加，膝关节滑膜细胞层次逐渐减少、炎症细胞明显减少，但软骨细胞退变改善在光学显微镜下不明显。结论：沙疗能增加治疗部位的血流，改善局部血液循环，促进炎症的消退，对正常关节无不利影响。     

膝骨性关节炎的关节镜微创手术治疗

目的 探讨膝骨性关节炎的关节镜微创手术治疗效果.方法 关节镜探查64例(68膝)膝骨性关节炎患者,通过关节镜微创手术进行镜下清理术治疗.结果 全部病例术后随访3～34个月,平均18.2个月.随访一年优良率81％;1～2年,优良率92％;2年以上者,优良率73％.结论 关节镜微创手术以其切口小,创伤小,疤痕少,康复快,并发症少等优点,为膝骨性关节炎提供了一种有效的治疗方法.     

Prevalence of Osteoporosis in Female Patients with Advanced Knee Osteoarthritis Undergoing Total Knee Arthroplasty

This study sought to demonstrate bone mineral density (BMD) conditions in elderly female patients with knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA). In addition, we sought to determine whether their BMD conditions differ from those of community-based females without knee OA. Finally we sought to determine whether clinical statuses are related to BMD in the knee OA patients. BMD conditions in 347 female patients undergoing TKA and 273 community-based females were evaluated. Additionally, comparative analyses of BMD between age and body mass index-matched knee OA groups (n=212) and the control groups (n=212) were performed. In the pre-matched knee OA group, regression analyses were performed to determine whether preoperative clinical statuses were related to BMD. Considerable prevalence of coexistent osteoporosis (31%) was found in the pre-matched knee OA patients undergoing TKA. We found no significant differences of the BMD T-scores and the prevalence of osteoporosis between the age and body mass index-matched knee OA and control groups. In the pre-matched knee OA patients, poorer preoperative clinical scores were related to poorer BMD T-scores in the proximal femur and/or lumbar spine. Our study suggests that more attention should be paid to identify and treat osteoporosis in elderly female patients with advanced knee OA undergoing TKA.

Graphical Abstract

相似文献   

骨性关节炎对膝关节软骨力学性质影响的实验研究

目的 研究正常国人新鲜尸体膝关节软骨和骨性关节炎膝关节软骨的生物力学性质,为临床提供生物力学参数。方法 取正常和病变的膝关节软骨在ShimadzuAUTOGRAPH电子万能试验机上进行一维拉伸实验。结果 得出了关节软骨最大载荷、伸长比、应力、应变等数据;用最小二乘法处理应力鄄应变数据,得出了其应力鄄应变关系表达式,拟合出了应力鄄应变曲线。结论 病变组各项力学性质指标均明显低于正常组。     

Total Knee Replacement After Arthroscopic Meniscectomy in Knee Osteoarthritis: A Nationwide Population-Based Cohort Study

BackgroundRecent studies raise concerns that arthroscopic meniscectomy (AM) for degenerative tear may be detrimental to the maintenance of the joint structure. This study was performed to examine the rate of total knee replacement (TKR) among patients with knee osteoarthritis (OA) who underwent AM for meniscal tears and compare this rate with those who did not.MethodsA retrospective cohort study was conducted using the National Health Insurance Database of South Korea. Among knee OA patients aged 50–79, those who were treated with AM due to meniscal damage from 2007 to 2009 were selected as the AM group while those not treated with AM despite the presence of meniscal damage were selected as control group. Both were matched based on a propensity score and followed-up until the earliest occurrence of: TKR, death, or 10 years. Cox proportional hazards models were used to compare the outcome.ResultsA total of 36,974 patients were included in AM groups and non-AM group after 1:1 matching. TKR occurred in 9.62% and 7.64% in AM and non-AM groups with the average duration after meniscectomy of 5.88 ± 2.77 and 5.50 ± 2.94 years, respectively. After adjustment for baseline confounders, the TKR rate in the AM group was calculated to be 25% higher than that in the non-AM group (subdistribution hazard ratio, 1.25; 95% confidence interval, 1.16–1.34). The mortality rate was 5.20%, which did not significantly differ between groups.ConclusionOA patients who underwent AM for the meniscal injury had higher incidence of TKR up to 10 years of follow-up than the non-operated group. The greater TKR utilization observed in patients undergoing AM merits caution when treating OA patients with meniscal injury.     

Effects of Risedronate on Osteoarthritis of the Knee

The purpose of the present study was to discuss the effects of risedronate on osteoarthritis (OA) of the knee by reviewing the existing literature. The literature was searched with PubMed, with respect to prospective, double-blind, randomized placebo-controlled trials (RCTs), using the following search terms: risedronate, knee, and osteoarthritis. Two RCTs met the criteria. A RCT (n = 231) showed that risedronate treatment (15 mg/day) for 1 year improved symptoms. A larger RCT (n = 1,896) showed that risedronate treatment (5 mg/day, 15 mg/day, 35 mg/week, and 50 mg/week) for 2 years did not improve signs or symptoms, nor did it alter radiological progression. However, a subanalysis study (n = 477) revealed that patients with marked cartilage loss preserved the structural integrity of subchondral bone by risedronate treatment (15 mg/day and 50 mg/week). Another subanalysis study (n = 1,885) revealed that C-terminal crosslinking telopeptide of type II collagen (CTX-II) decreased with risedronate treatment in a dose-dependent manner, and levels reached after 6 months were associated with radiological progression at 2 years. The results of these RCTs show that risedronate reduces the marker of cartilage degradation (CTX-II), which could contribute to attenuation of radiological progression of OA by preserving the structural integrity of subchondral bone. The review of the literature suggests that higher doses of risedronate (15 mg/day) strongly reduces the marker of cartilage degradation (CTX-II), which could contribute to attenuation of radiological progression of OA by preserving the structural integrity of subchondral bone.     

膝关节骨性关节炎的关节镜治疗体会

目的我科自2001～2005年4月对59例67膝的骨性关节炎（0A），进行关节镜检查及镜下清理术。方法镜检：膝关节骨性关节炎伴不同程度滑膜炎，滑膜皱壁粘连纤维片，关节软骨不同程度破坏。镜下清除增生滑膜，松解粘连，去除剥脱软骨、修复关节面。结果随访2月～4年，平均1.5年，术后综合评估2月～1年，优良率94％；1～2年，优良率79.2％；2年以上优良率54.8％。结论关节镜对膝关节骨性关节炎诊断能提供了比较全面的资料，并对骨性关节炎早期有良好疗效，具有创伤小、恢复快、并发症少和重复治疗等优点。     

臭氧联合体外冲击波治疗膝关节骨性关节炎的疗效观察

目的 观察臭氧关节腔注射联合体外冲击波、玻璃酸钠联合体外冲击波这两种方法治疗膝关节骨关节炎的临床有效性,并对比其临床疗效。方法 将60例患者随机分为两组,每组30例,对照组行玻璃酸钠关节腔注射联合体外冲击波治疗,观察组给予臭氧关节腔注射联合冲击波治疗,1次/周,5次为一疗程。治疗前及治疗1、2、3、5周时行视觉模拟评分（VAS）评估患者疼痛变化,用WOMAC评分评估患者膝关节功能改变。结果 治疗后两组患者均未发现严重不良反应;两组患者疗程结束后VAS、WOMAC均较治疗前有显著改善,差异有统计学意义（P＜0.05）。在治疗1周时,观察组VAS、WOAMC评分较对照组改善显著,差异有统计学意义（P＜0.05）,在其他观察时间点,两组未见明显差异（P＞0.05）。结论 臭氧联合体外冲击波、玻璃酸钠联合体外冲击波均能安全有效治疗膝关节骨关节炎,但臭氧联合体外冲击波起效更快,疗程更短。     

膝关节骨性关节炎的发病因素及治疗进展研究

膝关节骨性关节炎是一种老年性关节炎,会引起多种临床症状及并发症,对患者的生活带来严重的影响。本文通过对膝关节骨性关节炎的发病因素分析,从非药物治疗、药物治疗以及手术治疗分别讲述各自的特点,适用情况,为膝关节骨性关节炎的发病因素的临床治疗提供理论依据。     

COX-2 Inhibitor Use as an Early Treatment Option for Knee Osteoarthritis Patients in Korea: A Population-Based Cross-Sectional Study

BackgroundTo investigate the use of cyclooxygenase-2 (COX-2) inhibitors as an initial drug treatment for knee osteoarthritis (OA) patients.MethodsFrom 2013 to 2015, patients with knee OA were identified from the Korean nationwide claims database. Among them, we extracted incident cases of knee OA to identify the initial drug treatment. Trends in the use of non-steroid anti-inflammatory drugs (NSAIDs) including COX-2 inhibitors were analyzed during the first year after their diagnosis. Associated factors for COX-2 inhibitor use were examined using a multivariate logistic regression model.ResultsWe identified 2,857,999 incident knee OA patients (955,259 in 2013, 981,314 in 2014, and 921,426 in 2015). The mean ± standard deviation age of patients was 64.2 ± 9.8 years. The frequency of COX-2 inhibitor use as initial treatment increased from 3.5% in 2013 to 7.2% in 2015 (P < 0.01). In patients taking the medication regularly for one year after diagnosis (medication possession ratio ≥ 50%), COX-2 inhibitor use also rapidly increased from 5.5% in 2013 to 11.1% in 2015 (P < 0.01). However, the frequencies of non-selective NSAID and analgesic use did not decrease remarkably. Factors associated with patients using COX-2 inhibitors on initial drug treatment were older age (odds ratio [OR], 1.08), female (OR, 1.24), and comorbidity (OR, 1.03). Type of institution, physician speciality, and insurance type of patients were also associated.ConclusionIn Korea, COX-2 inhibitors have rapidly increased as an initial treatment for knee OA patients, but it has not appeared to reduce the use of non-selective NSAIDs and analgesics.     

消肿汤治疗膝骨性关节炎的临床疗效

目的 观察消肿汤治疗膝骨性关节炎临床疗效。方法 选择2018年5月~2019年5月在我院诊治的膝骨性关节炎患者76例,随机分为对照组和观察组,各38例。对照组采用常规西药治疗,观察组在对照组基础上联合消肿汤治疗,比较两组临床治疗总有效率、临床症状（疼痛、肿胀、僵硬）评分、膝关节功能评分、Lequesne总积分。结果 观察组治疗总有效率为94.73%,高于对照组的81.57%,差异有统计学意义（P＜0.05）;治疗后两组临床症状评分均低于治疗前,且观察组低于对照组,差异有统计学意义（P＜0.05）;两组患者膝关节功能评分均高于治疗前,且观察组高于对照组,差异有统计学意义（P＜0.05）;治疗后两组患者Lequesne总积分均较治疗前降低,且观察组低于对照组,差异有统计学意义（P＜0.05）。结论 消肿汤治疗膝骨性关节炎疗效确切,有助于缓解临床症状,促进膝关节功能的恢复,是临床治疗膝骨性关节炎的有效方法。     

Manual for guided home exercises for osteoarthritis of the knee

INTRODUCTION:

Physiotherapy is one of the most important components of therapy for osteoarthritis of the knee. The objective of this prospective case series was to assess the efficiency of a guidance manual for patients with osteoarthritis of the knee in relation to pain, range of movement , muscle strength and function, active goniometry, manual strength test and function.

METHODS:

Thirty-eight adults with osteoarthritis of the knee (≥ 45 years old) who were referred to the physiotherapy service at the university hospital (Santa Casa de Misericórdia de São Paulo) were studied. Patients received guidance for the practice of specific physical exercises and a manual with instructions on how to perform the exercises at home. They were evaluated for pain, range of movement, muscle strength and function. These evaluations were performed before they received the manual and three months later. Patients were seen monthly regarding improvements in their exercising abilities.

RESULTS:

The program was effective for improving muscle strength, controlling pain, maintaining range of movement of the knee joint, and reducing functional incapacity.

DISCUSSION:

A review of the literature showed that there are numerous clinical benefits to the regular practice of physical therapy exercises by patients with osteoarthritis of the knee(s) in a program with appropriate guidance. This study shows that this guidance can be attained at home with the use of a proper manual.

CONCLUSIONS:

Even when performed at home without constant supervision, the use of the printed manual for orientation makes the exercises for osteoarthritis of the knee beneficial.     

骨吸收抑制剂降钙素对骨关节炎大鼠软骨组织形态及蛋白多糖的影响

背景：近年来有报道指出降钙素在临床上治疗骨关节炎有较好的临床疗效,但关于其对骨关节炎的作用机制却少有报道。目的：观察降钙素对实验性骨关节炎模型大鼠软骨组织形态及蛋白多糖的影响。方法：将30只SD大鼠随机均分为3组,模型组与给药组均切断右肢前交叉韧带制作骨关节炎模型,假手术组仅打开关节腔,不做韧带切断,给药组于造模后成功后第2天开始皮下注射降钙素15 IU/(kg•d),模型组与假手术组均皮下注射等量生理盐水,连续给药6周。造模后10周,观察各组大鼠胫骨关节面,X射线检查股骨远端和内外侧踝软骨下骨骨密度,苏木精-伊红染色观察骨组织形态,甲胺苯蓝染色观察软骨组织中蛋白多糖含量。结果与结论：假手术组大鼠胫骨关节面光滑,有光泽;模型组大鼠胫骨关节面无光泽,关节软骨暗红色,有较大溃疡面形成;给药组大鼠软骨面无光泽,局部溃疡,表面粗糙不平。与假手术组比较,模型组内外侧踝软骨下骨骨密度、骨体积、骨小梁数目升高(P < 0.05),骨小梁分离度及蛋白多糖含量降低(P < 0.05);给药组内外侧踝软骨下骨骨密度、骨体积、骨小梁数目低于模型组(P < 0.05),骨小梁分离度及蛋白多糖含量高于模型组(P < 0.05)。表明降钙素对骨关节炎大鼠软骨有较好的保护作用,并能促进骨组织分泌蛋白多糖。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

A Framework for the in Vivo Pathomechanics of Osteoarthritis at the Knee

The in vivo pathomechanics of osteoarthritis (OA) at the knee is described in a framework that is based on an analysis of studies describing assays of biomarkers, cartilage morphology, and human function (gait analysis). The framework is divided into an Initiation Phase and a Progression Phase. The Initiation Phase is associated with kinematic changes that shift load bearing to infrequently loaded regions of the cartilage that cannot accommodate the loads. The Progression Phase is defined following cartilage breakdown. During the Progression Phase, the disease progresses more rapidly with increased load. While this framework was developed from an analysis of in vivo pathomechanics, it also explains how the convergence of biological, morphological, and neuromuscular changes to the musculoskeletal system during aging or during menopause lead to the increased rate of idiopathic OA with aging. Understanding the in vivo response of articular cartilage to its physical environment requires an integrated view of the problem that considers functional, anatomical, and biological interactions. The integrated in vivo framework presented here will be helpful for the interpretation of laboratory experiments as well as for the development of new methods for the evaluation of OA at the knee.     

Knee osteoarthritis affects the distribution of joint moments during gait

Alterations in lower extremity kinetics have been shown to exist in persons with knee osteoarthritis (OA), however few investigations have examined how the intersegmental coordination of the lower extremity kinetic chain varies in the presence of knee joint pathology. The objective of this study was to evaluate how knee OA and walking speed affect total support moment and individual joint contributions to the total support moment. Fifteen healthy subjects and 30 persons with knee OA participated in 3D walking analysis at constrained (1.0 m/s), self-selected and fastest tolerable walking speeds. Individual joint contributions to total support moment were analyzed using separate ANOVAs with one repeated measure (walking speed). Linear regression analysis was used to evaluate the relationship between walking speed and joint contribution. Persons with knee OA reduced the contribution of the knee joint when walking at constrained (p = 0.04) and self-selected walking speeds (p = 0.009). There was a significant increase in the ankle contribution and a significant decrease in the hip contribution when walking speed was increased (p < 0.004), however individual walking speeds were not significantly related to joint contributions. This suggests that the relationship between walking speed and joint contribution is dependent on the individual's control strategy and we cannot estimate the joint contribution solely based on walking speed. The slower gait speed observed in persons with knee OA is not responsible for the reduction in knee joint moments, rather this change is likely due to alterations in the neuromuscular strategy of the lower extremity kinetic chain in response to joint pain or muscle weakness.     

玻璃酸钠治疗膝关节骨性关节炎的疗效观察

目的 探讨玻璃酸钠治疗膝关节骨性关节炎的临床疗效。方法 选取2015年10月~2017年10月我院收治的膝关节骨性关节炎患者90例,随机分为观察组和对照组,各45例。对照组患者采用复方倍他米松治疗,观察组在此基础上加用玻璃酸钠治疗。观察两组临床疗效及治疗前后炎性因子指标改变情况,比较两组治疗前后骨关节功能评分、VAS评分、膝关节HSS评分,记录两组患者不良反应情况。结果 治疗后,观察组总有效率为93.33%,高于对照组的82.22%,差异有统计学意义（P＜0.05）;治疗后,两组患者骨关节功能评分、VAS评分、膝关节HSS评分均有所改善,且观察组改善程度优于对照组,差异有统计学意义（P＜0.05）;治疗后,两组患者IL-1β、IL-6水平均下降,IL-10水平均上升,且观察组患者变化程度更加明显,差异有统计学意义（P＜0.05）;观察组患者不良反应发生率为6.67%,高于对照组的17.78%,差异有统计学意义（P＜0.05）。结论 玻璃酸钠治疗膝关节骨性关节炎临床疗效显著,可改善患者骨关节评分和疼痛情况,改善患者炎性因子指标,且不良反应较少。     

髌软骨T2 mapping与膝关节骨性关节炎临床症状间的 关系及影响因素

目的 探讨膝骨关节炎患者髌软骨T2 mapping与临床症状、关节软骨缺损及骨髓病变间的关系。方法 回顾性选取2017年1月~7月本院32例符合1986年美国风湿学会症状性膝关节骨性关节炎患者,行膝关节MRI检查,包括T2WI、3D FSPGR和T2 mapping,评估髌软骨缺损及骨髓病变分级,在T2 mapping图像上勾画ROI,测量髌软骨T2值,以T2值中位数为区分标准,作各项指标的两组间比较,Logistic回归分析骨髓病变、软骨缺损与T2值间的相关性,行方差分析观察软骨缺损及骨髓水肿与T2值间的关系。结果 软骨缺损及骨髓病变在两组间有统计学差异,P值均＜0.05。Logistic回归分析发现软骨缺损及骨髓病变与T2值是否高于中位数相关,P值分别为0.003及0.032;不同等级关节软骨缺损及骨髓病变间T2值不同,且呈现增高趋势,P值均＜0.05。结论 不同等级的软骨缺损及骨损伤具有不同的T2值,且随着等级的增高,T2值亦呈现增高趋势。     

COX-2在膝关节骨性关节炎软骨中表达及临床意义

目的研究环氧化酶-2基因在膝关节骨性关节炎（osteoarthritis,OA）患者软骨组织的表达及其临床意义。方法对40例膝关节骨性关节炎取患者软骨组织设为OA组和7例膝关节正常软骨组织设为对照组。分别提取两组软骨组织RNA和总蛋白,通过RT-PCR检测各组COX-2mRNA转录水平以及COX-2基因表达蛋白Westernblot分析。结果 RT-PCR结果显示OA组出现大小约700bp条带,对照组扩增条带不明显;Western blot分析结果OA组COX-2基因表达蛋白明显,两组间灰度比有显著差异（〈0.05）。结论 COX-2基因及其表达蛋白在膝关节骨性关节炎软骨组织损害过程中起到重要作用。     

血清降钙素及相关指标对肺癌诊治的临床意义

探讨肺癌患者血清降钙素(CT)含量对肺癌诊治的临床意义.用ELISA检测血清CT含量,用电化学发光免疫分析法(ECLIA)检测血清CEA、神经元特异性烯醇化酶(NSE)、细胞角蛋白19片断(CYFRA 21-1)含量.肺癌患者血清CT含量明显高于对照组,化疗前后比较差别有统计学意义(P＜0.01),血清CT阳性率与病理分型无关(P＞0.05),与临床分期有关(P＜0.01).CT与CEA在肺癌中的阳性表达有差异(P＜0.01),与NSE和CYFRA 21-1无差异(P＞0.05).血清CT含量动态监测是辅助诊断肺癌、观察疗效和判断预后的重要指标之一.