85例半月板损伤与关节软骨损伤相关性研究

目的探讨关节软骨损伤与半月板破裂的关系。方法85例共96膝半月板损伤患者,按受伤到手术时间参考Keene时间划分标准分为三组:①急性期组;②亚急性期组;③慢性期组。观察半月板损伤的部位、形态及病程与关节软骨破坏程度范围之间的关系。结果整个病例组均有不同程度的软骨病损。其中急性损伤的软骨病损多为Ⅰ-Ⅱ度,亚急性损伤软骨病损为Ⅱ-Ⅲ度,慢性损伤以Ⅲ度为主,开始出现IV度病损。9例交叉韧带损伤及14例盘状半月板损伤的患者软骨损伤明显较同期患者严重。软骨损伤程度与半月板破裂时间成正相关(P<0.01)。结论半月板破裂能导致软骨损伤,同时软骨损伤能加重半月板损伤。应早期诊断和治疗半月板破裂,减少伤残的发生。     

85例半月板损伤与关节软骨损伤相关性研究

目的探讨关节软骨损伤与半月板破裂的关系.方法85例共96膝半月板损伤患者,按受伤到手术时间参考Keene时间划分标准分为三组①急性期组;②亚急性期组;③慢性期组.观察半月板损伤的部位、形态及病程与关节软骨破坏程度范围之间的关系.结果整个病例组均有不同程度的软骨病损.其中急性损伤的软骨病损多为Ⅰ-Ⅱ度,亚急性损伤软骨病损为Ⅱ-Ⅲ度,慢性损伤以Ⅲ度为主,开始出现Ⅳ度病损.9例交叉韧带损伤及14例盘状半月板损伤的患者软骨损伤明显较同期患者严重.软骨损伤程度与半月板破裂时间成正相关(P＜0.01).结论半月板破裂能导致软骨损伤,同时软骨损伤能加重半月板损伤.应早期诊断和治疗半月板破裂,减少伤残的发生.     

关节软骨损伤修复研究进展

各种原因导致的关节软骨损伤在临床十分常见,关节软骨缺乏血供,一旦受损,其自愈能力十分有限,甚至遗留永久性病变.所以关节软骨损伤的修复一直是国内外研究的热点问题.近年来随着生物学、力学、材料学等多学科的交叉发展,在关节软骨损伤修复方面又有了诸多发现.本文就目前各种关节软骨损伤修复方法,包括新兴的组织工程软骨与基因治疗技术的研究进展作一综述.     

关节软骨损伤的治疗（上）

关节软骨属于透明软骨，自身没有血供，无淋巴引流，无神经分布，软骨细胞是高度分化的组织细胞，成熟的关节软骨中软骨细胞的分裂能力非常有限，因此软骨损伤后修复能力差。早在1743年Hunter就提出“骨软骨一旦破坏，就不能得到修复”的观点，而关节软骨损伤及其修复问题，长期以来也一直是困扰骨科基础研究与临床治疗的棘手问题。随着社会的现代化进程和人口的老龄化，由于外伤和退变引起的关节软骨损伤患者显著增多，为此如何解决关节软骨修复的问题日益显得重要。     

生长因子在关节软骨损伤修复中的应用进展

关节是人体重要的运动器官,其组织结构特殊,成熟关节软骨组织没有血供,一旦损伤难以自愈.临床上常用的关节软骨损伤修复手段有微骨裂术、关节软骨移植、关节置换术、软骨组织工程等,但这些方法的修复效果都不理想.生长因子是体内组织分泌的一种具有生物活性的物质,可促进细胞生长、增殖、迁移和分化.软骨发育过程中有许多生长因子参与,如成纤维细胞生长因子(FGF)、骨形态发生蛋白(BMP)、胰岛素样生长因子(IGF)等.研究显示,在关节软骨修复过程中加入外源性生长因子可有效促进关节软骨损伤的修复.对目前应用于关节软骨损伤修复研究中的生长因子进行综述,讨论这些生长因子在关节软骨发育及其在关节软骨修复中的作用,分析生长因子在关节软骨修复应用中存在的问题.     

关节软骨损伤临床治疗新进展

关节软骨(articular cartilage,AC)缺乏直接的血液供应、淋巴循环和神经支配,并具有低代谢的生理特点,当外伤或疾病而发生缺损时通常不能自行修复,持续发展会导致骨关节炎。随着全民健身运动普及和社会老龄化等因素,因各种原因导致软骨缺损的发病率逐年递增,寻找行之有效的临床治疗手段迫在眉睫。目前临床修复关节软骨损伤的方法很多,大体分为刺激关节     

miR-564在关节软骨损伤修复中作用机制的研究进展

关节软骨损伤修复一直是关节外科的热点和难点,最新研究表明,miR-564可能在关节软骨损伤修复中起着至关重要的作用。miR-564是位于第3号染色体上的非编码RNA,其功能主要是通过影响mRNA的稳定性和翻译进而参与基因表达的转录后调节,因此未来有望通过调控miR-564实现关节软骨损伤的原位修复。本文就miR-564的结构、功能及在关节软骨损伤修复中的作用机制作一综述。     

关节软骨粘弹性的实验研究

作者通过单轴向压缩试验，对正常人体关节软骨的粘弹性进行了实验研究，在定载荷条件下测定了材料的蠕变曲线，１秒末的瞬时弹性模量和５分钟的蠕变模型，并将其与椎间盘纤维环的力学性质进行了比较。     

关节软骨损伤修复技术的研究与进展

背景：自体软骨因为软骨细胞密度低,新陈代谢率低以及没有血供而导致自我修复效果不理想。目的：就近年来组织工程技术的最新研究和外科治疗软骨损伤最新疗效方面一些最新研究及进展做一综述。方法：由第一作者检索PubMed数据库1992年1月至2013年12月文献,在标题和摘要中以“Articular cartilage;injury;tissue engineering;repair”为检索词进行检索。根据纳入排除标准最终选取61篇文献进行分析。  结果与结论：目前临床上常见的治疗关节软骨损伤方法有关节清理、镶嵌式成形技术、软骨膜及自体软骨细胞移植技术等,但都没研究表明某种治疗方法可以达到满意的长期疗效。其中主要的一个原因就是无法在软骨损伤处形成新的透明软骨,且修复的组织在机械性能上也无法和原有的自体软骨相比较。组织工程技术是今年来研究的热点,因其可以诱导自体软骨的形成而成为一种最有前景的治疗方法。组织工程技术利用内源性或者外源性的种子细胞,辅以诱导因子及营养因子诱导软骨的自身修复,以修复再生成有和自身软骨相似,甚至相同生物性能的透明软骨为最终的目标。如何简化治疗步骤和降低治疗费用是促进软骨再生修复进一步研究的动力。 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;组织工程全文链接：     

正常与病态股骨头软骨与半月板粘弹性实验研究

0 引言 关节软骨作为粘弹性体其粘弹性研究国内外学者作了大量工作[1～5],但是动物关节软骨和人尸体正常关节软骨居多.半月板损伤在临床上多见,其损伤原因诸如膝关节受到跌打碰撞等暴力,其损伤往往是弯矩与扭矩联合作用造成.半月板损伤给患者带来很大的痛苦,轻者疼痛,行走功能发生障碍,保守治疗失败后只有切除损伤的半月板.半月板的损伤机理一直是国内外学者研究的重要课题.搞清正常与病态股骨头软骨和半月板的粘弹性力学性质对研究股骨头坏死和半月板损伤具有重要意义.鉴于此作者对正常与病态股骨软骨、正常与病态半月板进行应力松弛、蠕变实验研究,得出了一些重要结论,并对实验结果进行分析讨论.     

关节软骨的仿生设计

人体滑膜关节中,天然关节软骨具有多重不可替代的特殊功能和重要作用.本研究从仿生学的视角,综述关节软骨的生物化学、组织形态学、病理学特征,以及生物材料学、生物力学和生物摩擦学性质;从结构、材料、功能三个方面对关节软骨进行宏、微观层次的仿生设计,建立关节软骨仿生设计模型;为带有"软垫轴承"的新型人工关节,以及仿生人工软骨的创新设计与制造,提供理论和实践基础.     

胎儿关节和兔关节软骨细胞的体外培养

本文报告了人胎儿关节软骨细胞和兔关节软骨细胞的体外培养,结果表明：胎儿关节软骨细胞和兔关节软骨细胞在胰蛋白酶和胶原酶作用下,在无ＣＯ２培养条件下,获得了大量的软骨细胞,且能生长分裂,复制。为将此法用于生物材料的人工软骨研究奠定了基础。     

天然关节软骨的液体质量分布特征

目的采用切片称重的方法,研究关节软骨的液体分布特征。方法通过Leica冷冻切片机把软骨样品切成31块均匀厚度的薄片,采用真空恒温箱和高精度电子天平,得到液体的质量分数随深度变化的关系曲线。结果软骨质量随距表面的深度呈动态变化,距表面的49％区域内,软骨薄片的质量最大。软骨液体的质量分数随深度呈波动式下降趋势,从最表层的94．2％到最底层的78．1％。结论液体的质量分布与关节软骨的生理结构有关,胶原纤维网架阻止了蛋白多糖的充分伸展,使得液体的质量分数与距表面的深度呈递减趋势。     

Increase of Decorin Content in Articular Cartilage Following Running

The effect of long distance running exercise (40 km/day for 15 weeks, five days a week) on the decorin content of articular cartilage from the knee joint was studied in female beagle dogs. Samples from load bearing sites on the lateral plateau of the tibia (TL), and pooled material from two minimum load bearing sites on the posterior section of lateral (FLP) and medial (FMP) femoral condyles were analyzed. The running exercise protocol did not lead to significant changes in the overall glycosaminoglycan content of the cartilage. However, the amount of decorin significantly increased in the TL samples, and also in the FMP pool. These results support earlier in vitro observations that decorin synthesis is stimulated by loading, independent of the synthesis of aggrecan.     

低频脉冲磁场对兔膝关节软骨缺损修复作用的实验研究

目的研究低频脉冲磁场在间充质干细胞和双层PLGA支架构建复合体修复兔骨软骨缺损过程的作用。方法用密度梯度离心法和贴壁培养法获得5月龄兔骨髓来源间充质干细胞,在体外培养并进行分化诱导后作为种子细胞复合双层PLGA构建成复合体植入兔膝股骨髁间设计骨软骨缺损模型,全过程施加低频脉冲磁场干预,于第24周取材,进行大体观察、组织学检查和病理评分。结果诱导MSCs+支架+2.0A.m-1脉冲电磁场刺激组在术后又继续进行脉冲电磁场照射后,兔膝关节骨软骨创伤修复明显加快,统计学分析各组单项评价指标得分差异有显著性(p<0.05),与自体骨软骨移植组相当。结论在适当低频脉冲磁场作用下,诱导MSCs+双层PLGA支架能较好地修复兔膝关节骨软骨创伤。     

Measurement of Articular Cartilage Thickness in the Articulated Knee

A radiographic and image analysis method was developed and applied in porcine knees for the measurement of articular cartilage thickness in articulated joints. The feasibility of the approach was assessed by implementing the method for the lateral femoral condyle from harvested limbs. Measurement of the undeformed cartilage thickness with this method was found to have a great degree of precision, with approximately a 1.0% (14 m) mean variation. Accuracy was also high when compared to an optical method for measuring the true cartilage thickness. An excellent linear correlation r² > 0.99) between the thickness determined optically and that obtained from the radiographic images was demonstrated. No significant differences were found between these two measures of cartilage thickness. This method, which minimizes disturbance to the structures of the knee to maintain its physiologic environment, also has promise to measure the changes in cartilage thickness as the tissue is deformed during joint loading. Information about the undeformed and deformed cartilage thicknesses can be combined with finite element models to examine cartilage behavior from both experimental and theoretical perspectives. © 1998 Biomedical Engineering Society. PAC98: 8759Hp, 0630Bp, 0705Pj     

股骨颈骨折后髋关节软骨退变的生物力学研究

在动物模型上研究股骨颈骨折后髋关节软骨退变在发生、发展、转归过程中软骨厚度和生物力学特性改变及其与伤后时间的关系。用新西兰白兔60只作股骨颈基底截骨制作骨折动物模型，于术后2、4、6、8、12、16周采用压凹法测定关节软骨厚度和生物力学特性。免股骨颈骨折后关节软骨持续增厚，6周达高峰，随后软骨迅速磨损、变薄；骨折后4周起软骨退变失代偿，弹性和机械强度进行性大幅度下降，退变至骨关节炎。股骨颈骨折后保守治疗形成局部低应力环境，关节软骨缺乏动态载荷，基质胶原网络迅速降解所引起的生物力学特性降低是导致并维持软骨退变不断前进的动力。     

Extracellular Matrix Composition of Full-Thickness Defect Repair Tissue is Little Influenced by Exercise in Rat Articular Cartilage

Full-thickness articular cartilage defects in the femoral condyles of adult rats were examined four and eight weeks after injury. Quantitative polarized light microscopic analysis showed that birefringence of the tissue in the central repair area increased more in rats exercised on a treadmill. Glycosaminoglycan content in the repair tissue was also higher than in the intermit-tent active motion group at four weeks after injury, but by eight weeks the levels were similar in both groups. No normal-looking articular cartilage was formed in the lesions, and only in one animal type II collagen was observed in the superficial zone of repair tissue. No 3B3(-) antigenicity of the proteoglycans was seen during repair. In conclusion, exercise minimally modified the repair of full-thickness articular cartilage defects in adult rats. The repair in the exercised group may occur slightly faster in the early stages but no difference was seen at the eight week time interval between the exercised and the intermittently active group.     

Automatic Articular Cartilage Segmentation Based on Pattern Recognition from Knee MRI Images

An automatic method for cartilage segmentation using knee MRI images is described. Three binary classifiers with integral and partial pixel features are built using the Bayesian theorem to segment the femoral cartilage, tibial cartilage and patellar cartilage separately. First, an iterative procedure based on the feedback of the number of strong edges is designed to obtain an appropriate threshold for the Canny operator and to extract the bone-cartilage interface from MRI images. Second, the different edges are identified based on certain features, which allow for different cartilage to be distinguished synchronously. The cartilage is segmented preliminarily with minimum error Bayesian classifiers that have been previously trained. According to the cartilage edge and its anatomic location, the speed of segmentation is improved. Finally, morphological operations are used to improve the primary segmentation results. The cartilage edge is smooth in the automatic segmentation results and shows good consistency with manual segmentation results. The mean Dice similarity coefficient is 0.761.     

Biochemical and Morphological Studies of Steady State and Lipopolysaccaride Treated Bovine Articular Cartilage Explant Cultures

Explants of bovine articular cartilage were cultured for up to 50 days in 20% fetal calf serum in the presence or absence of the endotoxin lipopolysaccharide (LPS); or in various protocols involving different treatment times with LPS followed by recovery times in the absence of LPS. Cultures were measured in terms of rates of proteoglycan synthesis (incorporation of [³⁵S]sulfate), proteoglycan contents and collagen contents. Histological sections were prepared for both light and electron microscopy. In fetal calf serum, the rates of synthesis and contents of proteoglycans per collagen remained constant, while for LPS treated cultures both parameters decreased. For recovery groups, the rates of proteoglycan synthesis increased during the time of recovery if the LPS treatment times were relatively short (2 weeks or less) and if the tissue was obtained from younger animals; net increase in proteoglycan contents occurred infrequently if at all during recovery protocols. Histological examinations revealed that chondrocytes in cultures maintained in fetal calf serum appeared normal with large stores of glycogen. In LPS treated cultures, chondrocytes were depleted of glycogen stores and contained numerous lipid droplets. In recovery cultures, chondrocytes replenished their glycogen contents, but the lipid droplets remained. For both LPS treated and recovery groups the extracellular matrix was depleted of proteoglycans with time in culture. The results provide further evidence for the ability of this explant culture system to maintain steady state metabolic parameters for proteoglycan metabolism over long time periods and for its utility to study reagents which regulate or perturb these parameters.