有限元分析技术在膝关节骨性关节炎诊疗中的应用进展

<正>膝关节骨关节炎（knee osteoarthritis,KOA）是最常见的膝关节疾病,这种复杂的多因素疾病以关节软骨、软骨下骨的退行性变和滑膜炎症为特征。应力累积是导致疾病进程的重要因素,一旦累积量超过临界值,蛋白多糖含量将会加速消耗,软骨随之发生不可逆转的变化。因此,了解软骨退行性变所涉及的生物力学机制对于制定有效的治疗策略来预防或治疗这种疾病至关重要。     

脂肪间充质干细胞治疗膝关节骨关节炎应用进展

膝关节骨关节炎(KOA)的特征是关节透明软骨局灶性丧失,滑膜组织炎症伴骨赘形成.目前KOA的治疗方法虽可在一定程度上减轻患者疼痛并改善关节活动度,但不能促进受损关节的软骨再生.脂肪间充质干细胞作为种子细胞,可用于KOA治疗中修复受损的关节软骨,为KOA治疗提供了一种新思路.该文对脂肪间充质干细胞治疗KOA的研究进展进行...     

骨骼肌影响膝骨关节炎的研究进展

<正>膝关节骨关节炎(knee osteoarthritis, KOA)是一种以关节软骨退变及关节边缘和软骨下骨骨质增生为特征的退行性关节疾病,并伴随着肌肉结构、功能、质量的改变。伸膝无力也被认为是KOA的一个重要危险因素,可影响关节的稳定性,导致KOA患者疼痛和功能下降。在2020版中国骨关节炎疼痛管理临床实践指南[1]中,运动治疗被推荐为OA疼痛管理的核心部分之一。但目前骨骼肌在KOA病理生理学中的作用机制尚不清楚,     

富血小板血浆治疗膝骨性关节炎的研究进展

膝骨性关节炎（knee osteoarthritis, KOA）是膝关节的慢性退变性疾病。KOA的主要病理改变是关节软骨的进行性破坏,软骨下骨质丢失。目前临床上对于早中期KOA的治疗方法十分有限。富血小板血浆（platelet-rich plasma, PRP）是外周血多次离心后的血小板浓缩物,在医学专业应用近三十年,近十年逐渐应用于骨科修复软骨、肌腱和韧带等,成为治疗KOA的热点。PRP治疗KOA的可能机制主要包括通过释放多种生长因子、促进蛋白多糖和胶原蛋白的合成以及刺激骨髓间充质干细胞和内源性透明质酸（hyaluronic acid, HA）的生成,达到修复软骨、延缓KOA进展的目的。多数研究表明,相对于传统的关节腔内注射药物和口服非甾体抗炎药（Non-steroidal anti-inflammatory drugs, NASIDs）,关节内注射PRP可有效改善KOA病人的临床症状,但是关于PRP的作用时间、使用剂量和注射次数尚无统一标准。本文通过回顾目前关于PRP治疗KOA的基础、动物及临床研究,对PRP的生物学特性、作用机制、临床疗效及存在的问题进行综述。     

骨骼肌影响膝骨关节炎的研究进展

改善膝关节肌肉健康能缓解膝骨关节炎(KOA)症状和改善膝关节功能。但是,骨骼肌影响KOA的机制尚未完全明确。KOA患者的骨骼肌成分有所改变,且骨骼肌能够释放肌源性细胞因子参与KOA发病机制。骨骼肌肌力测量和功能表现的评估可以作为KOA患者疼痛、膝关节功能和关节结构变化的预测指标。高水平的骨骼肌肌肉共激活可维持关节稳定,但也可能增加软骨损伤和KOA发病的风险。运动锻炼可改善KOA患者病情。该文对骨骼肌影响KOA的病理机制以及相关治疗的研究进展作一综述。     

胫骨高位截骨术后软骨再生影响因素的研究进展

膝关节骨关节炎(knee osteoarthritis,KOA)是全球公认的一种致残疾病.研究显示我国有症状的KOA的发病率为8.1％,并且KOA的患病率随着年龄增长呈上升趋势[1].KOA是整个关节的疾病改变,如滑膜、半月板、周围韧带的病变以及典型的关节软骨退行性病变等.关节软骨属于透明软骨,有着缓冲和传导压力等作用...     

MRI在老年膝骨关节炎患者内侧关节软骨损伤及分级中的诊断价值研究

目的 探讨分析MRI在老年膝骨关节炎（KOA）患者内侧关节软骨损伤及分级中的诊断价值研究。方法 选取2022年1月至2023年3月于本院行膝关节单髁置换术的83例老年膝骨关节炎患者进行回顾性研究。所有患者均完成患侧膝关节的X线、MRI检查，以术中所见关节软骨损伤及分级为“金标准”，分析X线及MRI检查在诊断老年KOA患者内侧关节软骨损伤及分级中的准确性、灵敏度及特异度。结果 所纳入的83例老年KOA患者内侧关节软骨损伤及其分级以术中所见为“金标准”，MRI检查在诊断老年KOA患者内侧关节软骨损伤中的准确率、灵敏度及特异度均显著高于X线检查（P<0.05）。在老年KOA患者内侧关节软骨损伤分级中，X线诊断诊断准确率为73.49%(61/83，例)，与“金标准”的一致性一般（Kappa=0.69,P=0.031）;MRI检查诊断准确率为89.16%(74/83，例)，与“金标准”的一致性较好（Kappa=0.86,P=0.254）。结论 MRI检查在诊断老年KOA患者内侧关节软骨损伤及损伤分级中的效能优于X线检查，且与金标准的一致性更好，能够为临床后续的治疗提供可靠的依据。     

TDP中药液照射及针灸和拔罐治疗膝关节炎45例

膝关节炎(Knee Osteoarthritis,KOA)是一种退行性骨关节病,又称增生性关节炎,退行性关节炎,软骨软化性关节病,中医称之为“骨痹”.KOA是一种常见的慢性、进行性关节软骨破坏及关节边缘骨赘形成的疾病,是引起膝关节痛及功能障碍的主要原因之一,以中老年人多发.主要的临床表现有膝关节疼痛、僵硬、活动障碍,膝关节肿大变形,其病程较长,缠绵难愈.笔者自2008年3月-2010年9月采用TDP中药液及针灸、拔罐等综合治疗膝关节炎45例,取得满意的效果.结果报道如下.     

膝关节骨关节炎的保膝治疗进展北大核心CSCD

目的基于遵循阶梯性治疗理念,对膝关节骨关节炎(knee osteoarthritis,KOA)保膝治疗进展作一综述。方法查阅近年国内外相关文献,对KOA各阶段治疗方法进行总结分析。结果 KOA的治疗旨在减轻症状、延缓关节结构性改变、维持关节功能和提高生活质量,因此保守治疗仍是早期KOA的首选治疗方法。关节镜手术可协助诊断和分级,并同期行关节内刺激物清理和软骨的有限修复。截骨术适用于下肢负重力线、关节线异常的KOA,能有效平衡膝关节负重应力,改善症状,缓解疾病进展。关节牵伸术治疗KOA能改善膝关节力学环境,一定程度修复缺损软骨,缓解症状。随着技术进步,近年来单髁关节置换(unicompartmental knee arthroplasty,UKA)重新兴起,UKA属于真正的关节表面置换,是前内侧KOA患者保膝治疗的重要手段。结论目前KOA保膝治疗方法较多,主要针对患者病程以及病情严重程度进行选择。截骨术和UKA是临床应用最多且保膝成功率高的重要外科技术,但应注意恰当选择适应证,术者需积累足够临床经验,以取得良好效果。     

创伤性关节炎发生机制相关性研究

创伤性关节炎发生机制研究显示,关节软骨凋亡或坏死引起关节软骨数量减少,导致关节软骨退变;关节生物力学及其关节周围环境应力改变引起关节软骨细胞及基质之间的动态平衡破坏,进一步引发关节软骨退变;关节损伤后关节液中细胞炎症介质对关节软骨的作用及介质之间相互作用在关节软骨退变中起着重要作用;关节损伤疾病发展过程及关节软骨代谢均与患者个体基因学关系密切。研究明确关节损伤后各种因素在创伤性关节炎中的作用及各种因素之间的联系,有助于更深入地了解创伤性关节炎的发生机制,更好地制定相关治疗方案,以治愈或延缓创伤性关节炎的发生发展。     

有氧运动对膝骨性关节炎作用机制研究进展

随着人口老龄化程度的加剧,膝骨性关节炎这一退行性关节疾病发病率逐年增加。运动疗法是预防和治疗膝骨性关节炎的非药物手段之一。运动处方的制定有必要考虑运动与关节软骨的相互作用机制,遵循运动项目合理、频率适中、强度渐进的原则,避免关节软骨受损。膝骨性关节炎的运动处方标准业界尚存争议,有氧运动对膝骨性关节炎关节软骨的保护和损伤机制有待于进一步研究。     

川芎嗪对膝骨性关节炎大鼠软骨BMP-2、Smad1及BMP-2mRNA、Smad1mRNA表达的影响

目的观察川芎嗪治疗膝骨关节炎(knee osteoarthritis,KOA)大鼠模型关节软骨中骨形态发生蛋白-2(bone morphogenetic protein-2,BMP-2)、Smad1表达的变化,并探讨川芎嗪治疗KOA的作用机制。方法制作大鼠膝关节炎模型,将建模成功的大鼠纳入模型对照组,常规饲养,川芎嗪高剂量组、川芎嗪低剂量组、阳性对照组行灌,正常组和模型组行等量生理盐水治疗6 w,实验结束后,各组大鼠分别行HE切片软骨Mankin评分、Western Blot检测软骨组织BMP-2、Smad1及实时荧光定量PCR检查BMP-2mRNA、Smad1mRNA的变化。结果各组软骨Mankin评分中,川芎嗪各剂量组和阳性对照组均较空白组高(P0.05),均较模型组低(P0.05),且川芎嗪高剂量组阳性对照组川芎嗪低剂量组(P0.05)。正常组、川芎嗪各剂量组及阳性对照组中软骨BMP-2、Smad1及BMP-2mRNA、Smad1mRNA相对表达量较模型组均高于模型组,差异有统计学意义(P0.05);与阳性对照组相比,川芎嗪高剂量组BMP-2、Smad1及BMP-2mRNA、Smad1mRNA表达量明显高于阳性对照组(P0.05),而川芎嗪低剂量组其表达则均低于阳性对照组。结论川芎嗪可能通过上调早期KOA大鼠BMP-2mRNA及Smad1mRNA基因的表达,从而促进BMP-2及Smad1蛋白的表达,这可能是在某种程度上减轻关节软骨退变、修复软骨损伤作用的机制之一。     

自主运动对高脂饮食诱导的肥胖小鼠膝骨关节炎软骨形态学的影响

目的研究高脂饮食诱导的骨性关节炎发生过程中骨关节软骨病变以及自主运动对骨性关节炎软骨的影响机制,探讨自主运动对膝骨关节炎软骨的保护作用,为临床治疗膝骨关节炎提供有效的实验证据。方法将28只C57BL/6 J小鼠随机分为正常饮食组(C-Sed组,n=6)、正常饮食加运动组(C-Ex组,n=6)、高脂饮食组(HF-Sed组,n=8)及高脂饮食加运动组(HF-Ex组,n=8)。C-Sed组和C-Ex组喂养基础饲料(13.5%Kcal),HF-Sed组和HF-Ex组喂养高脂饲料(60%Kcal)。喂养8周后,C-Ex组和HF-Ex组小鼠采用自主转轮运动进行干预,记录运动数据,运动3周后行颈椎脱臼处死;C-Sed组和HF-Sed组小鼠不进行运动干预,继续喂养不同膳食4周后行颈椎脱臼处死,取膝关节软骨组织进行固定、脱钙,制成4μm厚石蜡切片,并进行HE及甲苯胺蓝染色,测量各组小鼠软骨层厚度,探究自主转轮运动对肥胖小鼠膝骨关节炎软骨形态学的影响。结果喂养12周结束后,与C-Sed组小鼠相比,HF-Sed组小鼠体重明显增加,高脂饮食成功诱导了高脂饮食组小鼠发生肥胖,且经HE及甲苯胺蓝染色后,可观察到与C-Sed组小鼠相比,HF-Sed组小鼠软骨表面粗糙、部分缺损,软骨层厚度降低(P0.001);而HF-Ex组较HF-Sed组小鼠关节软骨表面光滑,软骨层厚度增加,Mankin评分分值降低。结论 3周自主转轮运动可增加高脂组小鼠软骨层厚度,降低Mankin评分分值,延缓骨关节炎软骨退变,起到保护关节软骨的作用。     

膝骨关节炎基因表达及中医药干预机制的研究进展

膝骨关节炎(knee osteoarthritis,KOA)是一种多发于中老年的关节退行性的、不可逆转的骨关节病,在人群中的患病率呈不断上升趋势。近年来研究发现,基因点突变和多种基因改变可能导致膝骨性关节炎的高发,中医药干预后能有效影响相关基因改变。笔者通过综述近年来中医药在基因方面对膝骨关节炎的影响研究进展,以期找到防治膝骨关节炎的新靶点和新途径。     

ceRNAs在软骨损伤中作用机制的研究进展

正常的关节软骨对肢体活动有重要作用，关节创伤、生物力学改变及年龄等危险因素均可导致关节软骨受到损伤，先前的研究虽然已在分子层面上对关节软骨损伤的原因做出报道，但关于软骨损伤发生及预后的分子间调控机制了解并不充分。竞争性内源RNA（competing endogenous RNAs，ceRNAs）是一种包括非编码RNA（non-coding RNA，ncRNA）等分子在内的庞大RNA分子间调控网络，其作为一种新兴的调控机制参与关节软骨的损伤与修复。研究发现，ceRNAs通过竞争结合微小RNA ( microRNA，miRNA )可调控关节软骨细胞的增殖、凋亡及软骨细胞外基质降解等过程进而影响关节软骨的健康。笔者查阅近几年相关研究文献，就ceRNAs在关节软骨损伤中的作用机制及潜在性应用展开综述，以期为关节软骨损伤的防治提供新的思路和方向。     

Patellar inward pushing method relieves knee osteoarthritis via regulating cytokines

BackgroundKnee osteoarthritis (KOA) is a chronic degenerative disease characterized by pain, morning stiffness and swelling in the knee joints. And KOA is common in the elderly and seriously affects the exercise function and physical health of patients. This study aimed to explore the curative effects of patellar inward pushing method (PIPM) on KOA.Material and methodIn this study, we established rabbit animal models of KOA for the research by using the New Zealand white rabbits. 30 New Zealand white rabbits were divided into 5 groups by random number table method: blank group, model group, glucosamine hydrochloride (GH) group, PIPM group and PIPM combined with GH group, then the rabbits were modeled.ResultsAfter 9-weeks cultured in groups, 5 ml blood was collected from the heart, and cytokines were detected. The result suggested that iNOS, NO and TNF-α were the pathogenic inflammatory factor of KOA, and aggravated cartilage damage and degeneration. Besides, this study indicated that PIPM combined with GH treatment significantly reduced the activity of inflammatory cytokines in serum and joint fluid of KOA models in rabbits. In addition, PIPM combined with GH therapy exhibited the best therapeutic effect among these treatments, which was working on KOA better than PIPM treatment alone or GH treatment alone.ConclusionsPIPM could effective treat KOA via regulating cytokines, and the PIPM combined with GH therapy could be a novel therapeutic strategy of KOA.     

A composition-based cartilage model for the assessment of compositional changes during cartilage damage and adaptation

OBJECTIVE: The composition of articular cartilage changes with progression of osteoarthritis. Since compositional changes are associated with changes in the mechanical properties of the tissue, they are relevant for understanding how mechanical loading induces progression. The objective of this study is to present a computational model of articular cartilage which enables to study the interaction between composition and mechanics. METHODS: Our previously developed fibril-reinforced poroviscoelastic swelling model for articular cartilage was combined with our tissue composition-based model. In the combined model both the depth- and strain-dependencies of the permeability are governed by tissue composition. All local mechanical properties in the combined model are directly related to the local composition of the tissue, i.e., to the local amounts of proteoglycans and collagens and to tissue anisotropy. RESULTS: Solely based on the composition of the cartilage, we were able to predict the equilibrium and transient response of articular cartilage during confined compression, unconfined compression, indentation and two different 1D-swelling tests, simultaneously. CONCLUSION: Since both the static and the time-dependent mechanical properties have now become fully dependent on tissue composition, the model allows assessing the mechanical consequences of compositional changes seen during osteoarthritis without further assumptions. This is a major step forward in quantitative evaluations of osteoarthritis progression.     

针灸治疗膝骨关节炎的作用机制研究

针灸治疗膝骨性关节炎虽可抑制炎症反应和延缓关节软骨退变，但其作用机制仍在探究中。现以肠道微生物介导的肠-关节轴为切入点，从经络脏腑理论分析，针灸可通过以下途径发挥治疗膝骨性关节炎的作用：调理气机升降；调节胃肠道动力，促进机体调节；调控肠道菌群平衡，使其恢复稳态；稳固肠黏膜机械屏障，维持肠道通透性。本文基于肠-关节轴理论，阐明针灸-肠道菌群-炎症反应之间具体作用机制，针灸可通过多通路、多靶点、双向性治疗膝骨关节炎，以期为针灸治疗膝骨性关节炎提供理论依据，为后期临床推广应用。     

Lipid peroxidation and antioxidant enzymes in synovial fluid of patients with primary and secondary osteoarthritis of the knee joint

OBJECTIVE: Osteoarthritis of the knee (KOA) is a common, age-related, joint disorder associated with loss of articular cartilage, osteophyte formation, sub-chodral bone change and synovitis. Recent studies have shown that reactive oxygen species (ROS) may participate in the initiation and progression of KOA. This study examines potential changes in the activities of antioxidant enzymes (superoxide dismutase, both isoenzymes zinc-copper superoxide dismutase and manganese superoxide dismutase) and glutathione transformation enzymes (glutathione peroxidase, glutathione reductase and glutathione-S-transferase) in synovial fluid of KOA patients, and estimates their relationship to the degree of lipid peroxidation in synovial fluid evaluated by malondialdehyde concentration, synovial fluid viscosity, type and duration of KOA. DESIGN: Synovial fluid samples obtained by transdermal arthrocentesis from 41 patients with KOA (23 had primary KOA and 18 had secondary KOA) and 22 control subjects were analyzed. Activities of antioxidant enzymes were analysed with the use of kinetic method, MDA concentration was measured fluorometrically by the Ohkawa method, and synovial fluid viscosity was measured using a cone-late viscometer Brookfield DV-II+ and a test by Ropes. RESULTS: Patients with KOA had significantly increased activities of all enzymes when compared to the control subjects for both KOA subgroups. The synovial fluid viscosity was significantly decreased and the synovial fluid test by Ropes was abnormal in KOA patients, mainly in the secondary KOA subgroup. The activities of all antioxidant enzymes were significantly negatively correlated with synovial fluid viscosity and duration of KOA. CONCLUSIONS: Patients with KOA display abnormal antioxidant status of synovial fluid with increased activities of antioxidant enzymes and decreased synovial fluid viscosity. Furthermore, synovial fluid viscosity, and activity of GR can be used to distinguish the primary from the secondary type of KOA.     

The effects of immobilization on the characteristics of articular cartilage: current concepts and future directions

OBJECTIVE: The purpose of this paper is to review current data and concepts concerning the effect of immobilization on articular cartilage in animal models. We also evaluate the methods to measure articular cartilage changes in humans. METHODS: Studies looking at the effects of immobilization on morphological, biochemical, and biomechanical characteristics of articular cartilage are reviewed. RESULTS: Articular cartilage changes in immobilized animals include altered proteoglycan synthesis, as well as thinning and softening of the tissue. The overall thickness of articular cartilage in the knee decreases up to 9% after 11 weeks of immobilization and the deformation rate under test load increases up to 42%. Quantitative data about changes in human articular cartilage following immobilization are not available. This is mainly due to the lack of an accurate, reproducible, and non-invasive method to characterize articular cartilage. DISCUSSION: An understanding of the alterations in articular cartilage following short and long term immobilization in humans is essential for the optimization of rehabilitation programs. Refined imaging techniques combined with state-of-the-art visualization tools could allow the systematical monitoring of articular cartilage morphology changes in immobilized humans.