运动对兔膝制动后软骨形态的影响及疗效观察

为了解不同运动方式对兔膝退变关节兔膝退变关节骨的形态学和关节功能的影响。以新西兰白兔为研究对象,采用左后膝伸直位管石膏固定８周的方法建立ＯＡ动物模型,通过施加主动活动,被动活动,主动加被动活动,自由活动等运动处理因素因素,观察Ｘ线检查,关节活动度,生物力学特性和软骨组织的形态学改变。     

运动对兔膝退变关节软骨形态学的影响

目的：了解不同运动方式对退变关节软骨的形态学影响。方法：以新西兰白兔为研究对象,用伸膝位石膏固定８周的方法建立ＯＡ动物模型,按运动方式不同,随机分成５组,从光镜、扫描电镜两方面观察运动对退变关节软骨的组织形态学影响。结果：关节制动可诱发关节软骨退变,运动对退变软骨具有保护和促进修复作用。结论：关节适宜运动可促进退变关节软骨的修复和重塑,增加关节稳定性。     

骨性关节炎靶向基因治疗的研究进展

骨性关节炎（osteoarthritis, OA）是常见的关节退行性疾病,其病理改变累及关节软骨、软骨下骨、韧带、关节囊和滑膜,主要表现为进行性软骨退变和继发性骨质增生。早期OA可选择运动、药物等治疗方式,病情加重时,则需要手术治疗。随着人类基因组信息不断揭示,为解决OA提供了新的思路。基因治疗借助病毒或非病毒载体将目的基因导入退变关节腔,使目的基因能够在关节稳定、可控、靶向的表达,通过减轻关节局部炎症、抑制软骨基质降解和促进软骨基质合成等方式,保护和修复受损的软骨。本文就OA基因治疗对炎症及软骨基质代谢的影响、基因递送系统、小核糖核酸（micro ribonucleic acid, miRNA）及长非编码核糖核酸（long non-coding ribonucleic acid, LncRNA）等方面进行综述,为未来相关研究提供参考。     

骨关节炎软骨下骨改变及其作用研究进展

骨关节炎（OA）时软骨下骨结构、生化组成、生物力学及细胞功能均表现异常。OA早期软骨下骨主要表现为骨吸收,晚期主要表现为骨形成。OA软骨下骨异常改变可引发关节疼痛和促进关节软骨退变,抑制或改善软骨下骨异常改变可减轻关节疼痛和延缓软骨退变,软骨下骨靶向治疗有望成为新的治疗手段。该文就OA软骨下骨异常改变及其作用研究进展作一综述。     

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,     

生物标记物在骨关节炎中应用进展

骨关节炎（osteoarthritis，OA）是一种随年龄增长发病率明显增加的退行性疾病，常累及膝、髋、脊柱等承重关节。关节滑膜、骨、软骨均参与OA的病程进展，又以关节软骨的退变丢失导致关节破坏和活动能力的严重丧失为显著特征。OA是老年人致残的主要原因之一，不仅严重影响生活质量，并且医疗支出巨大。     

选择性雌激素受体调节剂对骨关节炎作用的研究进展

目的综述选择性雌激素受体调节剂(selective estrogen receptor modulators,SERMs)对骨关节炎(osteoarthritis,OA)作用的研究进展。方法广泛查阅国内外有关雌激素和SERMs对OA作用效果及作用机制的有关文献,并进行综述。结果SERMs阻止OA软骨和软骨下骨破坏,减轻滑膜炎,维持关节健康,并在一定程度上改善OA样关节退变,延缓OA关节的破坏。结论 SERMs对OA关节具有保护作用,有望成为OA调修药的候选药物,但仍需完善相关的基础和临床研究,明确SERMs对OA的作用机制。     

软骨前体细胞及微小RNA-140在骨关节炎软骨损伤修复中的作用

目的总结软骨前体细胞(cartilage progenitor cells,CPCs)及微小RNA-140(microRNA-140,miR-140)在骨关节炎(osteoarthritis,OA)软骨损伤修复中的作用及应用前景。方法查阅国内外近年有关CPCs、miR-140及OA软骨损伤修复的相关研究,归纳总结后进行综述。结果 CPCs具有良好的自我增殖性、干细胞表面抗原表达特性及多向分化潜能等特点,其成软骨分化能力优于其他组织来源MSCs。CPCs与OA发生发展密切相关,但其在OA软骨损伤部位自主活化及成软骨分化能力方面并不能达到软骨完全修复的要求。miR-140具有软骨特异性,参与OA发病机制,具有抑制Notch信号通路、诱导活化CPCs并增强其增殖及成软骨分化的能力,从而促进OA软骨损伤修复的潜能。关节腔局部给药是目前治疗OA的主要方式之一,关节腔注射miR-140虽然对大鼠软骨退变具有显著抑制作用,但也存在非靶向聚集、生物利用度低及清除快等问题,基于关节软骨特性构建具有良好安全性、软骨靶向性且能高效递送miR-140的载体材料具有良好应用前景。此外,CPCs主要分散在软骨表层,而OA软骨损伤也开始于该层,因此强调OA早期干预至关重要。结论 miR-140具有诱导活化CPCs、促进OA早期软骨损伤修复的潜能,进一步探索miR-140在OA发生机制中的作用及研发基于miR-140的新的OA治疗策略具有重要临床意义。     

力学刺激对软骨细胞整合素亚单位的调控

骨关节炎（osteoarthritis,OA）是以关节软骨退变、关节缘骨质增生为主要改变的疾病。机械应力可以调节细胞的多种功能,而整合素作为细胞表面应力受体之一,主要介导细胞与细胞外基质（extracellularmatrix,ECM）间的黏附,在传导力学信号从而调节细胞的生理功能方面起着重要作用。因此,在软骨病变早中期选择适当的良性刺激（如推拿手法）作用于软骨,调控整合素的表达影响软骨细胞的功能,修复损伤的软骨细胞,延缓关节软骨退变,这对于骨关节炎的治疗有重要意义。     

关节镜膝关节清理术治疗中重度软骨退变的膝骨关节炎

目的探讨关节镜下膝关节清理术治疗中重度软骨退变的膝骨关节炎的效果. 方法采用关节镜下膝关节清理术联合术后康复训练治疗17例(21膝)中重度软骨退变的膝关节骨关节炎. 结果手术时间55～100 min,平均75 min.无并发症发生.术后住院15～20 d,平均13 d.术中关节被动活动范围0°～120°,术后关节活动度0°～110°.随访5～36个月,平均21个月,良好6例(8膝),尚可9例(11膝),差2例(2膝).关节活动范围0°～120°结论关节镜下膝关节清理术对中重度软骨退变的膝关节骨关节炎有一定的治疗效果.     

麻醉下的持续被动运动预防膝关节僵直

1991～1993年,69例膝关节术后在麻醉镇痛下持续被动运动.结果:优58例,良9例,一般2例.作者认为,关节持续被动运动具有刺激关节软骨增生,防止关节粘连和僵硬的积极作用.麻醉镇痛有助于关节持续被动运动.     

Muscle stabilization strategies in people with medial knee osteoarthritis: The effect of instability

The sensation of knee instability (shifting, buckling. and giving way) is common in people with medial knee osteoarthritis (OA). Its influence on knee stabilization strategies is unknown. This study investigated the influence of knee instability on muscle activation during walking when knee stability was challenged. Twenty people with medial knee OA participated and were grouped as OA Stable (OAS) (n = 10) and OA Unstable (OAU) (n = 10) based on self‐reported knee instability during daily activities. Quadriceps strength, passive knee laxity, and varus alignment were assessed and related to knee instability and muscle cocontraction during walking when the support surface translated laterally. Few differences in knee joint kinematics between the groups were seen; however, there were pronounced differences in muscle activation. The OAU group used greater medial muscle cocontraction before, during, and following the lateral translation. Self‐reported knee instability predicted medial muscle cocontraction, but medial laxity and limb alignment did not. The higher muscle cocontraction used by the OAU subjects appears to be an ineffective strategy to stabilize the knee. Instability and high cocontraction can be detrimental to joint integrity, and should be the focus of future research. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:1180–1185, 2008     

连续收肌管阻滞和连续股神经阻滞对膝关节置换术患者术后镇痛和早期功能康复的影响

目的 比较连续收肌管阻滞(adductor canal block,ACB)和连续股神经阻滞(femoral nerve block,FNB)在膝关节置换术(total knee arthroplasty,TKA)患者术后镇痛的效果和对早期功能康复的影响.方法 择期拟行单侧TKA患者60例,采用随机数字表法分为两组(每组30例):连续ACB组(A组)和连续FNB组(F组).术中采用全凭静脉麻醉.两组在麻醉诱导前分别行超声引导下ACB和FNB,并放置神经周围导管.术毕经神经周围导管予0.2％罗哌卡因实施患者自控周围神经阻滞镇痛.记录术后4、8、12、24、48 h静息和运动(膝关节被动屈曲45°)疼痛数字评分(numeric rating scale,NRS)、患肢股四头肌肌力Lovett评分和患肢运动阻滞改良Bromage评分.记录:术后1、2、3、14 d膝关节最大主动/被动活动度,术后14 d美国纽约特种外科医院(hospital for special surgery,HSS)膝关节功能评分,术后第1次下床活动时间和术后膝关节主动屈膝90°时间.记录术后48 h内镇痛泵有效按压次数和补救镇痛率.结果 两组术后静息和运动NRS评分、镇痛泵有效按压次数和补救镇痛率等比较,差异均无统计学意义(P＞0.05).A组术后12 h内患肢股四头肌肌力Lovett评分明显高于F组(P＜0.05)、息肢运动阻滞改良Bromage评分明显低于F组(P＜0.05).A组术后1、2、3d膝关节最大主动活动度明显大于F组(P＜0.05),但膝关节最大被动活动度、术后14 d膝关节最大主动活动度、术后14 d膝关节HSS评分以及术后第1次下床活动时间和术后膝关节主动屈曲90°时间两组间比较差异均无统计学意义(P＞0.05).结论 连续ACB和连续FNB可为TKA患者提供等同的术后镇痛效果,而且对早期功能康复具有相似的效果.     

Ankle osteoarthritis is associated with knee osteoarthritis. Conclusions based on mechanical axis radiographs

Introduction Osteoarthritis (OA) of the ankle with an unknown etiology (primary OA) is rare, whereas a secondary OA due to a known cause is not uncommon. OA of the knee can, when it progresses, change the alignment of the whole extremity including the ankle joint. Since we had observed in patients coming for OA knee surgery coexisting OA in the ankle joint, our objective of this study was to assess the prevalence of abnormal alignment and degenerative changes in the ankle joint and to determine if degenerative changes in the knee and ankle correlated. These aims were assessed retrospectively, utilizing mechanical axis (MA) radiographs of subjects with knee OA prior to surgery. Materials and methods This retrospective study consisted of 104 patients who had undergone surgery of the knee due to OA. A musculoskeletal radiologist and an orthopedic surgeon reviewed in consensus the preoperative and postoperative MA radiographs. We analyzed and measured the tibiofemoral (TF) angle, the mediolateral tibial translation, the deviation of the MA, the tilt of the talocrural joint and the degree of OA in the knee and ankle. Results The severity of OA of the TF joint correlated with the preoperative TF translation and moderately with the deviation of the MA and abnormal TF angle. Of the 104 patients, 30 showed coexisting OA of the ankle: the greater the tilt in the ankle, the more degenerative were the changes in the joint. The MA was corrected with surgery from a mean preoperative 5.4° varus to a postoperative mean 1.2° valgus, and the ankle tilt was changed significantly at the same time. Conclusion Ankle OA and tilt were not uncommon in our patients with knee OA. The assumption that associations may exist between knee and ankle OA and joint malalignment was confirmed. This work was done at ORTON Orthopaedic Hospital, 00280 Helsinki, Finland. No funding or grants was received for this study.     

连续股神经阻滞联合口服镇痛药用于全膝关节置换术术后镇痛的效果

目的观察连续股神经阻滞联合口服镇痛药用于全膝关节置换术患者术后镇痛的效果及其对膝关节早期康复的影响。方法选择择期行单侧全膝关节置换的患者60例,随机分为多模式镇痛组(M组)和静脉自控镇痛组(I组),每组30例。M组术前2d口服塞来昔布200mg/次、每天2次,羟考酮10mg/次、每天2次、持续2d,术后连续股神经阻滞镇痛并加服对乙酰氨基酚100mg/次、每天3次,羟考酮20mg/次、每天2次、持续3d;I组仅采用静脉自控镇痛。记录患者术后6、12、24、48h的静息状态、主动/持续被动功能训练时的VAS评分、主动/持续被动功能训练时患侧膝关节活动度、首次下床活动时间、住院时间、出院时患侧膝关节活动度及术后镇痛不良反应发生率。当VAS≥5分时,静脉注射地佐辛5mg,并予以记录。结果术后6、12、24、48h静息状态及主动/持续被动功能训练时M组VAS评分明显低于I组(P0.05);术后24、48、72h主动/持续被动功能训练时M组患侧膝关节活动度明显大于I组(P0.05);M组首次下床活动时间[(2.5±0.8)d]明显短于I组[(3.3±0.7)d](P0.05);M组住院时间[(9.1±2.3)d]明显短于I组[(10.8±2.0)d](P0.05);出院时M组患侧膝关节活动度[(95.6±17.2)°]明显大于I组[(82.5±15.2)°](P0.05);M组恶心呕吐1例(3.3%)及尿潴留2例(6.7%)明显低于I组恶心呕吐9例(30.0%)及尿潴留8例(26.7%)(P0.05);M组追加地佐辛1例(3.3%)明显低于I组12例(40.0%)(P0.05)。结论与静脉自控镇痛比较,连续股神经阻滞联合口服镇痛药的多模式镇痛方案能有效减轻全膝关节置换术患者术后疼痛,有利于膝关节功能的早期康复。     

The effect of bracing on proprioception of knees with anterior cruciate ligament injury.

This paper is a comprehensive review on the effect of bandaging, bracing, and neoprene sleeves on knee proprioception following anterior cruciate ligament (ACL) injury and reconstruction with a focus on studies that have measured joint position sense and threshold to detection of passive knee motion. Disruption of the ACL does not appear to alter joint position sense soon after injury, although there is evidence that in some subjects deterioration may occur over time. An ACL tear creates a deficit in the threshold to detection of passive knee motion soon after injury and in those with chronic tears. The magnitude of worsening is less then 1.0 degree of movement in flexion-extension and of questionable concern from a clinical and functional perspective. Application of a functional brace or neoprene sleeve to the ACL-deficient limb does not improve the threshold to detection of passive knee motion; however, application of an elastic bandage to a knee with an ACL tear improves joint position sense. Reconstruction of a torn ACL is associated with a deficit in the threshold to detection of passive knee motion, and during the first year of healing the use of a neoprene sleeve provides improvement. Two years following ACL reconstruction there is no deficit in the threshold to detection of passive knee motion and the use of a brace has no effect on this outcome.     

Proprioception in people with anterior cruciate ligament-deficient knees: comparison of symptomatic and asymptomatic patients

STUDY DESIGN: Nonrandomized prospective study. OBJECTIVE: To evaluate proprioception in 2 groups of patients with anterior cruciate ligament (ACL) deficiency who had different severity of symptoms. BACKGROUND: Defective proprioception has previously been found in patients with ACL-deficient knees. It has been suggested that sensory receptors of the ACL and other knee joint ligaments contribute to proprioception and knee joint function and stability. METHODS AND MEASURES: A total of 17 patients with ACL deficiency (mean [SD] age, 28.8 +/- 5.6 years; range, 22-39 years) with few, if any, symptoms were compared with 20 patients with ACL deficiency (mean [SD] age, 26.6 +/- 6.1 years; range, 18-39 years) having instability and episodes of giving way. The groups were compared with each other and with an age-matched reference group of 19 nonimpaired subjects. Their mean (SD) age was 25.6 +/- 3.7 years (range, 20-37 years). Three tests of proprioception were used: threshold to detection of passive motion from 2 starting positions (20 degrees and 40 degrees of knee flexion) toward flexion and extension, active reproduction of a 30 degrees passive angle change, and visual reproduction of a 30 degrees passive angle change. The Wilcoxon rank sum test was used for between-group comparisons. RESULTS: Symptomatic patients had higher threshold to detection of passive motion in their injured side in the flexion trial from 20 degrees (median of 1.5 degrees vs median of 0.5 degree) and in the extension trial from 40 degrees (median of 1.0 degree vs median of 0.5 degree) than the asymptomatic patients. No differences were found in the other threshold tests, active or visual reproduction tests. CONCLUSIONS: Patients with severe symptoms related to ACL deficiency were found to have inferior proprioceptive ability in some measurements compared with patients with a good knee function. The findings indicate that proprioceptive deficits might influence the outcome of an ACL injury treated nonoperatively.     

The effects of hip muscle strengthening on knee load,pain, and function in people with knee osteoarthritis: a protocol for a randomised,single-blind controlled trial

Background  

Lower limb strengthening exercises are an important component of the treatment for knee osteoarthritis (OA). Strengthening the hip abductor and adductor muscles may influence joint loading and/or OA-related symptoms, but no study has evaluated these hypotheses directly. The aim of this randomised, single-blind controlled trial is to determine whether hip abductor and adductor muscle strengthening can reduce knee load and improve pain and physical function in people with medial compartment knee OA.     

Effect of knee joint angle on motor unit synchronization.

Activity of the vasti has been argued to vary through knee range of movement due to changes in passive support of the patellofemoral joint and the relative contribution of these muscles to knee extension. Efficient function of the knee is dependent on optimal control of the patellofemoral joint, largely through coordinated activity of the medial and lateral quadriceps. Motor unit synchronization may provide a mechanism to coordinate the activity of vastus medialis (VMO) and vastus lateralis (VL), and may be more critical in positions of reduced passive support for the patellofemoral joint (i.e., full extension). Therefore, the aim of this study was to determine whether the degree of motor unit synchronization between the vasti muscles is dependent on joint angle. Electromyographic (EMG) recordings of single motor unit action potentials (MUAPs) were made from VMO and multiunit recordings from VL during isometric contractions of the quadriceps at 0 degrees, 30 degrees, and 60 degrees of knee flexion. The degree of synchronization between motor unit firing was evaluated by identification of peaks in the rectified EMG averages of VL, triggered from MUAPs in VMO. The proportion of cases in which there was a significant peak in the triggered averages was calculated. There was no significant difference in the degree of synchronization between the vasti at different knee angles (p=0.57). These data suggest that this basic coordinative mechanism between the vasti muscles is controlled consistently throughout knee range of motion, and is not augmented at specific angles where the requirement for dynamic control of stability is increased.