正常关节软骨和骨关节炎关节软骨细胞中血管活性肠肽表达的比较

背景：神经肽的发现给骨关节炎的治疗带来了新的希望,但神经肽的表达与骨关节炎发病以及软骨退变程度的关系尚不清楚。 目的：观察血管活性肠肽在正常关节软骨和不同退变程度骨关节炎软骨中的表达,以及血管活性肠肽表达与骨关节炎发病及软骨退变程度的关系。 方法：选取2007-03/11中南大学湘雅医院骨科进行关节置换的骨关节炎患者的关节软骨标本26个,选取因外伤行截肢的膝关节软骨或股骨颈暴力骨折的股骨头正常关节软骨标本10个为对照,根据大体观察凿取正常和骨关节炎不同退变程度软骨块50个,再根据关节软骨改良Mankin病理评分法进行分组,采用免疫组织化学染色检测软骨组织中血管活性肠肽的表达和分布。 结果与结论：各关节软骨中均可见到血管活性肠肽阳性神经纤维,正常关节软骨中血管活性肠肽的表达明显高于骨关节炎关节软骨(P < 0.05)。且血管活性肠肽表达与软骨改良Mankin病理评分呈负相关(r=-0.896,P < 0.05)。说明血管活性肠肽低表达与关节软骨退变程度、骨关节炎病程进展有关,可能是关节软骨退变、骨关节炎发病的机制之一。     

犬椎间盘经皮针刺退变模型的建立

背景：普通针头穿刺纤维环是目前较为公认的理想椎间退变模型制作方法,但存在对动物损伤大,操作不简捷等缺点。 目的：尝试在C臂机透视下经皮穿刺比格犬腰椎椎间隙建立腰椎间盘退变动物模型。 方法：选用8只健康成年犬,行腰椎MRI后在C臂机下经皮穿刺椎间隙,损伤L5/6椎间盘。术后3,6个月行腰椎MRI后,取标本行免疫组织化学观察椎间盘退变情况。 结果与结论：经皮椎间盘穿刺后3,6个月,L5/6椎间盘均出现了明显退变,MRI显示T2值均出现明显降低,并且椎间盘大多出现不同程度椎间盘突出征象;L5/6穿刺节段髓核Ⅱ型胶原阳性细胞含量较L4/5髓核均明显减少(P < 0.05)。说明经皮穿刺损伤椎间盘建立犬椎间盘退变模型是一种简单有效、重复性好的建模方法。     

上、下坡跑台训练膝骨关节炎模型大鼠关节软骨及炎症因子的变化

BACKGROUND: Different training methods have different effects on primary knee osteoarthritis. OBJECTIVE: To compare the effects of uphill or downhill running on articular cartilage degeneration and inflammatory responses of knee osteoarthritis rats.   METHODS: 108 female Sprague-Dawley rats were randomly divided into six groups: normal control group, ovariectomized group, uphill running group (run & up), downhill running group (run & down), uphill running model group (model & up), downhill running model group (model & down). The rats in the normal control group were raised routinely with no treatment; rats in the ovariectomized group were ovarientomized and raised in routine way; rats in the run & up group and run & down group were subjected to uphill running training on the slop +15° or downhill running training on the slop -15°; rats in the model & up group and model & down group were subjected to uphill running training on the slop +15°or downhill running training on the slop -15° after ovarientomized. Training programs were as follows: 28 m/min, 60 minutes per day, 6 days per week. RESULTS AND CONCLUSION: Compared with the other five groups, in the model & up group, the Mankin’s score was significantly increased, indicating that articular cartilage degeneration occurred, and the peak of carboxy-terminal telopeptide of type II collagen contained in the urine had passed, at 4 weeks after modeling. At 6 weeks, the Mankin’s score of the model & down group was increased to reach the degeneration standard, but it was still lower than that of the model & up group; the expression levels of tumor necrosis factor-α and interleukin-1β in the synovial fluid were significantly higher in the model & up and model & down groups than the other four groups. At 8 weeks, the Mankin’s score and the expression levels of tumor necrosis factor-α and interleukin-1β were further increased in the model & up and model & down groups, especially in the model & up group. These results indicate that treadmill running exercise after ovariectomized can result in articular cartilage injury and local inflammatory responses; compared with the downhill running training, the uphill running training can cause cartilage injury earlier and more efficiently.      

电针抑制骨性关节炎的炎症反应及延缓关节软骨退变

背景：研究表明基质金属蛋白酶3在关节软骨退变和破坏中有重要意义。 目的：观察长针透刺与透明质酸钠治疗大鼠膝骨关节炎后,大鼠化膜组织中基质金属蛋白酶3含量变化。 方法：SD大鼠通过膝关节腔内注射1.6%木瓜蛋白酶溶液并驱赶大鼠活动建立膝骨关节炎模型。造模2周后随机分为3组,长针透刺组用直径0.30 mm、长125 mm规格的毫针透刺大鼠犊鼻穴和膝眼穴;药物治疗组关节腔内注射透明质酸钠;模型组不干预。并设立不造模的正常组。 结果与结论：治疗4周后,模型组大鼠滑膜组织基质金属蛋白酶3含量较正常组显著升高(P < 0.05),长针透刺组、药物治疗组基质金属蛋白酶3含量较模型组显著降低(P < 0.05),长针透刺组与药物组相近(P > 0.05)。证实长针透刺疗法能有效纠正膝骨关节炎模型大鼠化膜组织中基质金属蛋白酶3的异常表达,这也可能是长针透刺治疗膝骨关节炎的作用原理之一。     

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。     

姜黄素保护关节软骨抑制骨关节炎的作用和机制

背景：研究证实姜黄素具有抗炎抗氧化抗凋亡作用。 目的：综合阐述姜黄素保护关节软骨及抑制骨关节炎等方面的机制和作用。 方法：作者检索 1973至2014 年 PubMed、Embase、Elseveir数据库文献。检索词为“Osteoarthritis,curcumin,chondrocyte,articular cartilage”,按照事先制定的标准逐一评价纳入研究的文献,提取有效资料进行综合分析。 结果与结论：姜黄素可通过抑制氧化作用酶,清除自由基,完成抗氧化作用,从而防止骨关节炎的发生和进展。姜黄素抑制基质金属蛋白酶的对软骨基质的消耗,增加Ⅱ型胶原的产生。姜黄素通过抑制胞浆型磷脂酶A2,环氧化酶2,脂氧合酶5,从而完成抗炎反应。姜黄素抑制白细胞介素1β导致的线粒体肿胀和凋亡,完成抗凋亡作用。临床研究提示,姜黄素或者其衍生物骨关节炎患者膝关节功能、关节疼痛等均有改善。高浓度姜黄素对体外培养的细胞和组织有毒性作用。 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：     

前交叉韧带离断骨关节炎大鼠印第安刺猬蛋白以及Runt相关转录因子2的表达

背景：印第安刺猬蛋白(Ihh)及其信号蛋白Gli1以及Runt相关转录因子2(Runx2)是骨关节炎密切相关的因子,在骨关节炎发病过程中,是引起关节退行性改变的重要原因之一。 目的：探索Ihh,Gli1以及Runx2在骨关节炎发病过程中的作用。 方法：将30只SD大鼠随机分成对照组(n=10)和模型组(n=20)。模型组大鼠取一侧膝关节行前交叉韧带离断建立骨关节炎模型,分别于造模后4周及12周,各取10只大鼠进行观察。对照组大鼠仅暴露前交叉韧带,于术后12周进行观察。 结果与结论：与对照组相比,造模4周后可见骨关节炎模型大鼠膝关节出现软骨退变,膝关节软骨中Ihh,Gli1及Runx2表达水平明显增高,而造模12周后软骨退变进一步加重,但膝关节软骨中Ihh,Gli1及Runx2表达水平下降。提示Ihh,Gli1及Runx2在骨关节炎退变过程中起重要作用,其表达水平在骨关节炎的早期即明显升高,可作为骨关节炎防治研究中的评价指标。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

手术诱导膝骨关节炎兔模型的制备方法

背景：目前常用的膝骨关节炎动物模型制备方法主要有手术创伤和关节腔内注射蛋白酶诱导两大类。关节腔内注射药物诱导模型并不稳定,传统的手术造模方法对膝关节损伤较大,且成模过程与临床膝骨关节炎的发展过程差异较大。目的：通过不同手术方式损伤膝关节制备兔膝骨关节炎模型,探讨膝骨关节炎动物模型的最佳制备方法。方法：将16只雄性五六月龄新西兰大白兔随机分为假手术组、模型A组、模型B组、模型C组,每组4只。假手术组切开右侧膝关节内侧后立即缝合;模型A组磨损右侧膝关节半月板、磨损前交叉韧带;模型B组摘除右侧膝关节半月板、磨损前交叉韧带;模型C组摘除右侧膝关节半月板、切断前交叉韧带。术后连续3 d注射抗生素,记录一般情况。4周后通过X射线片观察关节情况,苏木精-伊红染色观察软骨组织变化,酶联免疫吸附法检测右侧膝滑膜液和血清中炎症因子水平。结果与结论：(1)模型组右侧膝关节明显出现红肿热痛情况,皮温明显高于假手术组;(2)术后模型组右侧膝关节皮温较假手术组明显升高,差异有显著性意义(P <0.05);(3)X射线片显示假手术组膝关节未见异常,模型组出现不同程度的关节面破坏及关节间隙狭窄,其中模型C组最为...     

肾虚血瘀型膝骨性关节炎大鼠模型的建立

背景：建立骨性关节炎的中医证候模型,有利于对其进行辨证施治研究。 目的：采用病、证结合的方法建立肾虚血瘀型膝骨关节炎大鼠模型。 方法：选择2月龄雌性SPF 级SD大鼠30只,随机分为正常组、膝骨关节炎组和复合模型组,每组10 只。采用经典的Hulth造模法建立膝骨关节炎模型,去卵巢法建立肾虚模型,肾上腺皮质激素和肾上腺素法建立血瘀模型。复合模型由上述3种模型复合而成,先建立肾虚模型,8周后同时进行血瘀模型与骨关节炎模型造模。 结果与结论：复合模型组大鼠在肾虚模型建立后第3周时出现精神萎靡、活动不灵活、便溏等表现,在血瘀模型建立后第6周时大鼠出现皮毛无光泽、喜背光、舌质瘀紫、尾色及爪甲瘀青,体质量下降;低切还原黏度增高,血小板聚集性增强等血流缓慢、循环障碍特点;组织学染色观察发现膝骨关节炎组关节软骨结构有一定破坏但轻于复合模型组。可见实验成功建立了大鼠肾虚血瘀型大鼠膝骨关节炎模型,而肾虚血瘀加重了膝骨关节软骨的退变。     

木瓜蛋白酶诱导大鼠膝早期骨关节炎软骨表面的电镜扫描

背景：木瓜蛋白酶注射建立骨性关节炎动物模型是用于骨关节炎防治研究的常用方法之一。 目的：观察木瓜蛋白酶和L-半胱氨酸混合注射诱导大鼠膝早期骨关节炎进程中扫描电镜下软骨表面形态学变化。 方法：2%木瓜蛋白酶和0.03 mol/L左旋半胱氨酸按2∶1比例混匀,取0.15 mL注射至SD大鼠右膝关节腔诱导骨关节炎模型,左膝注射等量生理盐水为对照组,另取2只4膝不做处理为正常对照组,于注射后第2,4,6周后分别使用扫描电镜观察股骨内侧髁关节软骨表面形态学变化。 结果与结论：正常和对照组可见表面分布较均匀的浅坑。木瓜蛋白酶和L-半胱氨酸混合注射2周后大鼠软骨表面出现凹凸不平,皱缩扭曲变形;4周表面变薄,局部出现小裂纹;6周出现深大裂纹,软骨缺损。提示2%木瓜蛋白酶和0.03 mol/L左旋半胱氨酸混合注射诱导的早期骨关节炎模型的时间节点可以定在4-6周。 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：     

膝骨关节炎患者膝关节置换后下肢肌的表面肌电图变化

背景：膝骨关节炎患者膝关节置换后下肢肌功能恢复一直存在着争议。 目的：评价膝骨关节炎患者膝关节置换手术后下肢肌肉功能。 方法：应用TELEMYO 2400R G2表面肌电图遥测仪对25例双膝骨关节炎单膝关节置换后患者在平常自然步态下进行双下肢股直肌、胫前肌、股二头肌和腓肠肌内侧的表面肌电信号测试。在肌电图测试前,对患者双膝关节功能进行美国特种外科医院膝关节评分。 结果与结论：患者置换后美国特种外科医院膝关节评置换侧平均分91.44,其优良率达100%;未置换侧平均分54.52。置换侧在疼痛、关节功能方面有明显改善;膝关节置换后置换侧股直肌、胫前肌、股二头肌的肌电振幅、肌电积分、平均频率、中位频率的(平均值、最小值、最大值)与未置换侧相比差异无显著性意义(P > 0.05);置换侧腓肠肌内侧肌电振幅值及肌电积分值显著大于未置换侧(P < 0.05);置换侧腓肠肌内侧平均频率、中位频率与未置换侧相比差异无显著性意义(P > 0.05)。提示膝关节置换后置换侧的下肢肌没有恢复到正常的功能活动水平,因此膝关节置换后康复要特别重视患者的肌肉锻炼。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

关节镜微创治疗膝关节骨性关节炎的疗效观察

目的探讨关节镜下微创治疗膝关节骨性关节炎（OA）的疗效。方法对129例膝关节OA患者行关节镜检及有限化微创清理术,采用HSS膝关节评定系统及Denis疼痛测定法进行术后疗效评定。结果术后随访6～36个月,129例中104例患者临床症状明显缓解,关节功能改善,优良率达80.62%。结论关节镜有限微创清理术能有效缓解OA症状,改善关节功能,提高生活质量。     

高分子绷带结合塑料杆建立的兔膝骨关节炎模型

BACKGROUND: Various methods have been developed for establishing a rabbit osteoarthritis model worldwide. However, most of modeling methods are cumbersome, and the original gypsum braking method has some defects.     

电针对膝关节骨性关节炎患者疼痛改善及关节功能影响的荟萃分析

文题释义：电针法(electro-acupuncture)：将毫针刺入腧穴得气后,再通以接近人体生物电的脉冲电流,利用针和电的两种刺激,激发调整经络之气,以防治疾病的方法。 膝关节骨性关节炎(knee osteoarthritis,KOA)：又称为膝关节增生性关节炎、退行性膝关节炎,是中老年人常见的一种慢性骨关节病,主要病理特点为关节软骨退变、破坏、软骨下骨硬化、关节边缘软骨下骨增生,进而引起滑膜炎症、半月板损伤、游离体形成及关节外组织炎症等一系列病变,临床症状以膝关节的疼痛、肿胀、变形及活动受限为主。 背景：大量临床研究资料显示,电针治疗膝关节骨性关节炎具备起效速度快、治疗效果好、不良反应少等优点,但当前电针治疗该病缺乏多中心大样本的临床研究试验。 目的：应用荟萃分析法系统评价电针疗法对膝关节骨性关节炎患者疼痛改善及关节功能影响。 方法：检索中国知网(CNKI)、万方数据库(WF)、维普数据库(VIP)、美国医学在线(PubMed)、荷兰医学文献数据库(Embase)及国际循证医学图书馆(Cochrane Library)六大数据库中有关电针治疗膝关节骨性关节炎的临床随机对照试验文献,检索时限为各数据库自建库以来至2019年6月,经筛选后提取纳入研究的文献数据,采用Review Manager 5.3统计软件进行荟萃分析。 结果与结论：最终11篇文献被纳入研究,共727例膝关节骨性关节炎患者,其中采用单一电针疗法的治疗组366例,采用常规针刺或药物的对照组361例。与对照组比较,治疗组在提高总体有效率[OR=3.22,95%CI(2.13,4.87),Z=5.53,P < 0.000 01]及治愈率[OR=2.73,95%CI(1.80,4.15),Z=4.72,P < 0.000 01],降低目测类比VAS评分[MD=-1.00,95%CI(-1.71,-0.30),Z=2.80,P=0.005]、WOMAC评分[MD=-7.69,95%CI(-10.31,-5.07),Z=5.75,P < 0.000 01]及ISOA评分[MD=-2.22,95%CI(-3.74,-0.70),Z=2.86,P=0.004]等5个方面均有显著优势。基于以上Meta分析证据表明,电针治疗膝关节骨性关节炎的近期疗效确切,能够对患者疼痛症状及关节功能发挥积极效应且不良反应少。由于纳入研究的样本量较小、文献质量普遍不高及可能存在偏倚等因素,仍需更多更高质量的RCT研究来验证该研究的结论。 ORCID: 0000-0002-2201-5495(朱英) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

单髁置换术与全膝关节置换术在治疗膝内侧单间室骨性关节炎术后早期关节遗忘度中的比较

目的 比较膝关节单髁置换术（unicompartmental knee arthroplasty, UKA）与全膝人工关节置换术（total knee arthroplasty, TKA）治疗膝内侧单间室骨性关节炎的早期膝关节功能评分与关节遗忘度评分,评价并分析两类术式在早期关节遗忘度评分方面的差异。方法 回顾性分析上海中医药大学附属光华医院关节外科2016年10月至2020年10月期间行全膝关节置换术及膝关节单髁置换术患者共296例,根据不同手术方式进行分组,其中TKA组共144例,UKA组共152例。出院后对患者术后1、3、6、12、24个月进行门诊复查,进行关节遗忘度评分、膝关节功能HSS评分、目测类比评分（VAS评分）。结果 (1)296例患者获得24～37个月的随访,平均随访（30.41±6.93）个月;(2)术后24个月TKA组与UKA组的HSS评分与VAS评分均明显好于术前,组内比较差异具有统计学意义（P<0.05）;(3)两组患者术后24个月膝关节VAS评分的改善程度差异无统计学意义（P>0.05）,UKA组的HSS评分改善程度好于TKA组,且差异有统计学意...     

Histological characteristics of knee menisci in patients with osteoarthritis

Existing data indicate knee menisci in patients with osteoarthritis (OA) show tearing, maceration, and fragmentation, but little is known about the change in histological structure. The aim of this study was to evaluate the change in the menisci histological structure in patients with clinically diagnosed knee OA. Fourteen patients undergoing surgical treatment of knee OA (OA group) and 14 cadaveric knees (control group) were assessed. Demographic data, medical history, synovial fluid, OA severity, medial meniscus (MM) tissue, and lateral meniscus (LM) tissue were collected from the OA group. Three nonconsecutive 10 μm cross‐sectional tissue slices of menisci were analyzed for percentage of tissue calcification. Exact Mann–Whitney tests and Spearman correlation coefficients tested for relationships between variables. The major change in the histological structure of the menisci in patients with OA was calcification of the matrix, which was significantly greater in the OA group compared with the control group for MM (OA: 11.9%, cadaver: 5.17%; P < 0.001) and LM tissues (OA: 11.1%, cadaver: 4.2%; P < 0.001). A correlation between percent calcification of the MM and LM tissues existed in the OA group (ρ = 0.56, P = 0.04) but not the control group (P = 0.20). The most pronounced pathological change in the histology of menisci was calcification of the cartilage matrix, significantly greater in the OA group than the control group. A strong correlation between percent calcification of MM and LM tissues in patients with OA indicates changes in fibrocartilage matrix of menisci progress similarly in the medial and lateral compartments of the knee. Clin. Anat. 30:805–810, 2017. © 2017Wiley Periodicals, Inc.     

The effect of the dimensions of the distal femur and proximal tibia joint surfaces on the development of knee osteoarthritis

The aim of this study was to determine whether the dimensions of the distal femur and proximal tibia joint surfaces affect the etiology of knee osteoarthritis (OA). The study comprised the records of 1,324 patients who had been admitted to hospital with knee pain. Anterioposterior (AP) and lateral radiographs of the knee were taken. Using the Kellgren‐Lawrence Scale, the patient group comprised Stages 2, 3, and 4 radiographs and the controls comprised Stages 0 and 1 radiographs. Four lengths were measured for each patient in both groups: femur mediolateral (femur ML), tibia mediolateral (tibia ML), femur anteroposterior (femur AP), and tibia anteroposterior (tibia AP). Osteophytes were not included in the measurements in the patient group. All the measurements were repeated by two researchers at two different times. The groups were compared in terms of these measurements and the correlations between them. The mean femur ML length was significantly greater in the patient group than the control group (P = 0.032) and the mean femur AP length was significantly less (P = 0.037). In addition, the difference between the femur ML and AP lengths was significantly high in the patient group (P < 0.001). The difference between the tibia and femur ML lengths was significantly high in the patient group (P < 0.001) and the difference between the tibia and femur AP lengths was higher in the control group (P = 0.001). A longer femur ML and a shorter femur AP, together with a greater difference between these two lengths and a greater difference between the tibia ML and femur ML lengths, could be a risk factor for developing knee OA. More extensive anatomical and biomechanical studies in the future will enable these results to be corroborated. Clin. Anat. 28:672–677, 2015. © 2015 Wiley Periodicals, Inc.     

膝关节骨性关节炎中退变半月板的生物信息学分析

背景:半月板退变是膝关节骨性关节炎的表现之一,但其具体的分子机制仍不清楚.目的:探讨骨性关节炎退变半月板可能的分子生物学机制.方法:采用五指山猪的前交叉韧带切除法制备半月板退变猪模型,应用基因芯片技术检测在退变半月板组织中的差异表达基因,运用GO分析、通路分析和核心基因网络分析来发现相关的调控网络.结果 与结论:①研究...     

红姜提取物保护早期膝骨关节炎模型大鼠的关节软骨

背景:研究报道,联合使用姜提取物降低血清促炎细胞因子白细胞介素1β、白细胞介素6、肿瘤坏死因子α等水平与膝骨关节炎中软骨损伤的减轻有关.目的:观察红姜提取物灌胃对早期膝骨关节炎大鼠关节软骨保护情况及血清白细胞介素1β、白细胞介素6、肿瘤坏死因子α和软骨Col2α1 mRNA水平表达的影响,探讨红姜提取物对早期膝骨关节炎...     

Sonoelastography of the knee joint

Magnetic resonance imaging (MRI) is generally the preferred method for assessing lesions of the knee cartilage and subchondral bone. There have been a few cartilage imaging studies using real‐time elastosonography (RTE), which has increased in importance and range of use in recent years. The aim of this cadaveric study was to assess the efficacy of a new diagnostic method combining USG and RTE and also to perform intra‐articular examinations together with arthroscopy. A total of 12 fresh unpaired human knees were examined. The laparoscopic ultrasound transducer was deployed using standard anteromedial and anterolateral arthroscopic portals. Iatrogenic defects were examined using mosaicplasty tools in healthy‐looking areas of cartilage, and strain in those areas was measured using RTE. The median strain value of the pathological femoral cartilage region was significantly higher than that of the normal cartilage region (1.23 [0.71–2.24] vs. 0.01 [0.01–0.01], P = 0.002, respectively). Arthroscopic study of cartilage using RTE can be a guide for orthopedic surgeons and use of intra‐articular probes could be universalized. Clin. Anat. 32:99–104, 2019. © 2018 Wiley Periodicals, Inc.