Mild degenerative changes of hip cartilage in elderly patients: an available sample representative of early osteoarthritis

This study investigated the cellular and molecular changes which occur in cartilage from adults with femoral neck fracture (FNF) and osteoarthritis (OA), and explored the similarities in hip cartilage obtained from elderly patients and patients with early OA. Femoral heads were retrieved from 23 female patients undergoing total hip arthroplasty (THA). This group included 7 healthy patients with FNF (hFNF), 8 elderly adults with FNF (eFNF), and 8 elderly patients with hip OA (OA). After high-field MRI T2 mapping, osteochondral plugs were harvested from the weight-bearing area of femoral heads for subsequent macroscopic, histologic, and immunochemical evaluation. Additionally, the contents of cartilage matrix were analyzed, and gene expression was detected. The surface of cartilage from hFNF and eFNF patients appeared smooth, regular, and elastic, whereas it showed irregularities, thinning, and defects in OA patients. Elevated T2 values and decreased accumulation of glycosaminoglycans (GAGs) were detected in cartilage from eFNF patients. Furthermore, type I collagen accumulation was slightly increased and type X collagen concentration was obviously elevated in eFNF patients; however, type II collagen distribution and the contents and anisotropy of collagen fibrils in eFNF patients showed no significant changes. Consistent with histology and immunohistochemical results, aggrecan was downregulated and type X collagen was upregulated, while collagens types I and II showed no significant changes in eFNF patients. The cellular and molecular characteristics of hip cartilage in eFNF patients who showed no symptoms of OA were similar to those in patients with mild OA. Thus, eFNF cartilage can serve as a comparative specimen for use in studies investigating early OA.     

骨髓间充质干细胞和软骨细胞共培养复合同种异体脱钙骨基质修复关节软骨全层缺损

目的:探讨自体骨髓间充质干细胞(BMSCs)与软骨细胞共培养复合同种异体脱钙骨基质(DBM)修复关节软骨缺损的可行性,评价修复效果,为优化种子细胞源提供依据.方法:取浓度为5×109/L的第二代BMSCs和软骨细胞,按2:1比例混匀共培养作为种子细胞.DBM与共培养细胞复合植入修复为实验组(A组),单纯材料DBM组(B组)和不处理组(C组)作为实验对照组.移植8和16 wk后经大体观察、组织学评分和免疫组化染色评价缺损修复.结果:共培养的软骨细胞基质合成丰富,细胞增殖快,共培养5～7 d两种细胞比例达1:1以上.A组缺损修复组织呈软骨样,表面光滑平坦,与周围软骨整合的软骨细胞更为成熟.B组和C组的修复组织呈纤维组织.组织学评分表明A组优于B,C两组,差异具有统计学意义(P＜0.01),B组与C组差异无统计学意义(P＞0.05).免疫组化染色显示A组修复组织的细胞为透明软骨样细胞,柱状排列,Ⅱ型胶原染色阳性,与周围软骨及软骨下骨整合良好.结论:自体BMSCs与软骨细胞共培养,BMSCs能增强软骨细胞的增殖,促进软骨细胞基质合成,缩短软骨细胞培养时间和减少传代次数,可节省大量的软骨细胞,与DBM复合后能有效修复关节软骨缺损.     

脊柱形态测量仪(Spinalmouse)测评腰痛患者全脊柱运动能力

目的量化测量脊柱各个椎体椎间角度变化,评估腰痛患者全脊柱运动能力。方法使用脊柱动态测量仪（Spimalmouse）测量34例腰痛患者不同姿势下的脊柱形态,得出量化脊柱各个椎体之间椎间角角度,并摄腰段X线片并测量,所得数据间进行独立样本t检验和配对样本t检验。结果直立位胸腰椎各个节段之间椎间角度基本符合脊柱生理曲线,前屈时T1－7,没有椎间角度变化差异,T8以下差异均有统计学意义（P〈0．05）。后伸时T6-8,T12、L1,L2,3这4个节段椎间角变化差异均有统计学意义（P〈0．05）。在与X线片对比时,T11～L3的各个椎间角度的结果是与影像学资料测量的角度数据基本一致的,差异无统计学意义,但在L3～S1,测量结果差异有统计学意义（P〈0．05）.结论Spinalmouse可以直接、方便地测量出胸、腰椎各个椎间角变化,并且存在很好的可靠性、重复性和可信性,是脊柱各个节段运动能力评定的良好工具,且避免了X线辐射。     

膝关节伸直受限的关节镜下治疗

目的 分析膝关节伸直受限的发病机制,探讨关节镜下诊治方法。方法分析2003年1月～10月在本院接受关节镜下手术303例患者的临床资料,通过关节镜确认引起膝伸直受限的直接病因,并根据关节镜下检查结果选择相应的手术方式。结果95例患者膝关节伸直受限,发生率为31．4％。创伤是最常见原因,占67．4％,主要为半月板和韧带损伤。另外,膝关节急、慢性关节内炎性病变也是较常见原因,按发生例数由高到低为：退变性骨关节炎、非特异性滑膜炎、滑膜软骨瘤病、类风湿关节炎、色素沉着绒毛结节性滑膜炎、痛风性关节炎及急性化脓性关节炎等。术后随访3～20个月,平均13．3个月,82例关节镜术后均可立即伸直,9例术后未立即伸直,经伸直锻炼后3周内均可伸直,4例随访1年以上不能完全伸直,4例复发。结论关节镜是诊断膝伸直受限的最佳手段,早期关节镜检查可获得满意疗效。     

Biological resurfacing of the knee: a review of surgical management

Lesions of the articular surfaces of the knee have been managed by various techniques over the last 50 years. Surgical management has involved: excising the damaged area, refashioning the underlying bone to produce a fibrous response, and introducing allograft, autograft and synthetic materials to encourage a repair matrix. The techniques and their pitfalls are reviewed and discussed, and suggestions made as to the direction of future studies for the repair of osteochondral lesions in the painful knee.     

胫骨外侧髁骨折塌陷对关节轴线及接触压力的影响

目的:研究在胫骨外侧髁骨折中关节面塌陷和外侧半月板切除对膝关节轴线、接触面积及压力的影响。方法:6个新鲜尸体膝关节标本制成胫骨外侧髁劈裂骨折模型,通过使用支撑垫片制成关节面塌陷0、1、2、4和6mm。膝关节在屈膝0°,负荷500N和屈膝30°,负荷350N。通过数码相机记录关节轴线的变化;而关节内外间隙的压力和压力扩散则由F-Scan感应器记录。每个标本在保留和切除外侧半月板下进行测试。结果:随着关节面塌陷高度的增加,膝关节外翻角度、外侧间隙的平均和最大的接触压力逐渐增加,而接触面积则逐渐减少。在屈膝0°,关节面塌陷6mm时,外翻角度平均增加7.6°,平均接触压力和最大接触压力分别增加208%和97%;而接触面积则减少33%。在同一关节面塌陷高度,切除半月板平均增加38%的外翻角度和外侧间隙45%的接触压力;而接触面积则减少26%。结论:研究结果表明在治疗胫骨外髁劈裂骨折中,减少关节面的塌陷十分重要,特别是在需切除半月板的时候。