Pain and disability in osteoarthritis: A review of biobehavioral mechanisms

Pain and disability are cardinal symptoms in osteoarthritis. The literature is reviewed in order to identify causes of these symptoms at the articular, kinesiological, and psychological level. It is concluded that pain and disability are associated with degeneration of cartilage and bone (articular level), with muscle weakness and limitations in joint motion (kinesiological level), and with anxiety, coping style, attentional focus on symptoms, and possibly depression (psychological level). Biobehavioral mechanisms of pain and disability which explain the observed associations are described and the empirical evidence for these mechanisms is evaluated. Methodological and conceptual deficiencies in the research reviewed are pointed out and suggestions for further research are given.     

Study of the arterial vascularisation of the medial tibial condyle in the fetus

Summary Varus deformity of the knee is common in young children who have suffered from fulminating purpura. This study was directed at the anatomic features of the vascularisation of the upper end of the tibia that might account for such deformation. It was based on the dissection of 28 anatomic specimens prepared by injection of Indian ink into the vascular trunk. 16 specimens were diaphanised for better analysis of the intracartilaginous distribution of the vessels. The study showed that the vascularisation of the medial condyle of the tibia is poor and of terminal nature, which may explain the occurrence of ischemic growth disorders following fulminating purpura.

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Etude de la vascularisation artérielle du condyle médial du tibia chez le foetus

Résumé Les déformations en varus du genou chez les jeunes enfants ayant présenté un purpura fulminans sont fréquentes. Ce travail a pour objet de rechercher les caractéristiques anatomiques de la vascularisation de l'extrémité supérieure du tibia qui peuvent expliquer ces déformations. L'étude porte sur la dissection de 28 pièces anatomiques préparées par injection de l'axe vasculaire à l'encre de Chine. Pour mieux analyser la répartition intra-cartilagineuse des vaisseaux, 16 pièces ont été diaphanisées. Cette étude montre que la vascularisation du condyle médial du tibia est pauvre, de type terminal, ce qui peut expliquer la survenue de troubles de croissance ischémiques dans les suites d'un purpura fulminans.

     

Metaphyseal acroscyphodysplasia

Based on two independent personal cases and a pair of sibs from the literature, we delineate a new category of bone dysplasia with cup-shaped large metaphyses, for which the name metaphyseal acroscyphodysplasia is suggested. The main clinical features are severe growth retardation, micromelia predominating in the lower limbs, knee flexion, and severe brachydactyly. The radiological aspect of the knees is very specific: the lower femoral and upper tibial epiphyses embed themselves in their metaphyses, which are severely cup-shaped. Premature central epiphyso-metaphyseal fusion and gross deformation, or even coalescence, of the femoral condyles may occur. The femoral diaphyses are very short and broad, and there is progressive coxa valga. Bowed and/or short stubby tibiae with cone-shaped metaphyses, and varus deformity of the tibio-astragalian joint are other features. Slight deformations of the long bones occur in the upper limb. Severe brachydactyly, brachymesophalangy, phalangeal and metacarpal cone-shaped epiphyses and irregular, bent and shortened diaphyses are the main signs of hand involvement. Psychomotor retardation is present in 3/4. Autosomal recessive inheritance is likely.     

氨基葡萄糖胶囊干预膝骨关节炎患者外周血单个核细胞中软骨代谢相关基因的表达

背景:目前关于氨基葡萄糖的研究多集中于对膝骨关节炎的治疗作用,但关于其对膝骨关节炎患者外周血中软骨代谢相关基因影响的研究有限。目的:观察氨基葡萄糖胶囊对膝骨关节炎的治疗效果及对软骨代谢相关基因表达的影响。方法:选取2017年3月至2019年2月郑州大学附属郑州中心医院收治的90例膝骨关节炎患者,另选取同期医院体检中心收入的40例健康受试者,检测并对比健康受试者与膝骨关节炎患者治疗前外周血单个核细胞中软骨寡聚基质蛋白、Ⅱ型胶原纤维α1、聚糖蛋白、特异性组织抑制物3基因表达水平。采用随机数表法将膝骨关节炎患者分为常规组和研究组,分别给予双氯芬酸钠缓释片、双氯芬酸钠缓释片+氨基葡萄糖胶囊治疗12周,对比治疗前后2组外周血单个核细胞中各基因表达水平、Lequesne指数,统计治疗期间2组不良反应发生情况。结果与结论:①与健康受试者比较,膝骨关节炎患者外周血单个核细胞中软骨寡聚基质蛋白、特异性组织抑制物3 mRNA相对表达量升高(P<0.05),Ⅱ型胶原纤维α1、聚糖蛋白mRNA相对表达量降低(P<0.05);②治疗前研究组和常规组外周血单个核细胞中各基因表达水平比较,差异均无显著性意义(P>0.05);治疗后2组外周血单个核细胞中软骨寡聚基质蛋白、特异性组织抑制物3 mRNA相对表达量均低于治疗前,且研究组低于常规组(P<0.05);治疗后2组外周血单个核细胞中Ⅱ型胶原纤维α1、聚糖蛋白mRNA相对表达量均高于治疗前,且研究组高于常规组(P<0.05);③治疗前研究组和常规组Lequesne指数比较,差异均无显著性意义(P>0.05);治疗后2组Lequesne指数均低于治疗前,且研究组低于常规组(P<0.05);④研究组和常规组不良反应发生率比较,差异均无显著性意义(P>0.05);⑤结果表明,氨基葡萄糖胶囊可有效改善膝骨关节炎患者临床症状且安全可靠,可能通过抑制软骨寡聚基质蛋白、特异性组织抑制物3基因表达,促进Ⅱ型胶原纤维α1、聚糖蛋白基因表达实现的。     

一期全膝关节表面置换术治疗双膝骨关节病

目的：探讨一期全膝关节表面置换术治疗双膝骨关节病的可行性及疗效。方法：采用全膝关节表面置换术治疗双侧膝骨关节病患者16例，其中一期手术8例（Ⅰ组），分期手术8例（Ⅱ组）。结果：16例均得到随访1～3a，平均16个月。Ⅰ组术中出血量、输血量、手术时间、住院日，明显低于Ⅱ组（P〈0．05）；术后膝关节HSS评分，两组间比较其差异无统计学意义（P〉0．05）。结论：应用一期全膝关节表面置换术治疗双膝骨关节病安全，且近期疗效满意。     

中国汉族人与美国高加索白人膝关节几何形态的比较

背景:有研究显示中国人膝关节胫骨近端前后径和横径均小于美国高加索人,所以在膝关节形态学方面存在一定差异,因此常发生进口假体系统应用于国人后出现匹配度不高的现象。目的:测量中国人和美国人股骨远端、胫骨近端的几何形态学参数,比较其差异。方法:选择北京清华长庚医院骨科拟行前交叉韧带重建的中国汉族患者50例,以及美国匹兹堡大学运动医学中心拟行前交叉韧带重建的高加索白人后裔患者40例,对90例受试者膝关节进行CT扫描,使用AW Volume Share 5软件进行三维重建,利用Geomagic软件对胫骨近端和股骨远端的各项参数进行测量。结果与结论:①股骨近端测量参数中,中国人的外侧胫骨平台内外径小于美国人(P=0.027),外侧胫骨平台后倾角大于美国人(P<0.05);两组间胫骨平台内外径、内侧胫骨平台外径、内侧胫骨平台前后径、外侧胫骨平台前后径与内侧胫骨平台后倾角比较差异均无显著性意义(P>0.05);②股骨远端测量参数中,中国人的股骨远端横径、外侧髁内外径、内侧髁前后径、外侧髁前后径及髁间窝高度均小于美国人(P<0.05),股骨外翻角大于美国人(P<0.05);两组间内侧髁内外径、髁间窝宽度及滑车沟宽度比较差异无显著性意义(P>0.05);③结果表明,中国人与美国人在膝关节形态学的多个参数存在差异,有必要针对中国人设计更为个体化的膝关节假体。     

全膝关节置换后不放置引流的相关管理策略

背景:近年来,随着全膝关节置换技术提升、手术时间缩短、术中及术后止血药的应用,其总失血量不断减少,术后引流量也逐渐减少,术后快速康复理论应运而生,引流管放置也再次成为骨科医生所热议的问题,越来越多的医生认为可以常规取消放置引流,引流似乎已可有可无。目的:旨在复习既往文献,对全膝关节置换后引流放置的相关问题归纳总结,提供围术期引流管理的相关经验。方法:检索中国知网、万方、维普、中国生物医学文献数据库等中文数据库,以及PubMed、The Cochrane Library、WebofScience、EMBASE、OVID等外文数据库,以"引流,膝关节置换术"及"totalknee arthroplasty,drainage"为检索词,检索自建库始至2020年2月为止所有与主题相关的文献,总结归纳全膝关节置换后不放置引流管围术期各方面需综合考虑的要素。结果与结论:①引流管的放置问题关乎全膝关节置换手术的最终结果,与术后出血、血肿、血栓、感染等并发症的发生关系密切;②目前全膝关节置换术后不推荐常规放置引流,但不意味着不需要管理,其实际上对临床医护在围术期各方面的管理提出更高的要求,包括但不限于术前适应证选择、手术操作、止血带使用、术中及术后药物使用、物理疗法的使用等。     

计算机辅助全膝置换中股骨力线定位精度的实验研究

摘要利用光学定位追踪仪确定全膝置换中患者的股骨头中心从而确定其股骨力线，在力线的定位精度分析中，首次采用股骨的三维重建模型进行精度校验。实验结果表明通过追踪固定于股骨末端的刚性定位器即能确定精确的股骨力线，与传统的髓内定位相比，不仅可重复性好，而且大大地提高了术中股骨力线的位置精度，将其位置偏差减小到10以内。     

Chondral separation in the trochlear groove - a definite clinical entity

Four patients with unusual femoro-patellar chondral defects are presented. We were unable to find their particular lesion described adequately in the literature. The patients all gave a history of relatively minor non-contact injury and presented with anterior knee pain and persistent swelling. The main features on clinical examination were moderate effusion and marked patello-femoral crepitus. Plain X-rays of the knee were unhelpful. At arthroscopy large full thickness chondral defects were seen on the femoral side of the patello-femoral articulation at the site of patellar contact with the knee in about 60° of flexion. The synovium was found to be prolific and vascular. Multiple 1.6-mm drill holes were made in the defect and chondral debris was washed out. Two patients underwent associated lateral patellar release. When a clear cut mechanical patello-femoral disorder presents unexpectedly with associated effusion and a normal radiograph, we suggest that arthroscopy be advised with particular attention to the femoral trochlea.     

Approximately 80% of Japanese osteoarthritic patients fall out of the safety range in restricted kinematically-aligned total knee arthroplasty in an analysis of preoperative long-leg radiograms

BackgroundRestricted kinematically-aligned total knee arthroplasty (KA-TKA) is a reasonable modification to avoid the alignment outlier that may cause implant failure. However, despite a noted high incidence of constitutional varus in Japanese individuals, there has been no investigation into how many knees require the restriction in restricted KA-TKA (RKA-TKA) among Japanese patients. Therefore, we conducted a study using preoperative long-leg radiograms.MethodsWe studied long-leg radiographs of 228 knees in 114 consecutive patients. The numbers of knees within the safety range and their corrective osteotomy angle in the restriction algorithms advocated by Almaawi et al. (2017) and MacDessi et al. (2020) were evaluated.ResultsAccording to the algorithms used by Almaawi et al. and MacDessi et al., out of 228 knees, 46 (20%) and 39 (17%) fell within the safety range, respectively. The mean correction angles of the hip-knee-ankle angle, lateral distal femoral angle and medial proximal tibial angle were 2.8 ± 3.4°, 0.4 ± 1.4° and 2.4 ± 2.8° in the algorithm used by Almaawi et al., while they were −4.9 ± 4.7°, 1.1 ± 2.5° and −6.0 ± 3.4° in the algorithm used by MacDessi et al. Most of the knees needed to be restricted in order to perform RKA-TKA, regardless of the algorithm used.ConclusionsBased on a preoperative analysis of long-leg radiograms in a Japanese population, most knees fall out of the safety range in RKA-TKA. Surgeons must consider whether to allow component outlier or to perform corrective osteotomy that likely requires soft tissue release.