家猪体外胰蛋白酶消化关节软骨：7.0TMR T1ρ加权成像与量化分析

背景：T1ρ驰豫时间是探测软骨生化改变的最具吸引力的新的磁共振参数。早期骨关节炎主要表现为蛋白多糖的丢失以及胶原的轻微改变。目的：应用T1ρ成像技术与弛豫时间图量化分析方法,评价体外胰蛋白酶消化与未消化家猪髌骨软骨T1ρ驰豫时间的改变。设计、时间及地点：同体对照观察,于2007-02/2008-01在丹麦奥胡斯大学医院骨科与磁共振研究中心完成。材料：丹麦雌性长白猪10头,左右侧髌骨共20个。方法：选择10头家猪,取右侧髌骨10个为对照组,浸泡于PBS中4 h后取出。取左侧髌骨10个为消化组,浸泡于含有胰蛋白酶的PBS溶液中,4 h后取出。利用7.0T磁共振机,分别采用自旋锁定自动补偿脉冲簇的三维SE序列进行扫描,获得关节软骨的T1ρ加权图像。重构T1ρ弛豫时间图,测定关节软骨T1ρ值。取两组髌骨软骨标本行番红O/固绿染色进行组织学观察。主要观察指标：①T1ρ弛豫时间图量化分析结果。②两组软骨标本组织学结果。结果：经酶诱导消化的体外家猪髌骨关节软骨T1ρ加权图像成像清晰,呈分层状表现,对比度好,无异常伪影。大体观察两组关节软骨T1ρ加权图像,见局部的信号异常改变。重构T1ρ弛豫时间图并量化测定分析显示,消化组软骨表层T1ρ值高于对照组,差异具有显著性意义（P 〈 0.05）,其全层、深层与钙化层之间的比较差异无显著性意义（P 〉 0.05）。结论：经胰蛋白酶诱导消化可引起退变软骨T1ρ驰豫时间改变,特别是在软骨的表层变化明显,提示T1ρ驰豫时间是较敏感、特异性的检测指标,可进一步应用于关节软骨退变的早期诊断。     

血清阴性脊柱关节病患者血清软骨寡聚基质蛋白水平及意义的研究

目的探讨检测软骨寡聚基质蛋白(COMP)水平对血清阴性脊柱关节病(SpA)患者疾病活动性及早期软骨破坏的临床意义。方法采用酶联免疫吸附试验(ELISA)方法,检测40例SpA患者及40例正常人血清中COMP的水平。同时测定SpA患者的其他实验室及临床指标:类风湿因(RF)、血沉(ESR)、C-反应蛋白(CRP)、肿痛关节数、附着点压痛数、夜间背痛(h)、骶髂关节压痛、脊柱活动度(Schober试验)及骶髂关节的CT分级,分析它们与COMP的相关性。结果SpA患者血清COMP水平(11.459±3.091)U/L明显高于正常对照组(9.234±1.722)U/L,两组差异有统计学意义(P<0.001)。28例SpA活动期患者血清COMP水平为(12.772±2.223)U/L,与12例不活动期患者[(9.450±2.211)U/L]比较差异有非常显著性意义(P<0.001)。COMP水平与SpA患者的ESR、CRP、肿痛关节数、附着点压痛数、夜间背痛(h)、脊柱活动度及骶髂关节的CT分级,呈正相关(P<0.05),与年龄、病程、RF、骶髂关节压痛、无明显相关(P>0.05)。结论SpA患者血清中COMP高水平存在提示SpA疾病活动性和早期关节软骨破坏。     

Human nasal cartilage ultrastructure: characteristics and comparison using scanning electron microscopy

Objectives/Hypothesis: Human nasal cartilage is hyaline cartilage, although the function and loads placed on it are different depending on the location. We hypothesized that important differences exist between the nasal septal cartilage and lower lateral cartilage (LLC) ultrastructures. Such differences would be important in the field of cartilage engineering. Methods: Ten specimens (6 septum and 4 LLC) of cartilage from patients undergoing nasal surgery (rhinoplasty or septoplasty) were obtained and examined using scanning electron microscopy. Micrographs were then analyzed and measured using photograph analysis software. Results: The collagen fibers of septal cartilage were found to be arranged in a mesh framework, with larger lacunae and thicker fibers measuring 3.18 μm (standard deviation = 0.75 μm), with a 99.9% confidence interval of 2.74 to 3.54 μm. LLC fibers, on the other hand, were arranged in less‐organized sheets, with fibrous extensions, and had fewer, narrower lacunae. The fibers from the LLC averaged 2.29 μm, with a 99.9% confidence interval of 1.17 to 3.42 μm. Conclusions: Significant ultrastructural differences exist between the cartilage of the nasal septum and LLC. These are almost certainly the result of their embryologic origins and different forces placed on the structures they support. A less‐organized pattern with smaller collagen fibers is present in the LLC versus the more‐organized, layered, thicker collagen fibers of the septum. These differences may prove to be critical in the future of cartilage engineering.     

同种异体组织工程预定形态软骨的研究

目的研究以聚羟基乙酸(Polyglycolicacid,PGA)为细胞支架同种异体预定形态组织工程化软骨在有免疫力的动物体内构建的可行性。方法取1周龄乳兔肋软骨和关节软骨,收集体外培养第3～4代的软骨细胞,接种于塑为管状和片状经多聚赖氨酸处理的PGA材料上。分别于6、12周取材,行大体和组织学观察评价。结果软骨细胞-PGA复合物体外培养1周有基质产生。种植6周后,管状和片状复合物生成软骨,结缔组织内可见炎细胞;12周时软骨细胞成熟。结论同种异体软骨细胞与PGA所形成的复合物在有免疫力的动物体内可构建出预定形态软骨。     

聚乳酸吸附骨髓基质细胞修复软骨的实验研究

目的探索聚乳酸作为软骨组织工程载体材料的可行性。观察4、8、12周后软骨缺损的情况,并对组织切片评分。方法制备了聚乳酸(PLA)多孔泡沫,将吸附骨髓基质细胞的聚乳酸多孔膜植入兔膝关节软骨负重(内髁)和非负重区(外髁)缺损内。结果骨髓基质细胞可以修复关节软骨缺损。结论聚乳酸是适合吸附骨髓基质细胞修复软骨的载体材料。     

双侧耳郭软骨骨化1例并文献复习

目的 探讨耳郭软骨骨化的发病机制、临床表现、诊断依据、鉴别诊断、治疗方法。方法 回顾性分析1例耳郭软骨骨化患者的临床资料并复习相关文献进行总结。结果 耳郭软骨骨化的发病机制暂不明确,通常无明显不适症状,少数患者可伴有局部疼痛、听力下降等症状。颞骨CT可辅助诊断,最终确诊依赖于组织病理检查。症状不明显时可暂予观察,若症状严重影响了生活和工作,可予手术治疗。结论 耳郭软骨骨化在临床上较为少见,目前尚无有效逆转耳郭骨化的办法。积极寻找病因,及早干预,有利于避免病情进一步发展。     

Current Reviews in Musculoskeletal Medicine: Current Controversies for Treatment of Meniscus Root Tears

Purpose of ReviewThe role of the meniscus in preserving the biomechanical function of the knee joint has been clearly defined. The hypothesis that meniscus root integrity is a prerequisite for meniscus function is supported by the development of progressive knee osteoarthritis (OA) following meniscus root tears (MRTs) treated either non-operatively or with meniscectomy. Consequently, there has been a resurgence of interest in the diagnosis and treatment of MRTs. This review examines the contemporary literature surrounding the natural history, clinical presentation, evaluation, preferred surgical repair technique and outcomes.Recent FindingsSurgeons must have a high index of suspicion in order to diagnose a MRT because of the nonspecific clinical presentation and difficult visualization on imaging. Compared with medial MRTs that commonly occur in middle age/older patients, lateral meniscus root injuries tend to occur in younger males with lower BMIs, less cartilage degeneration, and with concomitant ligament injury. Subchondral insufficiency fractures of the knee have been found to be associated with both MRTs and following arthroscopic procedures. Meniscus root repair has demonstrated good outcomes, and acute injuries with intact cartilage should be repaired. Cartilage degeneration, BMI, and malalignment are important considerations when choosing surgical candidates. Meniscus centralization has emerged as a viable adjunct strategy aimed at correcting meniscus extrusion.SummaryMeniscus root repair results in a decreased rate of OA and arthroplasty and is economically advantageous when compared with nonoperative treatment and partial meniscectomy. The transtibial pull-through technique with the addition of centralization for the medial meniscus is associated with encouraging early results.     

前伸下颌后大鼠髁突软骨内明胶酶表达变化的研究

目的研究前伸下颌后明胶酶（MMP- 2、MMP- 9）在大鼠髁突软骨内表达的变化。方法选取5周龄雄性SD大鼠60只,随机等量分成实验组和对照组,实验组大鼠白天配戴自制的上颌斜面导板式活动矫治器引导下颌前伸,对照组大鼠不戴矫治器。在实验的1、2、4周处死动物,免疫组化检测明胶酶在大鼠髁突软骨内表达的变化。结果在正常髁突软骨内,MMP- 2呈中等强度表达,MMP- 9表达很低。前伸下颌后,髁突软骨内MMP- 2的表达无明显变化,而MMP- 9的表达显著增高（P<0.01）。结论明胶酶参与了功能矫形时下颌髁突软骨的适应性改建。     

一侧下颌角受力对双侧关节盘及髁突软骨的影响

目的:利用三维有限元分析法,从生物力学角度探讨一侧下颌角受力瞬间双侧颞下颌关节(TMJ)关节盘及髁突软骨的相应变化及其与临床实际的关系。方法:建立下颌骨和TMJ共5个不同开口度(闭口位及1、2、3、4cm开口位)的三维有限元数字模型;于左侧下颌角下缘向上,施以与眶耳平面垂直的1000N压力。获取受力后双侧关节盘和髁突软骨产生的平均主应力的分布及其峰值大小。结果:(1)闭口位时,双侧关节盘和髁突软骨的平均主应力(EQV应力)峰值明显较小;(2)在不同开口位,关节盘EQV应力峰值多位于后带,髁突软骨则多位于前斜面;(3)关节盘EQV应力峰值始终是左侧大于右侧,而髁突软骨在闭口位及1、4cm开口位时左侧EQV应力峰值大于右侧,2、3cm开口位时则是右侧大于左侧;(4)双侧关节盘和髁突软骨的EQV应力峰值出现的部位基本对称。结论:(1)本组模型较精确地反映了实物,并且实验结果与临床实际相接近,解决了以往实验中遇到的一些问题,为TMJ的生物力学研究提供了新的途径。(2)稳定的咬合关系可以明显减小TMJ的间接损伤。(3)关节盘后带病变及髁突器质性病变可能由下颌骨一次性暴力创伤后造成的TMJ间接损伤引起;受力侧关节盘比对侧更易受损伤,而双侧髁突软骨都有受到严重损伤的可能。     

纤维连接素对髁突软骨细胞在Cytodex-3微载体表面贴附、铺展及增殖的影响

目的:研究纤维连接素(FN)对下颌骨髁突软骨(MCC)细胞在Cytodex-3微载体表面生长的影响.方法:采用机械分离及酶消化法获得MCC细胞,将细胞以1×108/L密度分别接种于含有空白及FN(20mg∥L)包埋的微载体的自制转瓶细胞培养系统,利用环境扫描电镜对培养MCC细胞在两组微载体表面的生长方式进行动态观察.结果:MCC细胞可快速贴附于FN包埋的Cytodex-3微载体表面,铺展速度快于空白微载体组,细胞形态不规则,更为扁平,有较多伪足.细胞在包埋微载体表面生长速度显著快于空白微载体组,细胞指数生长期提前,细胞倍增时间缩短,最终生长密度高于对照组.结论:细胞在微载体表面的生长有赖于适当的细胞外基质成分,FN可促进MCC细胞在微载体表面的贴附及增殖,可用于MCC细胞大规模扩增的微载体表面处理.