膳食维生素C摄入水平对膝关节骨赘及关节间隙狭窄的影响研究

背景　既往研究表明维生素C可能影响骨关节炎的发生发展,但多数研究结果并不完全一致。目的　探讨膳食维生素C摄入水平对膝关节骨赘及关节间隙狭窄的影响。方法　选取于2013年10月-2014年11月在中南大学湘雅医院健康管理中心进行健康体检者5 764例为研究对象。收集体检者基本资料,并测定其膳食维生素C摄入水平。根据膳食维生素C摄入水平,采用3分位法将体检者分为3组：低维生素C摄入水平组（维生素C摄入水平≤85.65 mg/d,n=1 902）、中维生素C摄入水平组（维生素C摄入水平85.66~132.08 mg/d,n=1 902）、高维生素C摄入水平组（维生素C摄入水平≥132.09 mg/d,n=1 960）。采用多因素Logistic回归探讨膳食维生素C摄入水平对膝关节骨赘及关节间隙狭窄的影响。结果　低、中、高维生素C摄入水平组关节骨赘患病率分别为16.46%（313/1 902）、12.72%（242 /1 902）、12.45%（244/1 960）,差异有统计学意义（P<0.001）。多因素Logistic回归分析结果显示,维生素C摄入水平、年龄、性别、体质指数（BMI）、是否合并糖尿病、是否合并高血压是体检者患膝关节骨赘的影响因素（P<0.05）。低、中、高维生素C摄入水平组体检者膝关节间隙狭窄患病率分别为29.34%（558/1 902）、28.65%（545/1 902）、28.88%（566/1 960）,差异无统计学意义（P>0.05）。多因素Logistic回归分析结果显示,年龄、性别、BMI是体检者患膝关节间隙狭窄的影响因素（P<0.05）。结论　膳食维生素C摄入水平低可能是患膝关节骨赘的危险因素,但膳食维生素C摄入水平不是膝关节间隙狭窄的影响因素。     

Osteophyte of the femoral head after transtrochanteric rotational osteotomy

The relationship between change in the shape of the femoral head and the clinical results after transtrochanteric rotational osteotomy for osteonecrosis of the femoral head was investigated. Fifty-six hips in 50 patients, followed for at least 2 years, showed no progressive collapse and no osteoarthrotic change during that time. The growth of a superolateral osteophyte of the femoral head was observed postoperatively at a higher rate with progression of the preoperative stage. Excessive restoration of the rotated necrotic lesion of the femoral head was observed at a higher rate in hips with the growth of the superolateral osteophyte. The total Japanese Orthopaedic Association score at final follow-up in hips with these shape changes of the femoral head was significantly inferior to the score in hips without these changes. There was a tendency for hips with a low ratio of intact articular surface of the femoral head in the weight-bearing area to the acetabulum just after surgery to manifest these shape changes. Although such changes of the femoral head were considered to represent remodeling to stabilize the hip joint, excessive remodeling could worsen the clinical results. Received: June 10, 1999 / Accepted: December 16, 1999     

Postsurgical recurrence of osteophytes causing dysphagia in patients with diffuse idiopathic skeletal hyperostosis

Although cervical anterior osteophytes accompanying diffuse idiopathic skeletal hyperostosis (DISH) are generally asymptomatic, large osteophytes sometimes cause swallowing disorders. Surgical resection of the osteophyte has been reported to be an effective treatment; however, little study has been given to the recurrences of osteophytes. A prospective study was performed for seven patients who underwent surgical resection of cervical anterior osteophytes for the treatment of recalcitrant dysphagia caused by osteophytes that accompanied DISH. The seven patients were six men and one woman ranging in age from 55 to 78 years (mean age = 65 years). After a mean postoperative follow-up period of 9 years (range: 6–13 years), surgical outcomes were evaluated by symptom severity and plain radiographs of the cervical spine. On all operated intervertebral segments, the effect of postoperative intervertebral mobility (range of movement >1 degree) on the incidence of recurrent osteophytic formation (width >2 mm) was analyzed by Fisher’s exact test. Complete relief of the dysphagia was obtained within one month postoperatively in five patients, while it was delayed for 3 months in two patients. All of the patients developed recurrent cervical osteophytic formation, with an average increase rate of approximately 1 mm/year following surgical resection. Of the 20 operated intervertebral segments, the incidence of recurrent osteophytes was significantly higher (P = 0.0013) in the 16 segments with mobility than in the four segments without mobility. Five of the seven patients remained asymptomatic, although radiological recurrence of osteophytes was seen at the final follow-up. The two remaining patients complained of moderate dysphagia 10 and 11 years after surgery, respectively; one of these two required re-operation due to progressive dysphagia 11 years postoperatively. In patients with cervical DISH and dysphagia, surgical resection of osteophytes resulted in a high likelihood of the recurrence of osteophytes. Therefore, attending surgeons should continue to follow these patients postoperatively for more than 10 years in order to assess the regrowth of osteophytes that may contribute to recurrent symptoms.     

Osteocapsular debridement for elbow arthritis

Open capsular debridement is an excellent option for the treatment of elbow arthritis. This technique is particularly indicated in a patient population physiologically younger than 60 years. Given the young age and high functional demand of patients with primary osteoarthritis of the elbow, prosthetic replacement is generally not recommended. Open capsular debridement preserves the native joint and thus does not inherently require permanent activity modification as does replacement arthroplasty.     

Photochemically crosslinked collagen annulus plug: A potential solution solving the leakage problem of cell-based therapies for disc degeneration

Intra-disc injection of mesenchymal stem cells (MSCs) to treat disc degeneration may lead to unfavorable complications, particularly osteophyte formation. Development of an effective method to block the injection portal, prevent the leakage of injected cells and materials and, hence, prevent osteophyte formation is of the utmost importance before MSC-based therapies can be applied in a clinical setting. Here we seek to alleviate the cell leakage problem and the associated complication osteophyte formation by developing an injectable annulus plug to block the injection portal during intra-disc delivery. Specifically, we fabricated a needle-shaped collagen plug by photochemical crosslinking and successfully delivered it intra-discally, in association with MSCs in collagen microsphere carriers, using a custom-made delivery device. The mechanical performance of the plug and its effectiveness in reducing cell leakage were evaluated ex vivo under compression and in torsion push-out tests. The results demonstrate that the plug survived physiologically relevant loadings and significantly reduced leakage and enhanced retention of the injected materials. Finally, a pilot in vivo study in rabbits was conducted to evaluate the performance of the plug. Microcomputed tomography imaging and histology revealed that the plug significantly reduced osteophyte formation. This work suggests the potential of the annulus plug as an adjunct or annulus closure device for intra-disc delivery of cells and materials.     

Application of robotic technology in biomechanics to study joint laxity

Primary objective:?To evaluate whether in vitro joint testing using a robot with six degrees of freedom is useful for evaluating changes in joint laxity as a result of chronic osteoarthritis (OA).

Research design:?Repeated measures.

Methods:?Broyden's method of solving nonlinear systems of equations drove a hybrid method of load and position robotic control. Sheep stifles (knee joints) were loaded between 3 Nm of internal load through to 3 Nm of external load in 1 Nm increments. Kinematic and morphologic data from five healthy ovine stifles were compared to the chronic OA effects in four surgically destabilized stifles.

Results:?Stifles with chronic OA showed increases in stiffness while range of motion decreased. Gross morphologic changes included osteophytes and cartilage fibrillation.

Discussion:?Robotic testing proved useful for evaluating changes in joint mechanics as a result of chronic OA. We observed morphological changes and associated increases in joint stiffness and decreased laxity.     

Carpal tunnel syndrome secondary to an osteophyte of the trapezium

We report a 42-year-old man with a rare carpal tunnel syndrome (CTS) secondary to an osteophyte of the trapezium. The patient presented with a 3-year history of CTS, consisting of progressive pain and paresthesias in his right hand, positive Tinel and Phalen signs, and an electrodiagnostic study demonstrating median nerve compression at the wrist. The procedure was an open carpal tunnel release. Intraoperatively, a bony protuberance was found beneath the transverse carpal ligament (TCL), resulting in compression of the median nerve. The median nerve was decompressed and the patient’s symptoms resolved postoperatively. Surgical pathology revealed bony fragments, and a postoperative CT scan was supportive of an osteophytic remnant protruding from the trapezium. Carpal bone osteophytes are rarely reported causes of CTS.