Total knee arthroplasty in extra articular deformities: A series of 36 knees

Background:

The presence of extra articular deformities either in the femur or the tibia with arthritis of the knee makes total knee arthroplasty (TKA) technically demanding. The purpose of this study is to report outcomes with Total Knee Arthroplasty in patients with arthritis of the knee associated with extra articular deformity by intraarticular resection and soft tissue balancing.

Materials and Methods:

Thirty six knees (32 patients) who had arthritis of the knee associated with extra articular deformity, underwent total knee arthroplasty between 1999 and 2006 were included in this retrospective analysis. All patients had intraarticular resection with soft tissue balancing to correct the deformity. Full length weight bearing anteroposterior X-rays, Knee society scores, and Knee range of motion was recorded pre- and postoperatively.

Results:

The mean period of followup was 85 months (range 42-120 months). The deformities amenable to correction by intraarticular resection in our series were Femur- Coronal plane 11°-18° (mean 16.2°) Saggital plane 0°-15° (mean 10.1°) Tibia - Coronal plane 12°-24° (mean 21°). There was an improvement in the range of motion from mean of 54° preoperatively to 114° postoperatively (P value < 0.05). The Knee Society- Knee Score improved from 37 points to 85 points postoperatively (P value < 0.05). The functional score improved from a mean value of 19 to a mean of 69.5 at followup (P < 0.01). The preoperative hip knee ankle angle in the coronal plane improved from a mean of 14° ± 2° varus (26° varus to 4° valgus) to a mean of 2° ± 0.6° varus (6° varus to 2° valgus).

Conclusion:

With a good preoperative planning and templating, intraarticular bone resection and good soft tissue balancing both in flexion and extension, correction would be possible in majority of extraarticular deformities.     

RETRACTED ARTICLE: The Use of Metatarsal Bone Grafts in the Treatment of Saddle Nose Deformities

The results from segmental fourth metatarsal bone reconstruction of significant nasal dorsal defects are described. Solid bone graft reconstructions frequently lead to an unnatural hardness of the nasal tip. Rib cartilage reconstructions are pliable and soft, but pose a problem because they easily undergo warpage. The operation is performed using the open approach. An outer fourth metatarsal bone graft used for the bone component extends at least two-thirds of the dorsum length. It is secured in place with a compression screw and a Kirschner wire. The cartilage component comprises an abbreviated L-strut constructed of septal cartilage. It is slotted into the metatarsal bone in a tongue-in-groove manner and sutured to it through a drill hole in the bone. The dorsal profile is completed in this manner.     

兔膝骨性关节炎治疗中透明质酸钠与曲安奈德对滑膜和软骨的影响

目的：评估透明质酸钠与曲安奈德对兔膝骨性关节炎中关节滑膜及软骨的影响。方法24只新西兰兔制造骨关节炎模型后按数表法随机分为对照组、透明质酸钠(SH)组、曲安奈德(TA)组,每组各8只,分别进行关节腔注射生理盐水0.4 mL、SH 0.4 mL、TA 0.4 mL,每周一次,每组6次。6周后观察每组兔膝关节滑膜组织病理切片、血管滑膜SP法染色、软骨AB-PAS染色及MMP-1免疫组化。结果滑膜病理切片显示,SH组滑膜增生最少, TA组滑膜增生较少,对照组滑膜增生明显;滑膜SP法染色显示SH组、TA组VEGF阳性细胞百分数较对照组减少[(42.50±5.29)%、(50.80±5.24)%vs (53.38±4.75)%,P<0.05],SH组、TA组平均光密度值较对照组减少[(0.32±0.02)、(0.43±0.04) vs (0.48±0.05),P<0.05],TA组较SH组和对照组内软骨细胞减少,软骨基质成分减少,SH组、TA组较对照组软骨表层破坏减少。SH组、TA组软骨MMP-1细胞百分数评分优于对照组[(61.25±4.06)%、(76.27±4.68)%vs (87.13±3.64)%,P<0.05];SH组、TA组软骨Mankins评分优于对照组[(6.88±1.25)分、(7.27±0.68)分vs (8.13±0.83)分, P<0.05]。结论透明质酸钠和曲安奈德均能抑制滑膜炎增生,减少兔膝关节腔内的炎性细胞因子,减少了软骨基质的破坏,且透明质酸钠要优于曲安奈德。     

依达拉奉联合瑞舒伐他汀治疗心源性脑梗死的疗效及对血清CXCL12、UCH-L1、HC-gp39水平的影响

目的 探究依达拉奉联合瑞舒伐他汀治疗心源性脑梗死的疗效及对血清趋化因子12（CXCL12）、泛素C末端水解酶L1（UCH-L1）、人类软骨糖蛋白-39（HC-gp39）水平的影响。方法 选取2020年3月—2022年4月达州市中心医院收治的90例心源性脑梗死患者作为研究对象,随机分为对照组和观察组,各45例。对照组给予瑞舒伐他汀治疗,观察组给予依达拉奉联合瑞舒伐他汀治疗。比较两组疗效、CXCL12、UCH-L1、HC-gp39、血液流变学指标、血脂水平及美国国立卫生研究院脑卒中量表（NIHSS）评分。结果 观察组总有效率高于对照组（P <0.05）。观察组治疗前后血清CXCL12、UCH-L1、HC-gp39水平的差值高于对照组（P <0.05）。观察组治疗前后全血低切黏度、全血高切黏度及纤维蛋白原水平的差值高于对照组（P <0.05）。观察组治疗前后TC、TG、LDL-C水平的差值高于对照组（P <0.05）。观察组治疗前后NIHSS评分的差值高于对照组（P <0.05）。结论 依达拉奉联合瑞舒伐他汀治疗心源性心肌梗死可有效提高患者临床疗效,改善血液流变学指标、血脂、神经功能及炎症反应。     

缓释TGF-β3的去细胞软骨微丝/温敏型水凝胶复合支架的制备

目的：探讨一种可注射且能缓释TGF-β3的去细胞软骨微丝/温敏型水凝胶复合支架的制备方法。方法：使用去污剂-酶化学消化法和层层自组装技术制备缓释TGF-β3 的去细胞软骨微丝,混入温敏型水凝胶后制成缓释TGF-β3的去细胞软骨微丝/温敏型水凝胶复合支架,用ELISA试剂盒检测TGF-β3缓释情况;然后再将骨髓间充质干细胞（BMSCs）与复合支架共培养,显微镜下观察细胞生长情况,Western blot法检测Collagen II（Col II）、Aggrecan（AGG）和SOX9表达水平。结果：复合支架在低温状态下为溶胶状态,当温度升高至37 ℃时变为凝胶状态;复合支架中的TGF-β3 可有效缓释25 d左右;BMSCs在复合支架上生长情况良好,细胞呈现类似软骨细胞的形态,Col II、AGG和SOX9 的表达较对照组显著增加（P ＜0.05）。结论：成功制备了一种可注射且能缓释TGF-β3的去细胞软骨微丝/温敏型水凝胶复合支架,该支架能较好地诱导BMSCs成软骨分化。     

TRPV4抑制剂HC067047对小鼠膝骨关节炎软骨组织的影响

目的探讨瞬时受体电位香草素受体4型通道蛋白(TRPV4)抑制剂HC067047对小鼠膝骨关节炎软骨组织的影响。 方法将30只小鼠均分为假手术组、模型组、HC067047组。假手术组仅切开右侧膝关节髌韧带内侧皮肤,不予处理膝关节囊内结构;模型组、HC067047组手术切除小鼠板股韧带及内侧半月板前角以构建膝骨关节炎,分别用生理盐水、HC067047每天10 mg/kg灌胃。qRT-PCR检测各组小鼠软骨组织中TRPV4 mRNA表达水平。番红固绿染色评估关节软骨受损程度,HE染色分析膝关节软骨下骨的骨量变化。Western blotting检测各组软骨组织中细胞焦亡标志蛋白TRPV4、Caspase-1、核苷酸结合寡聚化结构域样受体家族热蛋白结构域蛋白3(NLRP3)、凋亡相关斑点样蛋白(ASC)、GSDMD-N蛋白水平;ELISA、Western blotting分别检测血清、软骨组织中炎症因子水平。 结果与假手术组比较,模型组TRPV4、NLRP3、ASC、Caspase-1、GSDMD-N、IL-1β、IL-18水平显著升高(P＜0.05)。与模型组比较,HC067047组NLRP3、ASC、Caspase-1、GSDMD-N、IL-1β、IL-18水平显著降低(P＜0.05)。HC067047能明显改善关节软骨形态及降低骨关节炎受损程度,并能维持软骨下骨的骨量。 结论TRPV4抑制剂HC067047能抑制软骨组织细胞焦亡,改善膝骨关节炎小鼠关节软骨的退变。     

自体富血小板血浆联合骨髓基质干细胞复合改建脱细胞真皮基质修复兔关节软骨的可行性研究

目的:研究自体富血小板血浆（PRP）联合骨髓基质干细胞（BMSCs）复合改建脱细胞真皮基质（ADM）修复兔关节软骨的修复效果及临床价值。方法:选择60只股骨髁关节损伤的青紫蓝兔作为研究对象,随机分为研究组、对照组和空白组,各20只。首先制备PRP,再分离BMSCs,并进行体外培养,接种于ADM支架上。研究组培养基添加10% PRP,其他条件同对照组,空白组兔不做任何处理。将BMSCs-ADM复合物植入兔关节缺损处,在1、2、3个月末对构建的软骨组织进行免疫力学、组织学、生物力学检测,比较PRP-BMSCs-ADM联合修复关节缺损的效果。结果:随着培养时间延长,BMSCs的细胞数目显著增多,呈现S形生长曲线,第3天后进入对数期,第9天后进入平台期;从第3天开始,细胞数目OD值研究组均明显高于对照组（P<0.01）;随着时间的延长,各组标本软骨样细胞数目增多,软骨陷窝逐渐成熟,软骨表面逐渐光滑,IRCS宏观评分和组织学评分均呈现增长趋势（P<0.01）,标本压力弹性模量有上升趋势（P<0.05）;同时期研究组标本评分与压力弹性模量均显著高于对照组和空白组（P<0.01）;3个月后,研究组软骨缺损修复状况明显优于对照组和空白组。结论:自体PRP联合BMSCs复合改建ADM修复兔关节软骨的修复效果良好,具有可行性。     

茶多酚对大鼠骨关节软骨氧化损伤的保护作用

目的探讨茶多酚对大鼠骨关节软骨氧化损伤的保护作用,以进一步了解茶多酚摄入机体对骨折早期愈合的影响机制。方法选取3~4月龄健康雄性Sprague-Dawley大鼠45只作为观察对象,随机将其分为A、B、C三组,每组15只。各组均制造骨折前茶多酚生物效应,对三组大鼠进行皮下注射,A组剂量为5 mg/(kg·d)茶多酚,B组剂量为10 mg/(kg·d)茶多酚,而C组剂量为0.5 m L/(kg·d)生理盐水;注射3周后,将每只大鼠桡骨中下1/3交界处造成左侧桡骨3 mm完全骨质缺损的骨折模型,不固定;骨折后继续注射茶多酚,制造骨折后茶多酚生物效应;采用HE染色分别观察大鼠在骨折愈合不同时期(造模后3、7、14、21 d)的骨痂厚度及骨痂成熟度。结果 1骨痂厚度:经HE染色观察,造模后3 d,三组间比较差异无统计学意义(P>0.05);造模后7 d,B组明显高于其他两组,差异有统计学意义(P<0.05);造模后14 d,A组与B组明显高于C组,差异有统计学意义(P<0.05);造模后21 d,B组明显高于A组与C组,且A组明显高于C组,各组间差异均有统计学意义(P<0.05)。2A组与B组大鼠术后3 d即可见到骨内外膜开始增厚,术后7 d骨折端肉芽组织形成,术后14 d骨折端肉芽组织开始重新生长,术后21 d骨折端纤维性骨痂与纤维母细胞有明显减少;C组术后3、7 d骨内外膜也有所增厚,但是与术前相比差异不明显,术后14、21 d骨痂中纤维细胞、毛细血管密度及纤维性结缔组织有明显增加,出现新生血管,但是成骨细胞的增殖数量与A、B组相比明显偏低,而且骨痂的成熟度也相对较低,内外骨痂改造塑形期出现较晚。结论茶多酚对骨关节软骨氧化损伤具有明显的保护作用,其可以通过促进骨痂增殖分化,增加骨痂含量,加快骨痂的成熟,从而提高骨折的愈合速度。     

Age related changes in thyroid and cricoid cartilages: An autopsy based radiological analysis

Forensic age estimation is an invaluable aspect of human identification. Out of these many means of age estimation, few regions with untapped potential for assistance in forensic age estimation are the age-related changes in the laryngeal cartilages. As the age advances, the thyroid and cricoid cartilages undergo gradual calcification in an individual. These age-related changes can be visualized in both the living and the dead using conventional radiography and can be objectively assessed. The objective of the present study was to evaluate the age-related changes in the laryngeal cartilages and the results may be utilized for age estimation in forensic examinations. The laryngeal cartilages were carefully dissected using standard procedures from 75 cadavers of age ranging from 17 to 65 years, during the post-mortem examination. The laryngeal cartilages were radiographed and replaced in the body cavity before culminating the post-mortem examination. The calcification of both cartilages was studied by using the standard grading method. Calcification scores of individual regions of both the laryngeal cartilages show a statistically significant positive correlation with chronological age (P < 0.05). Regression models derived from the degree of calcification of thyroid and cricoid cartilages showed standard error of estimates that ranged between 9.90 and 11.07 years. Considering the standard error of estimates of the regression analysis, the present study concludes that these regression models can be used in adjunct with other methods of age estimation such as the skeletal and dental age or when such methods are not viable as in cases of charred or mutilated remains.     

Developmental and evolutionary significance of the mandibular arch and prechordal/premandibular cranium in vertebrates: revising the heterotopy scenario of gnathostome jaw evolution

The cephalic neural crest produces streams of migrating cells that populate pharyngeal arches and a more rostral, premandibular domain, to give rise to an extensive ectomesenchyme in the embryonic vertebrate head. The crest cells forming the trigeminal stream are the major source of the craniofacial skeleton; however, there is no clear distinction between the mandibular arch and the premandibular domain in this ectomesenchyme. The question regarding the evolution of the gnathostome jaw is, in part, a question about the differentiation of the mandibular arch, the rostralmost component of the pharynx, and in part a question about the developmental fate of the premandibular domain. We address the developmental definition of the mandibular arch in connection with the developmental origin of the trabeculae, paired cartilaginous elements generally believed to develop in the premandibular domain, and also of enigmatic cartilaginous elements called polar cartilages. Based on comparative embryology, we propose that the mandibular arch ectomesenchyme in gnathostomes can be defined as a Dlx1-positive domain, and that the polar cartilages, which develop from the Dlx1-negative premandibular ectomesenchyme, would represent merely posterior parts of the trabeculae. We also show, in the lamprey embryo, early migration of mandibular arch mesenchyme into the premandibular domain, and propose an updated version of the heterotopy theory on the origin of the jaw.