手法松解联合关节腔注射对前交叉韧带重建术术后关节僵硬患者关节功能的影响

目的 探讨手法松解联合关节腔注射对前交叉韧带（ACL）重建术后关节僵硬患者关节功能的影响。方法 回顾分析我院ACL重建术后关节僵硬性手法松解患者59例,根据是否行关节腔注射分成观察组和对照组,其中对照组27例,观察组32例。对照组患者行手法松解,观察组患者先行关节腔内注射,再行手法松解。记录两组患者治疗前和治疗后2周、4周、8周主动关节活动度（ROM）、活动时疼痛视觉模拟评分（VAS）、Lysholm膝关节评分和国际膝关节文献委员会（IKDC）膝关节评分,同时记录治疗时患者疼痛VAS评分。结果 观察组患者治疗后2周、4周和8周ROM、Lysholm评分和IKDC评分均显著高于对照组患者（P<0.05）。观察组患者治疗时、治疗后2 w、4 w和8 w患膝疼痛VAS评分均显著低于对照组患者（P<0.05）。结论 手法松解联合关节腔注射可减轻ACL重建术后关节僵硬患者疼痛,增加膝关节活动度,改善膝关节功能。     

Biomechanical properties of orthogonal plate configuration versus parallel plate configuration using the same locking plate system for intra-articular distal humeral fractures under radial or ulnar column axial load

IntroductionPrevious reports have questioned whether an orthogonal or parallel configuration is superior for distal humeral articular fractures. In previous clinical and biomechanical studies, implant failure of the posterolateral plate has been reported with orthogonal configurations; however, the reason for screw loosening in the posterolateral plate is unclear. The purpose of this study was to evaluate biomechanical properties and to clarify the causes of posterolateral plate loosening using a humeral fracture model under axial compression on the radial or ulnar column separately. And we changed only the plate set up: parallel or orthogonal.Materials and methodsWe used artificial bone to create an Association for the Study of Internal Fixation type 13-C2.3 intra-articular fracture model with a 1-cm supracondylar gap. We used an anatomically-preshaped distal humerus locking compression plate system (Synthes GmbH, Solothurn, Switzerland). Although this is originally an orthogonal plate system, we designed a mediolateral parallel configuration to use the contralateral medial plate instead of the posterolateral plate in the system. We calculated the stiffness of the radial and ulnar columns and anterior movement of the condylar fragment in the lateral view.ResultsThe parallel configuration was superior to the orthogonal configuration regarding the stiffness of the radial column axial compression. There were significant differences between the two configurations regarding anterior movement of the capitellum during axial loading of the radial column.DiscussionThe posterolateral plate tended to bend anteriorly under axial compression compared with the medial or lateral plate. We believe that in the orthogonal configuration axial compression induced more anterior displacement of the capitellum than the trochlea, which eventually induced secondary fragment or screw dislocation on the posterolateral plate, or nonunion at the supracondylar level. In the parallel configuration, anterior movement of the capitellum or trochlea was restricted because of the angular stability of the plate and locking screws in the condyle.ConclusionsThe posterolateral plate tended to bend anteriorly under axial compression of the radial column in the orthogonal configuration, which led to secondary displacement of the posterolateral plate and eventual screw loosening.     

中药熏洗配合透明质酸钠关节内注射治疗膝关节骨性关节炎疗效观察

为探讨中药熏洗配合透明质酸钠关节内注射治疗膝关节骨性关节炎的临床疗效。将73例膝关节骨性关节炎患者分为两组,治疗组（通经活络洗方熏洗配合透明质酸钠关节内注射）43例,对照组（透明质酸钠关节内注射）30例,分别观察并 比较其临床疗效及镇痛和改善关节功能的效果。结果显示治疗组临床疗效及镇痛和改善关节的效果均优于对照组（P＜0．05）。表明中药通经活络洗方熏洗配合透明质酸钠关节内注射治疗膝关节骨性关节炎具有较好的临床疗效及缓解疼痛 和改善关节功能的作用     

Intra-Articular Fractures of the Distal Tibia

In a study of 23 intra-articular fractures of the distal tibia of which 18 were re-examined after an average follow-up period of 5.4 years, two major fracture patterns were identified: type A, a rotational pattern, caused by low energy trauma and type B, a compressive fracture pattern caused by high energy trauma. Type B fractures could be divided into three subgroups: 1) An isolated fracture of the anterior or posterior margin of the distal tibia, 2) an extra-articular comminuted fracture with extension into the ankle joint and 3) a comminuted intra-articular fracture.

When the initial displacement and comminution were severe or the reduction was not complete, the final results of the comminuted intra-articular fractures were not acceptable. The incidence of osteoarthritis was highest in the group of comminuted intra-articular fractures. The extra-articular comminuted fractures seemed to have a better prognosis as indicated by the final clinical results, including the occurrence of osteoarthritis.

It is clear from this study that comminuted intra-articular fractures should not be treated by primary operation. All fractures treated non-operatively had acceptable final clinical results.     

Development of nanoparticles-in-microparticles system for improved local retention after intra-articular injection

Abstract

To increase the intra-articular (IA) retention time of osteoarthritis drugs in the synovial cavity and slow down the burst release of microspheres (MPs), we prepared a novel drug delivery system named nanoparticles-in-microspheres (NiMs). The system was constructed by dispersing the brucine-loaded nanoparticle, which was prepared by an emulsification method in the MPs. The NiMs were characterized by scanning electron microscope, Fourier transform infrared spectra and differential scanning calorimetry. After investigating the biocompatibility with synovium of NiMs in rats, the pharmacokinetics was studied and FX-imaging was used to visualize the transmission of nanoparticles after IA administration in rats. From the results, we know that the NiMs were spherical, there was no chemical bond between the drug and the polymer, and the drug was dispersed in the polymer in an amorphous form. Compared with MPs (41%), the burst release of NiMs could be slowed down to 9%. After that, the drug was released from NiMs by diffusion. The results of FX imaging in rats showed that the NiMs could stay in the articular cavity for over 11?d. The studies of pharmacokinetics revealed that the NiMs could slow down the burst release and improve retention in vivo. This study demonstrates the feasibility of using NiMs to slow down the burst release and increase the retention of therapeutic agents in articular joints.     

Comparison of Minimally Invasive Procedures to Treat Knee Pain Secondary to Osteoarthritis: A Systematic Review and Meta-Analysis

PurposeTo review and indirectly compare the outcomes of genicular artery embolization (GAE), radiofrequency (RF) ablation, and intra-articular (IA) injection for the treatment of knee pain secondary to osteoarthritis (OA).Materials and MethodsA literature review of the MEDLINE and Cochrane databases was conducted with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement in June 2020. The visual analog scale (VAS) was recorded at baseline and at all available time points for each therapy. Standard mean differences were calculated at each time point and compared between treatments to assess the magnitude of the treatment effect.ResultsAll 3 treatments demonstrated significant differences in VAS scores after therapy. RF ablation produced the greatest significant mean reduction in relative VAS score from baseline at 1 year of follow-up (mean, 0.49; 95% confidence interval, 0.4–0.59; P = .03). GAE reported the most significant reductions in VAS scores across all measured time points. Overall, the comparison did not demonstrate a significant difference in VAS scores among patients receiving IA injections, RF ablation, and GAE.ConclusionsThe current evidence does not suggest a significant difference in outcomes among IA injection, RF ablation, and GAE for knee pain secondary to OA.     

关节镜清理术联合药物注射治疗膝关节骨性关节炎的疗效分析

目的分析关节镜清理术联合玻璃酸钠注射治疗膝关节骨性关节炎(knee osteoarthritis,KOA)的效果,并观察复方倍他米松和罗哌卡因辅助治疗KOA的镇痛及改善关节功能的效果。方法收集2011年6月至2013年5月我院收治的KOA患者129例,依照标准筛选出90例纳入本研究,随机分为三组,每组30例,关节镜清理组单行关节镜清理术,联合玻璃酸钠组行关节镜清理术联合注射玻璃酸钠,联合多种药物组行关节镜清理术联合注射玻璃酸钠、复方倍他米松和罗哌卡因。应用疼痛视觉模拟评分法(visual analogue scale,VAS)以及各种定性评定标准评定治疗效果。结果在术后4个时间点记录所有病例的VAS评分,比较各组的VAS评分,差异均有统计学意义(均P<0.05),其中联合多种药物组评分最低,其次是联合玻璃酸钠组,关节镜清理组最高。术后6个月,关节镜清理组的治疗优良率为60.0%,有效率为76.7%;联合玻璃酸钠组的治疗优良率为76.7%,有效率为90.0%;联合多种药物组的治疗优良率为83.3%,有效率为93.3%。术后6个月,各组间两两比较治疗有效率和膝关节HSS评分,关节镜清理组与联合玻璃酸钠组、联合玻璃酸钠组与联合多种药物组比较,差异均有统计学意义(均P<0.05);联合玻璃酸钠组与联合多种药物组比较,差异无统计学意义(P>0.05)。结论关节镜清理术联合注射玻璃酸钠(或加用复方倍他米松和罗哌卡因)治疗KOA效果显著,优于单独运用膝关节镜清理术治疗早期骨关节炎。     

复方倍他米松关节腔灌注联合双氯芬酸治疗膝骨关节炎的效果观察

目的 :探讨复方倍他米松关节腔灌注联合双氯芬酸治疗膝骨关节炎疗效。方法 :将我院门诊及病房就诊的确诊膝骨关节炎的60例患者随机分为复方倍他米松治疗组和常规治疗组,复方倍他米松治疗组于基线时予复方倍他米松关节腔灌注治疗1次,同时予双氯芬酸口服治疗,常规治疗组单用双氯芬酸口服治疗。两组患者均予奥美拉唑肠溶胶囊20 mg/d口服,预防消化性溃疡的发生。于基线和4周后观察两组患者的20 m步行痛、关节触痛、Western Ontario and Macmaster Universities(WOMAC)骨关节炎指数。采用VAS标准评估。结果 :常规治疗组20 m步行痛、关节触痛和WOMAC功能在基线时分别为51±15、51±17、618±177;4周后分别为36±1、32±13、392±152;复方倍他米松治疗组20 m步行痛、关节触痛和WOMAC功能在基线时分别为53±13、51±17、620±193,4周后分别为28±12、21±15、336±129;与基线时比较4周后常规治疗组和复方倍他米松治疗组患者的主要疗效指标均较治疗前明显好转(P<0.05)。4周后复方倍他米松关节腔灌注治疗组的主要疗效指标较常规治疗组改善更明显(P<0.05)。结论:两组患者临床症状均较治疗前明显改善,联合复方倍他米松关节腔灌注治疗疗效更佳。