跟腱愈合过程中的力学生物学

跟腱断裂修复后采用传统的重力垂足位长腿石膏固定， 势必使跟腱处于无张力甚至是“失用性”的负性平衡体系下愈合，这种状态可能会抑制跟腱愈合过程中感应“主动”机械信号刺激的关键时机，在此过程中给予的超声波、振动等治疗，也只能使跟腱“被动、间歇”地接受机械刺激。如果在术后采用早期功能锻炼的运动疗法，可以提高跟腱存组织修复过程中功能维持及再塑形的能力，有助于跟腱生物力学特性的恢复。蛋白质组学技术便于从高通量的分子水平揭示运动疗法健进跟腱愈合的机制。     

早期运动对家兔跟腱断裂术后愈合的组织学影响

目的 动物实验的角度分析跟腱断裂术后早期运动与制动状态下组织学差异,为术后早期运动提供组织学证据.方法 将新西兰家兔随机分成正常组,早期运动组,石膏固定组.造模后对家兔跟腱进行组织学检查,寻找组织学差异.结果 家兔跟腱HE染色后,光镜下观察,早期运动组胶原纤维更粗[（8.417±1.649）μm vs（6.818±1.025）μm,t=2.76,P＜0.05],排列更整齐,成纤维细胞更成熟;电镜下观察,早期运动组胶原原纤维的直径更大,差异有统计学意义[（26.915±2.123）nm vs（21.725±3.768）nm,t=4.12,P＜0.01].结论 术后早期运动能够促进跟腱的组织学愈合.     

病灶清除植骨内固定治疗胸腰椎结核的近期疗效分析

目的　临床研究同期病灶清除植骨融合内固定术治疗胸腰椎结核的近期疗效。方法 将一期病灶清除植骨融合内固定术治疗并随访到的46例,平均随访2.5年,植骨融合按Moon观察标准为主,神经功能恢复情况按Frankel分级进行评价。结果 胸腰椎后凸畸形全部矫正(P<0.01)。平均12d下床活动。术后3个月骨性融合率60%;6个月骨性融合率90%。31例并截瘫者神经功能平均恢复3级(Frankel分级);结核治愈率98%。结论 一期病灶清除植骨融合内固定术可有效地治疗胸腰椎结核并可早期活动。     

Differentially expressed proteins on postoperative 3 days healing in rabbit Achilles tendon rupture model after early kinesitherapy

Objectives: Surgical repair of Achilles tendon (AT) rupture should immediately be followed by active tendon mobilization. The optimal time as to when the mobilization should begin is important yet controversial.Early kinesitherapy leads to reduced rehabilitation period.However, an insight into the detailed mechanism of this process has not been gained. Proteomic technique can be used to separate and purify the proteins by differential expression profile which is related to the function of different proteins, but research in the area ofproteomic analysis of AT 3 days after repair has not been studied so far.Methods: Forty-seven New Zealand white rabbits were randomized into 3 groups. Group A (immobilization group,n=16) received postoperative cast immobilization; Group B (early motion group, n= 16) received early active motion treatments immediately following the repair of AT rupture from tenotomy. Another 15 rabbits served as control group (Group C). The AT samples were prepared 3 days following the microsurgery. The proteins were separated employing twodimensional polyacrylamide gel electrophoresis (2D-PAGE).PDQuest software version 8.0 was used to identify differentially expressed proteins, followed by peptide mass fingerprint (PMF) and tandem mass spectrum analysis, using the National Center for Biotechnology Information (NCBI) protein database retrieval and then for bioinformatics analysis.Results: Amean of 446.33,436.33 and 462.67 protein spots on Achilles tendon samples of 13 rabbits in Group A,14 rabbits in Group B and 13 rabbits in Group C were successfully detected in the 2D-PAGE. There were 40, 36 and 79unique proteins in Groups A, B and C respectively. Some differentially expressed proteins were enzyme with the gel,matrix-assisted laser-desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). We successfully identified 9 and 11 different proteins in Groups A and B,such as GAPDH, phosphoglycerate kinase 1, pro-alpha-1type 1 collagen, peroxiredoxin 1, alpha-1-antiproteinase E a-1and MAD2L1 binding protein, etc. And some with the molecular chaperone, oxidative stress, energy metabolism,signal transduction, coupled with the tendon cell expression and protein synthesis, proliferate, differentiate and are closely related to the AT healing. The GAPDH protein was further validated through Western blotting. It was indicated that some differentially expressed proteins were involved in various metabolism pathways and may play an important role in initial healing of AT rupture.Conclusion: Differentially expressed proteins in rabbit healing AT model may contribute to 3 days healing of AT rupture through a new mechanobiological mechanism due to the application of postoperative early kinesitherapy.     

Active Achilles tendon kinesitherapy accelerates Achilles tendon repair by promoting neurite regeneration

Active Achilles tendon kinesitherapy facilitates the functional recovery of a ruptured Achilles tendon. However, protein expression during the healing process remains a controversial issue. New Zealand rabbits, aged 14 weeks, underwent tenotomy followed immediately by Achilles tendon microsurgery to repair the Achilles tendon rupture. The tendon was then immobilized or subjected to postoperative early motion treatment (kinesitherapy). Mass spectrography results showed that after 14 days of motion treatment, 18 protein spots were differentially expressed, among which, 12 were up-regulated, consisting of gelsolin isoform b and neurite growth-related protein collapsing response mediator protein 2. Western blot analysis showed that gelsolin isoform b was up-regulated at days 7-21 of motion treatment. These findings suggest that active Achilles tendon kinesitherapy promotes the neurite regeneration of a ruptured Achilles tendon and gelsolin isoform b can be used as a biomarker for Achilles tendon healing after kinesitherapy.     

有限小切口松解与常规切开松解修复腕管综合征的Meta分析

背景：自1991年以来,许多医师在使用腕横纹开放式小切口技术试图结合传统腕管切开松解的简单性和安全性减少组织损伤和术后复发率。但哪一种技术更具优势一直存在争议。目的：对非内窥镜的有限小切口松解和传统腕管切开松解治疗腕管综合征的疗效进行系统评价。方法：按照Cochrane系统评价的方法,计算机检索MEDLINE（1966年1月至2010年3月）、EMBASE（1966年1月至2014年5月）、Cochrane图书馆（2014年5月）及中国生物医学文献数据库（1979年1月至2013年12月）,并手工检索相关的中英文骨科杂志。收集所有相关的随机对照试验,并评价纳入研究的方法学质量,采用Cochrane协作网提供的软件Revman5.2进行Meta分析,以获得有限小切口松解与传统腕管切开松解治疗腕管综合征的疗效及其安全性是否有差异的相关证据。结果与结论：共纳入7个随机对照试验进行评价。Meta分析显示,有限小切口松解组与传统腕管切开松解组的瘢痕痛、柱状痛,主观满意率、治疗后恢复日常工作时间差异无显著性意义（P〉0.05）;有限小切口松解组后并发症发生率和手术时间显著低于传统腕管切开松解组（P〈0.05）。结果表明,与传统腕管切开松解相比,有限小切口松解可降低腕管综合征治疗后并发症,缩短手术时间;两种术式治疗后瘢痕痛率、柱状痛率、主观满意度、恢复日常工作时间差异无显著性。因研究质量及样本的局限性,此两种治疗方法与治疗后恢复时间、治疗后疼痛和手功能等指标的比较上有待进一步研究。     

Kazakh Therapy on Differential Protein Expression of Achilles Tendon Healing in a 7-Day Postoperative Rabbit Model

Objective: To compare the effect of cast immobilization with that of early Kiymil arkili emdew (Kazakh exercise therapy) on the post-operative healing of Achilles tendon rupture in rabbits, and to observe the influence of early Kiymil arkili emdew on the differentially expressed proteins in the healing tendon. Methods: Forty-five New Zealand white rabbits were randomly divided into three groups (Arm A: control group; Arm B: postoperative immobilization group; and Arm C: postoperative early Kiymil arkili emdew group). After tenotomy, the rabbits of the two experimental groups received microsurgery to repair the ruptured tendons, and then received either cast immobilization or early Kiymil arkili emdew treatment. Achilles tendon tissue samples were collected 7 days after the surgery, and two-dimensional gel electrophoresis and MALDI-TOF-MS technique were used to analyze differentially expressed proteins in the tendon tissue of the three Arms. Results: A total of 462.67±11.59, 532.33±27.79, and 515.33±6.56 protein spots were detected by the two-dimensional polyacrylamide gels in the Achilles tendon samples of the rabbits in Arms A, B, and C, respectively. Nineteen differentially expressed protein spots were randomly selected from Arm C. Among them, 7 were unique, and 15 had five times higher abundance than those in Arm B. These included annexin A2, gelsolin isoforms and α-1 Type III collagen. It was confirmed by western blot that gelsolin isoform b, annexin A2, etc. had specific and incremental expression in Arm C. Conclusions: The self-protective instincts of humans were overlooked in the classical postoperative treatment for Achilles tendon rupture with cast immobilization. Kiymil arkili emdew induced the specific and incremental expression of proteins in the repaired Achilles tendon in the early healing stage in a rabbit model, compared with those treated with postoperative cast immobilization. These differentially expressed proteins may contribute to the healing of the Achilles tendon via a mechanobiological mechanism caused by the application of Kiymil arkili emdew.     

蛋白质组学及其在骨科疾病研究中的应用与展望

蛋白质组学是后基因组时代的新研究领域,主要研究细胞、组织或器官内蛋白质的表达及功能,通过检测蛋白质来分析生命中重要的病理生理变化.利用蛋白质组学方法能发现与疾病诊断、治疗、判断预后有关的低丰度、小分子量蛋白质和多肽的信息,进而在基础医学和临床医学研究中取得重要突破.蛋白质组学在骨科疾病的研究中已取得很大进展,显示了广阔的发展前景.本文就蛋白质组学技术的发展、研究现状及其在骨科学中的应用与展望作一综述.     

Clinical outcome of exercise therapy and early post-operative rehabilitation for treatment of neglected Achilles tendon rupture: a randomized study

Purpose

Treatment of neglected Achilles tendon rupture is very challenging. This randomized study aimed to compare the clinical outcome of early post-operative rehabilitation (EPR) with post-operative cast immobilization (PCI).

Methods

Fifty-seven patients with neglected Achilles tendon rupture were randomized to receive EPR (n = 26) or PCI (n = 31) management following surgery. Clinical outcome was monitored by follow-up at weeks 8, 12, 18 and 26 and year 2. The significance of intergroup differences from the Leppilahti scoring system (LSS), ultrasonography, multislice spiral computerized tomography (MSCT) and electromyography was assessed.

Results

Ultrasonography and MSCT revealed no occurrence of tendon elongation or adhesion. Four patients could perform sustained single-leg heel-raise exercise for 60 s at post-operative day 40. The PCI group also showed increased post-operative LSS score, but recovery was slower. Post-operative complications, such as ankle joint ankylosis and osteoporosis, only occurred in the PCI group.

Conclusions

Compared with cast immobilization, early post-operative rehabilitation results in better clinical outcome and faster overall tendon regeneration of neglected Achilles tendon rupture.

Level of evidence

II.

     

类风湿关节炎单独甲氨蝶呤与三联疗法治疗的系统评价

背景：目前类风湿关节炎在治疗上选择甲氨蝶呤单独疗法还是三联疗法存在争议。目的：系统评价甲氨蝶呤单独疗法与甲氨喋呤+羟氯喹+柳氮磺吡啶三联疗法比较治疗类风湿关节炎的有效性和安全性。方法：计算机检索 Cochrane 图书馆、PubMed、EMBASE NRR (http://www.updatesoftware.com/National)、CCT(http://www.controlled-trails.com)和中国生物医学文献数据库(CBM)。手工检索(中文主要骨科杂志)。收集甲氨蝶呤单独疗法与甲氨喋呤+羟氯喹+柳氮磺吡啶三联疗法比较治疗类风湿关节炎的随机对照试验, 并评价纳入研究的方法学质量。统计采用Cochrane协作网提供的Revman 5.0软件进行分析。结果与结论：共纳入随机对照试验4篇,共297例患者,方法学质量均为B 级。Meta分析结果表明, 甲氨蝶呤单独疗法与三联疗法比较,甲氨蝶呤单独疗法在血沉方面的改善要大于三联疗法[MD=7.01 95%CI(2.82,11.19),P=0.001],三联疗法在关节改善情况方面优于单独疗法[OR=0.62 95%(0.41,0.95),P=0.03],在不良反应上,两者差异无显著性意义。而ACR因文献未提供详细数据未能做Meta分析。与三联疗法治疗相比,甲氨蝶呤单独疗法更明显降低成人类风湿关节炎的血沉,但在关节功能改善方面三联疗法要优于甲氨蝶呤单独疗法。而在不良反应上,两组差异无显著性意义。因这次系统评价纳入的病例数较少,尚需更多设计严格的大样本随机对照研究来增加证据的强度。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：