关节镜下一期人工韧带治疗膝关节多发韧带损伤

目的探讨一期关节镜下应用人工韧带治疗膝关节多发韧带损伤的疗效。方法回顾性分析2014年1～12月膝关节多发韧带损伤(SchenckⅢ型)19例资料。手术距受伤时间6～18 d,平均11.6 d。均一期在关节镜下应用LARS人工韧带(Ligament Advanced Reinforcement System)重建前和(或)后交叉韧带。采用膝关节Lysholm评分、Tegner评分评定疗效。结果 19例术后随访22～28个月,平均24.5月。无膝关节感染、韧带断裂、韧带松弛等。末次随访时,膝关节Lysholm评分(85.6±2.2)分,Tegner评分(5.4±1.1)分,均较术前(33.2±2.3)分及(2.4±0.9)分明显提高(配对t检验,t=-22.422、-24.312,P均=0.000)。结论应用LARS人工韧带治疗膝关节多发韧带损伤疗效满意。     

闭合复位陈旧性髋关节脱位21例临床分析

髋关节脱位是一种常见的创伤性疾病，脱位时间超过3周以上者为陈旧性髋关节脱位，治疗上国内外多主张手术切开复位。笔者自1995年-2004年收治陈旧性髋关节脱位31例，其中有21例试行闭合复位，15例复位成功，总结如下：     

预混地塞米松的高分子自交联透明质酸水凝胶抑制软骨细胞凋亡缓解早期创伤性骨关节炎的作用机制

目的探究预混有地塞米松(Dex)的高分子自交联透明质酸(cHA)水凝胶(cHA-Dex水凝胶)抑制软骨细胞凋亡缓解早期创伤性骨关节炎(PTOA)的作用机制。方法取2月龄雄性SD大鼠140只分两组, 70只进行前交叉韧带切断(ACLT)手术制造PTOA动物模型, 以假手术组(70只)为对照, 在术后不同时间点(1～14 d, 每组每个时间点5只大鼠)检测关节灌洗液中白细胞介素1β(IL-1β)、IL-6、肿瘤坏死因子α(TNF-α)、基质金属蛋白酶3(MMP-3)及MMP-13等炎性指标的变化趋势。将cHA-Dex(0.5 mg/ml)水凝胶(实验组, n=70)及预混有Dex的普通低分子透明质酸(HA)水凝胶, 即HA-Dex(0.5 mg/ml)水凝胶(对照组, n=70)注入PTOA大鼠关节腔, 检测每个时间点(1～14 d, 每组每个时间点5只大鼠)大鼠关节液中的Dex的释放量及累计释放量, 揭示cHA-Dex水凝胶的缓释机制。取2020年1月至2022年12月在山西医科大学第二医院关节科进行膝关节置换术后的骨关节炎(OA)患者(胫骨平台上Outbridge评分1～2分, n=1...     

钽棒置入治疗股骨头坏死的疗效分析及预后模型建立

BACKGROUND: Porous tantalum implantation is a novel treatment method for osteonecrosis of the femoral head (ONFH), but its therapeutic effect is under discussion. OBJECTIVE: To analyze the survival data of two kinds of porous tantalum implants for early- and mid-stage ONFH, and to determine the independent prognostic factors. METHODS: Thirty-four cases of ARCO stages I-III ONFH were enrolled, and 25 patients (31 hips) were treated with porous tantalum implantation (simple group), and the other 9 patients (10 hips) treated with porous tantalum implantation combined with bone allograft (combination group). Afterwards, the Harris scores and total survival rate of hips were recorded; the prognostic factors were analyzed by Cox regression. RESULTS AND CONCLUSION: The mean follow-up time in the simple and combination groups was (32.9 ±16.8) and (25.3±12.4) months respectively. The Harris scores at the last follow-up in the two groups were both higher than those before surgery, and moreover, the scores were higher in the simple group than the combination group (P < 0.05). The total survival rate of hips significantly differed between groups (P=0.014). Cox regression showed that the history of hormone, accompanied with other chronic diseases, and adverse reactions made effects on the prognosis. These results suggest that porous tantalum implantation is an effective treatment method for ARCO stages I-III ONFH, and it can improve the functional recovery and survival rate of the hips.     

多孔钽金属置入治疗早期股骨头坏死的研究与应用现状

BACKGROUND: Porous tantalum rod implantation is a relatively new technique that has been applied to patients with early-stage osteonecrosis of the femoral head, but its efficacy is mixed. OBJECTIVE: To review the etiology and pathogenesis of osteonecrosis of the femoral head and the latest research progress of porous tantalum rod implantation. METHODS: A computer-based search of PubMed and CNKI database was performed for articles related to the pathogenesis of osteonecrosis of the femoral head and porous tantalum rod implantation published from 1985 to 2015. The key words were “osteonecrosis of the femoral head, etiology, porous tantalum rod, tissue engineering, nanomaterials, bone marrow mesenchymal stem cells” in Chinese and English in the title and abstract. Finally, 67 articles were included in result analysis. RESULTS AND CONCLUSION: The porous tantalum rod is considered effective for early-stage osteonecrosis of the femoral head patients in short term. More recently, the porous tantalum rod implantation combined with other therapies, such as stem cell transplantation, has developed for long-term reserving the hip in early-stage osteonecrosis of the femoral head. Therefore, we need further clinical trials for long-term follow-up to give a final clinical and socioeconomic assessment of porous tantalum rod implantation. Moreover, the most effective approach and position of porous tantalum rod implantation have not been reported until now.       

关节软骨损伤和滑膜炎关系的临床研究

目的探讨不同关节软骨损伤情况下关节滑膜的表现。方法收集2001—2008年关节镜手术337例339膝,其中男性161例,女性176例;年龄11~82岁,平均43岁。采用Outerbridge评分标准分别对髌骨面、股骨髌面、股骨内侧髁、股骨外侧髁、胫骨内侧髁和胫骨外侧髁共6个区域的关节软骨损伤病理变化情况进行评分,并将评分累加。对滑膜采用Ayral评分法,对膝关节滑膜9个区域进行评分,按公式计算出滑膜炎评分。结果软骨损伤评分和滑膜炎评分做Spearman相关分析结果表明软骨损伤评分与滑膜炎评分呈正相关（r=0.690,P〈0.01）。当软骨损伤评分为零分时,将年龄和滑膜评分作Spearman相关分析,结果表明年龄与滑膜炎评分呈正相关（r=0.353,P〈0.01）;性别与滑膜炎两者之间无相关性（r=0.020,P=0.827）。结论随着软骨损伤程度逐步加重,滑膜炎程度亦同时加重;然而,随着滑膜炎程度逐步加重,软骨损伤程度并不一定加重（出现最严重滑膜炎时,软骨也不一定有损伤）;并且,年龄因素对滑膜炎程度起重要作用。由此可以得出,软骨损伤对滑膜炎起决定作用,但同时,滑膜炎受多种因素影响,滑膜炎并不具备提示软骨损伤,并且加重骨关节炎的作用。     

转化生长因子β1基因单独转染及与胰岛素样生长因子1基因联合转染治疗兔膝骨关节炎

目的 观察重组大鼠转化生长因子β1(transforming growth factor beta-l,TGF-β1)基因单转染及与胰岛素样生长因子1(insulin-like growth factor-1,IGF-1)基因共转染兔膝关节后对骨关节炎(osteoarthritis,OA)的治疗效果.方法 新西兰白兔24只,随机分为4组,Ⅰ组为空白对照组,Ⅱ组为手术对照组,Ⅲ组为TGF-β1基因转染组,Ⅳ组为TGF-β1和IGF-1双基因转染组.前十字韧带切断法制成兔膝关节OA模型,向膝关节内注射转染不同重组基因的阳性克隆软骨细胞.4、8周后,取关节标本进行Mankin评分,AB-PAS染色,TGF-β1、IGF-1、Ⅱ型胶原原位杂交和免疫组化检测,透射电镜观察.结果 Ⅱ组软骨损伤程度较大,其Mankin评分明显高于Ⅰ组和Ⅲ、Ⅳ组.各因子原位杂交和免疫组化染色,Ⅰ组及Ⅲ、Ⅳ组的灰度值均高于Ⅱ组,Ⅳ组的灰度值较Ⅲ组高;8周时各对应组灰度值较4周有明显下降.透射电镜观察显示,Ⅱ组的超微结构较Ⅰ组明显紊乱,治疗4周后,超微结构逐渐恢复正常,但在8周后紊乱程度又逐渐加重.结论 关节内注射转基因软骨细胞对OA有一定治疗作用;TGF-β1和IGF-1双基因治疗效果优于TGF-β1单基因;基因治疗4周后,基因表达逐渐减弱,基因治疗具时效性.     

关节液中多糖含量与关节软骨损伤的关系

目的研究膝关节外伤后,关节液中糖胺多糖含量与关节镜下关节软骨损伤程度的关系,探讨糖胺多糖作为一种生物标记物早期诊断和监测由创伤造成的骨性关节炎病变的可能性。方法1999年5月至2001年9月收集由创伤造成的单侧膝关节外伤病例74例(年龄范围15~70岁,平均年龄39岁),患膝已渡过急性炎症期并无炎症的病人(均为受伤2个月后),可有程度不等的关节功能障碍。于关节镜手术前抽取关节液,采用Alcian blue染色法用酶标仪测定糖胺多糖含量;并在关节镜下,采用Outerbridge分期评定软骨损伤程度。结果关节镜下软骨有轻度损伤的病例较无损伤的病例糖胺多糖含量高(P<0.05);在关节软骨损伤程度较轻时,糖胺多糖含量与软骨损伤程度间存在正相关关系(rs=0.553,0.05>P>0.02)。结论当关节软骨损伤程度较轻时,糖胺多糖可以早期诊断关节软骨损伤,并可用来监测骨性关节炎的病情发展,以及作为评价疗效的一种手段。     

低温诱发高血压机制的研究进展

高血压是最常见的心血管疾病,是心肌肥厚、心力衰竭等心脏疾病发生的重要危险因素。近年来,越来越多的研究者关注低温暴露对高血压影响这一研究领域并取得了一系列进展,本文归纳总结了低温暴露诱发及加重高血压的相关机制,主要包括低温暴露对神经内分泌系统、大电导钙激活钾通道(BKCa)、氧化应激反应、内皮功能、炎症反应及盐皮质激素受体这几方面的影响。通过探讨其病理机制为寻找其预防治疗措施提供理论参考。     

可信限的计算在骨科研究中的应用

在医学研究中，结果常需做统计学分析，人们越来越对有统计学的显性差异感兴趣，而忽略了所研究内容差异的大小，甚至发展到在章中不提具体的数据结果，而只讲P值的大小。实际上大部分医学研究的目的正是后。读最关心的是新的方法与其他方法有多大的差异，而不仅仅是一个P值的大小。可信限要比一个单纯的P值提供更多的信息。可信限将一个样本的单一估计值（如样本均数）转变为一个能反映总体均数所在的范围。[第一段]