小型猪颞下颌关节腔内压的测定与分析

 【目的】测量小型猪颞下颌关节上腔内压在下颌3个功能位的变化规律。【方法】用关节内压力测量仪对11只健康成年雌性小型猪在休息位、被动大开口位、被动闭口位的22侧颞下颌关节测量关节内压值。【结果】小型猪左右侧颞下颌关节腔内压值差异无统计学意义（P〉0．05）；休息位压力为（-0．36±0．32）kPa．被动大开口位为（2．02±1．01）kPa，被动闭口位为（0．42±0．36）kPa，3个功能位压力值差异有统计学意义（P〈0．05）。【结论】小型猪两侧颞下颌关节腔内压无显著差异；在休息位，颞下颌关节上腔内压力为负值，被动大开口时压力迅速升高为较大的正压，被动闭口时压力升高为较小的正压。小型猪颞下颌关节无关节后结节，在开口运动中盘后组织跟随盘突运动是被动开口位压力升高为正值的重要解剖生理基础。     

Is Anesthetic Hip Joint Injection Useful in Diagnosing Hip Osteoarthritis? A Meta-Analysis of Case Series

To assess the diagnostic value of intra-articular anesthetic hip injection in patients with hip pain atypical for osteoarthritis (OA), literature was searched. Included were studies assessing the diagnostic value of anesthetic hip injections in differentiating between pain caused by OA or another source. Pooled estimates of sensitivity and specificity with 95% confidence intervals (CI) were calculated. Of the 1387 potentially eligible articles, nine case series with high risk of bias could be included. The pooled sensitivity was 0.97 (95% CI 0.87, 0.99). Specificity was 0.91 (95% CI 0.83, 0.95). For clinical practice, no recommendation can be made regarding the use of hip injections for diagnosing hip OA. High quality, accurately reported studies are needed to provide better evidence on the diagnostic role of hip injection.     

(iii) Principles of acetabular fractures

Acetabular fractures are rare, significant injuries involving the articular surface of the acetabulum. They are typically associated with a high-energy mechanism of injury, though fragility type fractures are now increasingly seen. Associated injuries to another organ system are seen in half of all cases. Radiographic assessment is performed using antero-posterior pelvic radiographs and Judet views, as well as computerized tomography (CT). Classification is based on the column theory and describes fracture anatomy in relation to the anterior and posterior columns. Non-operative treatment is indicated when there is less than 2 mm of articular displacement or when patient factors (such as associated injuries/co-morbidities) or soft tissue injury are incompatible with surgery. Open reduction and internal fixation is indicated in displaced fractures, total hip arthroplasty being used in unreconstructable injuries. Operative treatment involves difficult exposures and technically demanding reduction and fixation techniques. Significant associated injuries include neurovascular injury, bleeding, open fracture wounds, soft tissue injury, hip dislocation and femoral fractures. Late complications include post-traumatic osteoarthritis, avascular necrosis and heterotopic ossification. The goals of treatment should be to give the patient a congruent, functional hip whilst minimizing the complications from both the injury and surgery. Poor results are more likely if the reduction is non-anatomical.     

Outcome of manipulation under anesthesia with or without intra-articular steroid injection for treating frozen shoulder: A retrospective cohort study

Manipulation under anesthesia (MUA) combined with intra-articular steroid injection (ISI) is preferred in management of the refractory frozen shoulder (FS). This study aimed to evaluate the effect of MUA with ISI or not on pain severity and function of the shoulder.Data on 141 patients receiving MUA with primary FS refractory to conservative treatments for at least 1 month were retrospectively obtained from medical records. We performed propensity score matching analysis between patients receiving MUA only and those receiving MUA plus ISI, and then conducted logistic regression analysis to identify the risk factors for the need to other treatments during 6-month follow-up.More improvement in terms of the SPADI pain scores and passive ROM at 2 weeks after first intervention remained in patients receiving MUA plus ISI after matching. The need to other treatments during 6-month follow-up occurred in 10.6% patients (n = 141). Logistic regression analysis revealed that a repeat MUA 1 week after first intervention was a protective factor (OR 0.042; 95% CI 0.011–0.162; P = .000) and duration of disease was the only one risk factor (OR 1.080; 95% CI 1.020–1.144; P = .008) for the need to other treatments during follow-up.ISI immediately following MUA provided additional benefits in rapid relief of pain and disability for patients with refractory FS. Pain and disability of the shoulder may be rapidly alleviated by an earlier MUA from the onset of the symptoms and a repeat MUA 1 week after first intervention.     

针刀松解联合丹参注射液关节腔注射治疗骨性关节炎模型兔

文题释义： 针刀疗法：用一个完整的语言来概括应该是一种介于手术方法和非手术疗法之间的闭合性松解术。针刀疗法是将东方中医学的基本理论和西方医学的手术解剖基本理论融为一体，针刀疗法其操作的特点是在治疗部位刺入深部到病变处进行轻松的切割、剥离等不同的刺激，以达到止痛祛病的目的。 丹参注射液：其化学成分主要是水溶性酚酸类化合物，通过多种靶标起到促进血液循环和祛瘀的作用。动物研究表明，丹参注射液可通过抑制IκBα磷酸化来抑制NF-κB信号通路的激活。保护软骨下骨及软骨细胞，有效防治骨关节炎。 背景：丹参注射液与针刀松解术都是临床中治疗骨关节炎很常用的技术，目前缺乏对2种治疗方法联合使用的研究。 目的：对比单独使用针刀松解术、单独使用丹参注射液与两种方法联合使用治疗兔模型骨关节炎的效果。 方法：实验方案经黑龙江中医药大学动物实验伦理委员会批准。50只新西兰白兔分为5组：空白对照组；模型组；丹参注射液组；针刀组；针刀联合丹参注射液组。除空白对照组外，其他4组兔均制备膝关节骨关节炎模型。造模成功后，对针刀组兔内外侧支持带、内外侧膝眼，膝关节上方髌上囊、股四头肌各肌肌腹，膝关节内侧股薄肌肌腹及止点、收肌肌群肌腹及止点和胫骨平台附近部位进行针刀松解；空白对照组及模型组兔关节腔注射生理盐水0.3 mL；丹参注射液组兔关节腔每次注射0.3 mL丹参注射液；针刀联合丹参注射液组：每周进行1次针刀治疗同针刀组，每次针刀干预之后，关节腔注0.3 mL丹参注射液。上述干预每周1次，持续5周。对各组兔膝关节软骨进行大体观察及病理切片组织学观察，ELISA 检测关节液白细胞介素1、肿瘤坏死因子α水平。 结果与结论：①大体观察：模型组膝关节磨损较为严重，针刀组、丹参注射液组、针刀联合丹参注射液组膝关节轻度磨损；②病理切片评分：丹参注射液组评分略高于针刀组和针刀联合丹参注射液组差异无显著性意义；③ELISA 检测结果：针刀联合丹参注射液组白细胞介素1、肿瘤坏死因子α水平显著低于或针刀组或丹参注射液组(P < 0.05)；④结果说明，在兔膝关节骨关节炎模型中降低白细胞介素1、肿瘤坏死因子α水平方面，针刀松解术结合丹参注射液关节腔注射治优于单独使用针刀或单独使用丹参注射液关节腔注射。ORCID: 0000-0003-4119-633X(刘广宇) 中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程     

Change of site of intra-articular injection of hypertonic dextrose resulted in different effects of treatment

Most minimally invasive treatments for dysfunction of the temporomandibular joint (TMJ) are empirical, and aimed at the painful trigger points with the purpose of preventing muscular spasm and restoring normal function. In this prospective study I investigated whether the choice of site of injection of hypertonic dextrose affected the benefits of treatment of internal derangement and pain. I studied 72 patients with pain and clicking as a result of dysfunction of the TMJ. Patients were divided into four groups with four separate sites for intra-articular injection. Dextrose was injected into the superior joint space, inferior joint space, retrodiscal tissue, and anterior capsule injection. Results showed that the retrodiscal site was the most effective for reducing clicking and subsequently improving derangement, while the inferior joint space was the best site for the relief of pain, and the extracapsular site should be used in cases of hypermobility. In conclusion, the injection site should be selected according to the symptoms being treated, and could be used as an adjunct to other sites to improve outcome.     

Comparative Efficacy of Intra-Articular Steroid Injection and Distension in Patients With Frozen Shoulder: A Systematic Review and Network Meta-Analysis

Objective

To compare the efficacy of intra-articular (IA) steroid injection and distension in patients with frozen shoulder.

Surgical treatment of displaced intra-articular calcaneal fractures: is bone grafting necessary?

Background

The aim of this retrospective study was to determine the need for bone grafting in the surgical treatment of displaced intra-articular calcaneal fractures. We reviewed 390 cases of displaced intra-articular calcaneal fractures treated with plate osteosynthesis with or without autologous iliac bone grafting, and compared outcomes and complications related to fracture stabilization.

Materials and methods

Three hundred ninety patients with displaced intra-articular calcaneal fractures that were treated with plate osteosynthesis from December 2002 to December 2010 were reviewed. Two hundred two patients (group A) were treated by osteosynthesis with autologous bone grafting, and 188 patients (group B) were treated by osteosynthesis without bone grafting. One hundred eighty-one patients with an AO type 73-C1 fracture (Sanders type II), 182 patients with an AO type 73-C2 fracture (Sanders type III), and 27 patients with an AO type 73-C3 fracture (Sanders type IV) were included in this study. Bohler’s angle, the crucial angle of Gissane, and calcaneal height in the immediate postoperative period and at the 2-year follow-up were compared. Any change in the subtalar joint status was documented and analyzed. The final outcomes of all patients were evaluated by the AOFAS Ankle–Hindfoot Scale and compared in both groups.

Results

The mean full weight-bearing time in group A (with bone grafting) was significantly lower (median 6.2 months, range 2.8–9.2 months) than that in group B (without bone grafting; median 9.8 months, range 6.8–12.2 months). The immediate-postoperative Bohler’s angle and that at the 2-year follow-up were significantly higher in group A. The loss of Bohler’s angle after 2 years was significantly lower in group A (mean 3.5°; 95 % CI 0.8°–6.2°) than in group B (mean 6.2°; 95 % CI 1.0°–11.2°). The average change in the crucial angle and the average change in calcaneal height were not statistically significant for either group. The infection rate in the bone grafting group was higher, though statistically insignificantly so, than in the nongrafting group (8.3 vs. 6.3 %). No significant difference was found between the groups in terms of the rates of good reduction, postoperative osteoarthritis, and subtalar fusion. Regarding the efficacy outcomes, the mean AOFAS score was lower (mean 76.4 points; 95 % CI 65.8–82.9 points) in group A than in group B (mean, 81.6 points; 95 % CI, 72.3–88.8 points), but this difference was not significant (p > 0.05).

Conclusions

Bohler’s angle showed improved restoration and the patients returned to full weight-bearing earlier when bone grafting was used in the treatment of intra-articular calcaneal fracture. However, the functional outcomes and complication rates of both groups were similar.     

Development and characterization of oxaceprol-loaded poly-lactide-co-glycolide nanoparticles for the treatment of osteoarthritis

Oxaceprol is well-defined therapeutic agent as an atypical inhibitor of inflammation in osteoarthritis. In the present study, we aimed to develop and characterize oxaceprol-loaded poly-lactide-co-glycolide (PLGA) nanoparticles for intra-articular administration in osteoarthritis. PLGA nanoparticles were prepared by double-emulsion solvent evaporation method. Meanwhile, a straightforward and generally applicable high performance liquid chromatography method was developed, and validated for the first time for the quantification of oxaceprol. To examine the drug carrying capacity of nanoparticles, varying amount of oxaceprol was entrapped into a constant amount of polymer matrix. Moreover, the efficacy of drug amount on nanoparticle characteristics such as particle size, zeta potential, morphology, drug entrapment, and in vitro drug release was investigated. Nanoparticle sizes were between 229 and 509 nm for different amount of oxaceprol with spherical smooth morphology. Encapsulation efficiency ranged between 39.73 and 63.83% by decreasing oxaceprol amount. The results of Fourier transform infrared and DSC showed absence of interaction between oxaceprol and PLGA. The in vitro drug release from these nanoparticles showed a sustained release of oxaceprol over 30 days. According to cell culture studies, oxaceprol-loaded nanoparticles had no cytotoxicity with high biocompatibility. This study was the first step of developing an intra-articular system in the treatment of osteoarthritis for the controlled release of oxaceprol. Our findings showed that these nanoparticles can be beneficial for an effective treatment of osteoarthritis avoiding side effects associated with oral administration.