Intra-Articular Distal Radius Fracture with Lunate Fossa Rotated and Associated Lesions: Radiologic Analysis

Introduction: Intra-articular distal radial fractures in young patients occur in high energy trauma which can lead to a combination of bone and ligaments lesions. An articular step superior to 2 mm is pejorative, for that an adequate radiologic analysis is necessary accessing to the best surgical treatment. The purpose of our study was to investigate this type of fracture and expose radiologic analysis (radiograph and CT-scan) of bone and ligamentous associated lesions of this specific twisted lunate facet fracture for recognizing it and accessing to the best surgical treatment. Patients and Methods: Seven patients with severely displaced type 4 articular fractures of the distal radius whose wrists had been exposed to violent compression are reported in our series, they are required open treatment for the reduction and fixation of disrupted articular surfaces by using an antero-medial approach which allows direct access to the fragment of the lunate facet and easier visualization of the distal radio-ulnar joint. Results: All the patients were clinically examined with antero-posterior and lateral X ray, completed by a CT scan, all the fractures were type IV according to Melone classification. In all of our seven cases there was a lesion of the distal radioulnar joint (DRUJ) identified in the CT scan. The CT scan allowed us to individualize well the void of the lunate fossa and calculate his exact degree of rotation, which is very important for planning therapeutic management. Discussion: In all of our cases the CT scan was to expose all of the osseous and ligamentous injuries;in the sagittal reconstruction we were able to objectify and calculate the exact degree of the rotation of the lunate fossa fragment;in the frontal reconstruction the void of the lunate fossa is visible and in the axial reconstruction we can determine the incongruence of the distal radio-ulnar joint (DRUJ). Intra-articular involvement has long been recognized as a poor prognostic factor in fractures of the distal radius. However, despite early studies reporting poor results with non operative treatment for these injuries, most authors opposed operative intervention, due to lack of a good radiological analysis and the CT scan;knowledge that a number of studies have shown that inadequate reduction of intra-articular distal radius fractures leads to the development of arthritis.

Comparison of intra-articular injection of parecoxib vs oral administration of celecoxib for the clinical efficacy in the treatment of early knee osteoarthritis

BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions of oral NSAIDs in elderly people cannot be underestimated.Intra-articular injection of NSAIDs may be a new attempt for early knee osteoarthritis treatment.Parecoxib may be a suitable drug for intra-articular injection.AIM To observe the clinical efficacy of the intra-articular injection of parecoxib for early knee osteoarthritis.METHODS Early knee osteoarthritis patients(n=110)were retrospectively analyzed.These patients were divided into three groups:Basic treatment+oral glucosamine(group A,n=37),oral celecoxib+basic treatment+oral glucosamine(group B,n=37),and intra-articular injection of parecoxib+basic treatment+oral glucosamine(group C,n=36).Intra-articular injection of parecoxib was performed once every 2 wk at a dose of 40 mg each time,for three times total.The three groups were compared in terms of visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores and patient satisfaction before and after treatment.The levels of inflammatory cytokines in the synovial fluid were detected in the three groups before and after treatment.RESULTS All patients were followed up for an average of 15.5±2.7 mo.The clinical efficacy was estimated by VAS and HSS scores at 12 mo after treatment.Inflammatory cytokine levels in the synovial fluid were evaluated at 3 mo after treatment.VAS and HSS scores were significantly improved in each group compared with before(P<0.001).There were significant differences among the three groups in VAS and HSS scores(P<0.001).The clinical efficacy of group C was superior to that of groups A and B(P<0.001),while group B outperformed group A in this respect(P<0.001).The patient satisfaction was the highest in group C(P<0.001).After treatment,the levels of tumor necrosis factorα(TNF-α)and interleukin(IL)-6 in the synovial fluid decreased in each group compared with before(P<0.001),while the levels of IL-10 increased(P<0.001).The three groups differed significantly in the levels of TNF-a,IL-6 and IL-10 in the synovial fluid after treatment(P<0.001).CONCLUSION For patients with early knee osteoarthritis,intra-articular injection of parecoxib could effectively improve clinical symptoms.This method may be a reliable alternative for early knee osteoarthritis.

Intra-articular delivery of tetramethylpyrazine microspheres with enhanced articular cavity retention for treating osteoarthritis

Tetramethylpyrazine(TMP) is a traditional Chinese herbal medicine with strong antiinflammatory and cartilage protection activities, and thus a promising candidate for treating osteoarthritis. However, TMP is rapidly cleared from the joint cavity after intra-articular injection and requires multiple injections to maintain efficacy. The aim of this study was to encapsulate TMP into poly(lactic-co-glycolic acid)(PLGA) microspheres to enhance the TMP retention in the joint, reducing injection frequencies and decreasing dosage. TMP microspheres were prepared by emulsion/solvent evaporation method. The intra-articular retention of the drug was assessed by detecting the drug concentration distributed in the joint tissue at different time points. The therapeutic effect of TMP microspheres was evaluated by the swelling of knee joints and histologic analysis in papain-induced OA rat model. The prepared freezedried microspheres with a particle size of about 10 μm can effectively prolong the retention time of the drug in the articular cavity to 30 d, which is 4.7 times that of the TMP solution.Intra-articular injection of TMP microspheres efficiently relieved inflammatory symptoms,improved joint lesions and decreased the depletion of proteoglycan. In conclusion, intraarticular injection of TMP loaded microspheres was a promising therapeutic method in the treatment of OA.

Intra-articular transplantation of porcine adipose-derived stem cells for the treatment of canine osteoarthritis: A pilot study

AIM: To test whether intra-articular injection of porcine adipose-derived stem cells(ADSCs) can treat canine osteoarthritis(OA).METHODS: To enroll in this study dogs must have stifle joint OA that had lasted ≥ 3 mo and been treated with OA medication without significant improvement. Three dogs fulfilled these criteria and were thus subjects for ADSCs treatment. ADSCs were isolated from abdominal adipose tissue of a 2-mo-old female Yorkshire pig. Their stem cell marker expression was examined by immunofluorescence staining. For treatment, 5 million ADSCs were injected into the diseased joint of each dog. In the next 48 h, the patient was observed for signs of inflammatory and allergic reactions. Thepatient was then discharged to the owner and, at 2, 6, and 12 wk, followed up with orthopedic assessment, owner questionnaire, X-ray imaging, and force-plate gait analysis.RESULTS: Porcine ADSCs expressed mesenchymal stem cell markers CD90 and CD105. Injection of porcine ADSCs into canine stifle joints did not cause any inflammatory or allergic reactions. Orthopedic evaluation found improvements in two dogs, particularly at the longest time point. Owners' evaluation found increased capacity and decreased pain in all three dogs' activities such as walking and running. Radiographic evaluation did not find statistically significant differences before and after treatment. Force-plate analysis found significant improvements in all three dogs after treatment.CONCLUSION: Xenotransplantation of ADSCs for the treatment of OA is feasible. Further studies are needed to validate this novel treatment modality, which can then be implemented for the routine treatment of OA in veterinary medicine.

Nanoparticle–Cartilage Interaction: Pathology-Based Intra-articular Drug Delivery for Osteoarthritis Therapy

Osteoarthritis is the most prevalent chronic and debilitating joint disease,resulting in huge medical and socioeconomic burdens.Intra-articular administration of agents is clinically used for pain management.However,the effectiveness is inapparent caused by the rapid clearance of agents.To overcome this issue,nanoparticles as delivery systems hold considerable promise for local control of the pharmacokinetics of therapeutic agents.Given the therapeutic programs are inseparable from pathological progress of osteoarthritis,an ideal delivery system should allow the release of therapeutic agents upon specific features of disorders.In this review,we firstly introduce the pathological features of osteoarthritis and the design concept for accurate localization within cartilage for sustained drug release.Then,we review the interactions of nanoparticles with cartilage microenvironment and the rational design.Furthermore,we highlight advances in the therapeutic schemes according to the pathology signals.Finally,armed with an updated understanding of the pathological mechanisms,we place an emphasis on the development of“smart”bioresponsive and multiple modality nanoparticles on the near horizon to interact with the pathological signals.We anticipate that the exploration of nanoparticles by balancing the efficacy,safety,and complexity will lay down a solid foundation tangible for clinical translation.

Continuous Intra-Articular Ropivacaine/Tramadol Combination Infusion Therapy Improves Postoperative Outcome of Total Knee Arthroplasty

Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: Sixty patients accompanied by arthrosis were randomly divided into three equal groups: The ropivacaine group, which obtained a continuous intraarticular (IA) infusion of ropivacaine alone;the combination group, which obtained a continuous (IA) infusion of a combination of ropivacaine and tramadol at a rate of 6 ml/h for 72 h postoperatively;and the control group, which did not receive IA medications. After release of the ischemic tourniquet and assurance of haemostasis, a vacuum drainage tube was applied. The (IA) infusion was delivered through a multipored catheter for 72 h. Postoperative pain was assessed using visual analogue pain scale (VAS), and intravenous meperidine was administered as rescue analgesia if the (VAS) pain score was greater than or equal to (4) or on patient’s request. The total rescue analgesia consumption, angle of flexion of the knee and hospital stay were recorded. Results: The ability to achieve better angle of flexion was significantly higher in the combination group compared with the other groups, with a significant difference in favour of the ropivacaine group compared with the control group. At 2 h postoperatively, the mean pain (VAS) scores were significantly lower in patients who received (IA) analgesia compared with the control group and in the ropivacaine/tramadol group versus the ropivacaine group. The number of requests and total dose of rescue analgesia consumed were significantly lower with (IA) analgesia, with a significant difference in favour of the combination group. There was significant correlation between pain (VAS) scores and angle of flexion of the knee joint. Conclusion: Continuous (IA) ropivacaine/tramadol infusion safely reduced postoperative pain and spared administration of rescue analgesics with a significantly improved range of joint movement.

Primary Combined Intra-articular and Extra-articular Synovial Osteochondromatosis of Shoulder: a Case Report

PRIMARY synovial chondromatosis is a rarecondition in which foci of cartilage develop in thesynovial membrane of joints, bursae and tendonsheaths. It typically involves a single large jointin a young adult male.1 The ectopic foci of cartilage canresult in painful joint effusion, and the generation of loosebodies can cause mechanical symptoms.2,3 The etiology ofprimary synovial chondromatosis remains unknown, butmetaplastic theory is the most popular hypothesis. Thecommonly involved joints are knee, elbow, and hip.^4 Theshoulder is a rare site of synovial chondromatosis2,3,5 andthe extra-articular involvement even rarer, with only fewcases presented in literature. This report presents a rarecase of primary combined intra-articular andextra-articular synovial chondromatosis of shoulder jointtreated with arthroscopy.

Target Transfusion Intra-Articular Therapy for Osteoarthritic Joints

The comparison of biochemical composition and biophysical properties of synovial fluid and blood serum leads to a conclusion about the pathogenetic expediency of using serum as a corrector of synovial medium of osteoarthritic joints. Serum modification was realized by preliminary prescription of a single-dose drug to the patient. Then, the patient’s blood was sampled in the period of its maximal saturation with the drug. Autoserum from such blood samples was injected thrice into the knee joints affected by osteoarthritis of the 2nd or 3rd stages. The value of treatment results after 4 - 6 months of described therapeutics shows a significantly better therapeutic effect in the experimental of patient’s group as compared with the control group. The effect is connected with pain diminishing, normalization of the tissue joint nutrition, suppression of the local inflammation, and improvement of cartilage lubrication.

Arthroscopic Assessment of Intra-Articular Injury in Patients with Acute Unstable Malleolar Fracture

Introduction: Purpose to study prevalence of the intraarticular chondral lesion in the malleolar fracture by using ankle arthroscopy to fully understand the severity and complexity of the injury. Methods: Cross sectional study of 32 patients diagnosed with ankle fracture and undergone open reduction and internal fixation with arthroscopic assessment performed stimultaneously. The mechanism of injury, patterns of injury and intraarticular chondral injury were documented. Results: Mean age was 38 years (SD = 14.1, range 18 - 68 years). Eighteen were female and 14 were male. Fifteen involved syndesmostic distruption, 22 had Danis-Weber B injury and 16 had supination external rotation (SER). Ten (31.2%) had positive intraoperative cartilage injury. Significant correlation between the Lauge-Hansen classifications with positive findings with 6 had SER, 2 had pronation adduction and 2 had pronation external rotation. Conclusion: The prevalence of chondral injury in ankle fracture was quite high and may leads to poor outcome. Arthroscopy procedure allow surgeon to assess intraarticular surface and reduction of the ankle fracture which prompt further intervention that may improve the clinical outcomes and prognosis of the patients.

Treatment of metacarpophalangeal intra-articular fractures assisted with metacarpophalangeal arthroscopy

To explore the clinical results of metacarpophalangeal (MP) intra-articular fractures treatment assisted with MP arthroscopy.Methods Five patients suffered from MP joint fractures were treated with closed reduction and K-wire fixation under the MP arthroscopy.The age of the patients was from 17 to 53 years with an average of 23.5 years.There were four males and one female.All the fractures were caused by direct trauma.The head of metacarpal bone was injured in one case while the bases of proximal phalange were involved in four cases.2 were of simple fractures and 3 of comminuted fractures.No joint surface defects were found preoperatively.The duration from injury to surgery was from 5 days to 3 weeks.The treatment results were evaluated with respect to MP arthroscopical findings,the fracture union and the postoperative function.Results The fracture lines could be seen in 4 cases under arthroscopy except one located at the palmar aspect of metacarpal head,which was then treated with open reduction and internal fixation.During the examination with MP arthroscopy,one case each of volar plate injury and collateral ligament injury was found.The patients were followed up 3～6 months with an average of 4.8 months postoperatively.All the patients obtained fracture union with a smooth joint surface.The motion of involved MP joints achieved nearly to their normal active range in 3 cases.No pain or snapping was found during the movement of MP joints.There was also no lateral instability.Only in one case,because of the massive and comminuted fracture,the involved finger was immobilized with plaster for five weeks,the ROM of MP joint became 90° for flexion and -56° for extension at 5 months postoperatively.Conclusion It is a less invasive procedure with good results to treat MP joint fractures assisted with MP arthroscopy.It is suitable for some acute MP intra-articular fractures.4 refs,2 figs,1 tab.

低剂量类固醇激素联合玻璃酸钠治疗粘连性肩关节囊炎的临床效果

目的比较低剂量类固醇激素、高剂量类固醇激素及低剂量类固醇激素联合玻璃酸钠治疗粘连性肩关节囊炎的效果。方法选取2020年12月至2021年12月我科收治的60例粘连性肩关节囊炎患者为研究对象,采用随机数字表法将其分为低剂量组、高剂量组和联合组,各20例。低剂量组给予关节腔内注射0.5 mL复方倍他米松注射液,高剂量组给予关节腔内注射1 mL复方倍他米松注射液,联合组给予关节腔内注射0.5 mL复方倍他米松注射液联合2.5 mL玻璃酸钠。比较三组的治疗效果。结果治疗后2、4、8、16周,三组的视觉模拟评分法(VAS)、肩关节疼痛与功能障碍指数(SPADI)评分低于治疗前(P<0.05);治疗后2、4、8、16周,联合组的VAS、SPADI评分低于低剂量组(P<0.05);治疗后2、4、8、16周,联合组和高剂量组的VAS、SPADI评分无明显差异(P>0.05)。治疗后2、4、8、16周,三组的肩关节外展活动度及肩关节外旋活动度大于治疗前(P<0.05);治疗后2、4、8、16周,三组的肩关节外展活动度及肩关节外旋活动度无明显差异(P>0.05)。结论低剂量类固醇激素联合玻璃酸钠可以缓解粘连性肩关节囊炎患者的疼痛,改善关节功能,其效果与高剂量类固醇激素相当,优于低剂量类固醇激素。

膝关节软骨退变损伤的生物力学研究进展

膝关节是结构复杂的滑膜关节,软骨覆盖于关节表面,具有缓冲压力及减轻震荡等作用。关节软骨具有多种力学特性,受应力强度、持续时间及频率等因素影响,软骨退变损伤是个复杂的过程,从生物力学角度而言,就是异常应力超出了软骨的适应能力,进而引起软骨成分及微结构等改变。因此,生物力学因素在软骨退变损伤的进程及机制中发挥重要作用,并对软骨修复具有重要意义。综述膝关节软骨力学性能的相关研究文献,阐述软骨的生物力学特性、退变损伤过程以及生物力学因素在软骨退变损伤、修复过程中的作用及机制,为膝关节软骨相关疾病的病程发展、预防及治疗提供理论依据。

氨基葡萄糖联合膝关节腔注射富血小板血浆治疗膝骨关节炎的临床效果

目的探讨氨基葡萄糖联合膝关节腔注射富血小板血浆(PRP)治疗膝骨关节炎(KOA)的临床效果。方法选取2018年1月至2022年3月于广东省梅州市人民医院关节外科就诊的81例KOA患者,按随机数字表法分为观察组(40例)和对照组(41例)。对照组予硫酸氨基葡萄糖胶囊治疗,观察组在对照组基础上联合膝关节腔注射富血小板血浆治疗,2组均连续治疗12个月。比较2组临床疗效以及视觉模拟量表(VAS)评分、美国特种外科医院膝关节评分(HSS)、血液标本指标、关节积液指标水平以及不良反应发生率。结果观察组总有效率高于对照组[95.0%(38/40)比73.2%(30/41)](χ^(2)=7.161,P=0.008)。治疗后6、12个月,2组VAS评分均低于治疗前、且观察组低于对照组,2组HSS评分均高于治疗前、且观察组高于对照组(均P<0.05)。治疗后6、12个月,2组C反应蛋白、红细胞沉降率、白细胞介素6、透明质酸结合蛋白水平均低于治疗前、且观察组均低于对照组(均P<0.05);2组转化生长因子β1及透明质酸合酶1(HAS1)、HAS2、HAS3蛋白及mRNA水平均高于治疗前、且观察组均高于对照组(均P<0.05)。2组不良反应发生率比较差异无统计学意义(P>0.05)。结论氨基葡萄糖联合膝关节腔注射PRP治疗KOA的临床效果良好,可明显改善患者膝关节功能、减轻患者炎症反应。

初次全膝置换中氨甲环酸一种改良局部应用的效果分析

背景:近些年来,氨甲环酸被广泛应用来应对全膝关节置换术中产生的大量失血,但局部应用的最佳方法还没有定论。目的:评估术中局部应用氨甲环酸联合物理加压包扎降低全膝关节置换围术期出血量的有效性和安全性。方法:回顾性分析2021年1月至2022年12月在西安市红会医院进行全膝关节置换的90例患者,根据术中氨甲环酸不同局部使用方法将患者分为3组,每组30例。加压包扎组将2 g氨甲环酸置于关节腔内,纱布和棉垫填塞伤口后使用绷带对伤口加压包扎;周围浸润组将2 g氨甲环酸注射到关节腔周围组织;腔内注射组将2 g氨甲环酸注射于关节腔内。统计分析3组患者的出血量、手术时间、凝血指标、炎症指标以及术后并发症。结果与结论:①在总失血量、隐性失血量、血红蛋白下降值方面,周围浸润组最少,加压包扎组和周围浸润组无统计学差异(P>0.05);在术中失血量方面,加压包扎组最少,且与周围浸润组、腔内注射组比较,均有统计学差异(P<0.05);在手术时长方面,3组患者比较均无统计学差异(P>0.05);②3组患者术前,术后第1,3天凝血指标(D-二聚体、纤维蛋白降解产物)和炎症指标(C-反应蛋白、红细胞沉降率)均无统计学差异(P>0.05);③3组患者在患肢血流缓慢、肌间静脉血栓、软组织肿胀、伤口并发症发生率方面均无统计学差异(P>0.05),且均未出现深静脉血栓和肺栓塞;④局部应用氨甲环酸联合加压包扎这一方式,在操作简单、减少围术期失血量方面达到与关节腔周围注射效果相同的同时,避免了反复穿刺带来的创伤,也未增加术后并发症的发生率,值得临床推广。

MSCT和MRI在膝关节半月板、关节软骨损伤诊断及分期评估中的应用

目的:探讨多层螺旋CT(MSCT)与磁共振成像(MRI)在膝关节半月板及关节软骨损伤(MACI)诊断及分期评估中的价值。方法:对97例均接受MSCT、MRI检查的MACI患者的临床资料进行回顾性分析,金标准为关节镜诊断结果,分析MSCT、MRI的诊断效能。结果:关节镜诊断结果显示,97例患者的194个半月板中,损伤103个,未损伤91个;97例患者存在582个关节软骨面,其中损伤284个,未损伤298个;MSCT诊断结果显示,97例患者存在194个半月板,损伤106个,未损伤88个;MRI诊断结果显示,97例患者存在194个半月板,损伤109个,未损伤85个。MRI诊断膝关节半月板损伤和软骨关节损伤的准确度、特异度及敏感度均高于MSCT(P<0.05);MRI对半月板损伤分级和软骨关节损伤分期的诊断准确率高于MSCT。结论:MRI在MACI诊断中的价值优于MSCT,能准确反映损伤严重程度。

关刺法不同针刺频率及留针时效对膝骨性关节炎患者疼痛、最大主动关节活动度及血清FGF-2水平的影响

目的:探究关刺法不同针刺频率及留针时效对膝骨性关节炎(KOA)患者疼痛、最大主动关节活动度及血清成纤维细胞生长因子-2(FGF-2)水平的影响。方法:将100例KOA患者随机分为关刺1组(50例,治疗时需留针40 min, 3 d/次)与关刺2组(50例,治疗时需留针30 min, 2 d/次),治疗3周后,观察比较两组患者治疗前后的疼痛评分、骨关节炎指数(WOMAC)评分、最大主动关节活动度及血清FGF-2水平的变化情况。结果:关刺1组总有效率(45/50,90.00%),关刺2组总有效率(48/50,96.00%),两组比较差异无统计学意义(P>0.05)。治疗后,关刺1组、关刺2组KOA患者的疼痛评分和WOMAC评分(关节功能评分、僵硬评分、疼痛评分与总分)均低于治疗前,差异具有统计学意义(P<0.05),关刺2组KOA患者的疼痛评分、WOMAC评分(关节功能评分、僵硬评分、疼痛评分与总分)均低于关刺1组,差异具有统计学意义(P<0.05);关刺1组、关刺2组KOA患者的最大主动关节活动度和血清FGF-2表达水平均高于治疗前,差异具有统计学意义(P<0.05),关刺2组KOA患者的最大主动关节活动度、血清FGF-2表达水平均高于关刺1组,差异具有统计学意义(P<0.05);两组治疗期间均未出现明显的不良反应。结论:采用关刺法留针30 min, 2 d 1次的方法治疗KOA效果确切,可降低患者疼痛程度,提高血清FGF-2水平,并能改善患者最大主动关节活动度。

小针刀联合关节腔注射玻璃酸钠治疗肩周炎患者的效果

目的:分析小针刀联合关节腔注射玻璃酸钠治疗肩周炎患者的效果。方法:选取2020年3月—2023年2月福建中医药大学附属第二人民医院收治的100例肩周炎患者。根据随机数表法将其分为研究组与参考组,各50例。参考组给予关节腔注射玻璃酸钠治疗,研究组在参考组基础上给予小针刀治疗。比较两组治疗前后肩关节功能、疼痛程度及临床疗效。结果:治疗后,研究组总有效率显著高于参考组,两组活动度、功能、肌力、症状评分均升高,研究组上述指标均高于参考组,研究组视觉模拟评分法(VAS)评分低于参考组,差异有统计学意义(P<0.05)。结论:小针刀联合关节腔注射玻璃酸钠治疗肩周炎患者可以有效减轻疼痛程度,改善肩关节功能。

几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎的临床疗效分析

目的:探讨几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎的临床疗效。方法:回顾性分析2021年6月—2022年12月在南京医科大学第一附属医院骨科门诊就诊并随访的膝骨关节炎患者共164例。按治疗方式分为3组:A组(对照组,口服给药)55例,B组(几丁糖关节腔注射+口服给药)53例,C组(几丁糖联合小剂量糖皮质激素关节腔注射给药)56例。比较3组治疗前后的疼痛视觉模拟评分(visual analogue scale,VAS)、Lysholm评分、美国特种外科医院(Hospital for Special Surgery,HSS)评分和关节液炎性细胞因子白介素(interleukin,IL)-1、IL-6和肿瘤坏死因子(tumor necrosis factor,TNF)-α水平的变化,并对临床疗效进行评价。结果:所有病例均获得随访,随访时间7~12个月,无失访病例。每组治疗后的VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL-1、IL-6和TNF-α水平均优于治疗前,差异有统计学意义(P<0.05)。治疗前VAS评分、Lysholm评分、HSS评分和关节液炎性细胞因子IL-1、IL-6和TNF-α水平在3组间的差异无统计学意义(P>0.05);但治疗后各项指标在3组间的差异有统计学意义(P<0.05);两两比较显示,C组优于A、B两组,B组优于A组,差异均有统计学意义(P<0.05)。3组临床疗效评价比较,差异有统计学意义(P<0.05)。结论:几丁糖联合小剂量糖皮质激素关节腔注射治疗早中期膝骨关节炎临床疗效显著,具有创伤小,起效迅速,疗效持久的特点,同时避免了外用或口服非甾体类抗炎药的不良反应,作为一线治疗方案,建议在临床推广和使用。

关节腔冲洗联合液态浓缩生长因子注射治疗单侧颞下颌关节骨关节炎的初步研究

目的:观察关节腔冲洗联合液态浓缩生长因子(concentrated growth factor, CGF)注射治疗单侧颞下颌关节骨关节炎(temporomandibular joint osteoarthritis, TMJOA)的短期临床效果,以期为TMJOA患者提供新的治疗选择。方法:采用非随机对照研究,选择2021年6月至2023年1月于北京大学口腔医院颞下颌关节病及口颌面疼痛诊治中心就诊的单侧TMJOA患者作为研究对象,分为试验组和对照组,由患者自行选择入组。试验组行关节腔冲洗联合液态CGF注射治疗,对照组行关节腔冲洗联合透明质酸(hyaluronic acid, HA)注射治疗,分别治疗3次,每两周1次。治疗完成后6个月通过最大自主张口度、疼痛值和下颌功能受限程度等指标评价临床治疗效果,通过治疗前后的锥形束CT(cone beam CT,CBCT)图像融合技术评价髁突骨质的变化。结果:试验组纳入20例患者,其中男性3例,女性17例,平均年龄(34.40±8.41)岁;对照组纳入15例患者,其中男性1例,女性14例,平均年龄(32.20±12.00)岁,两组患者一般资料差异无统计学意义(P>0.05)。两组患者治疗前的张口度、疼痛值及下颌功能受限程度差异均无统计学意义(P>0.05),治疗后上述指标较治疗前均有所改善(P<0.05),但试验组患者治疗后的张口度显著大于对照组(P<0.05),下颌功能受限程度显著低于对照组(P<0.05)。CBCT二维图像显示两组患者治疗后的髁突骨质均较治疗前光滑,图像融合分析显示试验组10例(50.0%)患者和对照组5例(33.3%)患者的髁突出现修复改建区域,两者之间差异无统计学意义(P>0.05)。除1例试验组患者外,两组其余患者的髁突均有部分区域吸收。结论:关节腔冲洗联合液态CGF注射在短期内可以改善单侧TMJOA患者的临床症状和体征,且在增加张口度和改善下颌功能方面优于HA对照组。两组患者的CBCT融合图像均显示部分病例有髁突骨质修复改建的表现,但其与治疗方案的相关性仍需要扩大样本量进一步研究。

胫骨高位截骨促进软骨再生治疗膝骨关节炎

背景:对于全膝关节置换无法取得满意疗效的早期膝骨关节炎,胫骨高位截骨能促进受损软骨再生,缓解患者症状,是治疗膝骨关节炎的经典保膝治疗方案。目的:对胫骨高位截骨刺激膝骨关节炎软骨再生的有效性、作用机制及应用前景展开回顾与讨论,为利用胫骨高位截骨术联合软骨再生策略治疗膝骨关节炎提供理论基础。方法:计算机检索PubMed数据库、Web of Science、中国知网、万方医学数据库收录的相关文献。英文检索词为“knee osteoarthritis,high tibial osteotomy,limb alignment,chondrocytes,biomechanics,intra-articular”,中文检索词为“膝骨关节炎,胫骨高位截骨术,下肢力线,软骨细胞,生物力学,关节腔注射”,主要收集数据库中2013-2023年相关的文献,最终纳入75篇文献进行分析。结果与结论:①胫骨高位截骨纠正下肢力线能有效缓解患者的症状,延缓甚至避免全膝关节置换,是骨科阶梯化治疗的重要组成部分;②正常的力学微环境对软骨细胞的表型和功能维持是必须的,异常的力学信号可以通过初级纤毛、整合素、细胞骨架和核骨架成分等机械传感器转化为细胞内的化学信号,导致软骨基质代谢和炎症调控的紊乱;③异常应力作用后的软骨细胞在合适的应力下仍有恢复为正常表型的潜能,胫骨高位截骨术纠正力学微环境后可导致自发性软骨修复和滑膜炎症缓解;④对于尚不满足全膝关节置换的早期膝骨关节炎患者,胫骨高位截骨术联合软骨再生策略的前景值得期待。