Association Between Knee Alignment,Disease Severity and Subchondral Trabecular Bone Microarchitecture in Patients with Knee Osteoarthritis

Objective Most patients with knee osteoarthritis(OA)have alignment deformity with the change of Hip-knee-ankle(HKA)angle.The knee alignment influences load distribution at the tibial plateau.Meanwhile,change of subchondral trabecular bone microstructure is related to load bearing and OA progression.However,the relationship between knee alignment on the changes of subchondral trabecular bone microstructure and OA severity have been poorly investigated.The main goal of this work was to investigate variation in tibial plateaus subchondral trabecular bone microstructure in knee OA patients and their association with the severity of OA with the change of knee alignment.Methods Seventy-one knee OA patients planning to undergo total knee arthroplasty were enrolled in this study.The HKA angle and OA disease severity(OARSI score,compartment-specific Kellgren-Lawrence(K-L)grade and OARSI Atlas grade)based on full-leg standing posteroanterior radiographs were evaluated preoperatively in all patients.The tibial plateau collected during surgery was first used for micro-computed tomography(μCT)to analyze the subchondral trabecular bone microstructures,and then used for pathological sections to analyze cartilage degeneration(OARSI score).Pearson and spearman correlations were used to examine linear relationships between knee alignment,OA disease severity and subchondral trabecular bone microstructure.Patients were then divided into group I(HKA angle exceeds 0°in the valgus direction),group II(varus angle<10°)and group III(varus angle≥10°).The differences in subchondral trabecular bone microstructural parameters between the three groups were analyzed by the one-way ANOVA with a post hoc Tukey test.Results HKA angle was significantly correlated with all tibial plateau subchondral trabecular bone microstructure parameters.Regardless of the medial or lateral tibia,HKA angle was most strongly correlated with bone volume fraction(BV/TV),M:(r=0. 613,P<0.01);L:(r=-0.490,P<0.01).In addition,for the media-to-lateral ratios(M:L)of the subchondral trabecular bone microstructure parameters,the HKA angle is positively correlated with M:L BV/TV(r=0.658,P<0.01),M:L trabecular number(Tb.N)(r=0.525,,P<0.01),M:L trabecular thickness(Tb.Th)(r=0.636,P<0.01),and negatively correlated with M:L trabecular separation(Tb.Sp)(r=-0.636,P<0.01)and M:L Specific Bone Surface(BS/BV)(r=-0.792,P<0.01).The BV/TV,Tb.N,and Tb.Th of the medial tibia were sequentially incremented in the order of groupⅠ,Ⅱ,Ⅲof knee alignment,while the Tb.Sp and BS/BV were decreased in this order.The lateral tibia is the opposite.In addition,most of the severity indices of OA are associated with subchondral trabecular bone microstructures,of which OARSI score and BV/TV in medial tibia are the most relevant(r=0.787,P<0.01).HKA angle is significantly correlated with all OA severity grades in medial compartment,but only with OARSI score and Bone sclerosis grade in lateral compartment.Conclusions Tibial plateau subchondral trabecular bone microarchitecture is associated with the HKA angle and OA severity.With the increase of varus angle and the severity of OA,the subchondral trabecular bone in medial tibia has more obvious sclerosis changes and vice versa,suggesting that knee malalignment may promote abnormal subchondral trabecular bone remodeling by altering joint load distribution,thereby affecting the progression of OA.

Profile of Knee’s Bone and Joint Tuberculosis in Adults: About 33 Cases

The authors report toward a monocentric retrospective and descriptive study on a 08 year period, 33 cases of knee osteoarticular tuberculosis (OAT) of adult, certified by bacteriologic and/or histolological evidence proof of the sample (synovial biopsy) after a knee arthrotomy. There were 07 cases of arthritis and 26 cases of osteoarthritis. The treatment of knee OAT was medical (anti-tubercular poly-chemotherapy) on one year duration. The surgery was useful in front of some clinical presentations. After a minimum of 18 months, a functional evaluation was done following the Lequesne algo-functionnal index. None had signs of local recurrence testifying the adequacy of medical treatment, even if it is long and binding. The main of our case series is to establish an epidemiological, clinical and biological profile of the knee tuberculosis of adult and to research elements of prognosis through an analysis of results.

Total knee arthroplasty in patients with Paget's disease of bone: A systematic review

AIM To determine the functional outcomes, complications and revision rates following total knee arthroplasty(TKA) in patients with Paget's disease of bone(PDB). METHODS A systematic review of the literature was performed. Four studies with a total of 54 TKAs were included for analysis. Functional outcomes, pain scores, complications and revision rates were assessed. The mean age was 72.0 years and the mean follow-up was 7.5 years.RESULTS All studies reported significant improvement in knee function and pain scores following TKA. There were 2 cases of aseptic loosening, with one patient requiring revision of the femoral component 10 years after the index procedure. Malalignment, bone loss, soft tissue contractures were the most commonly reported intraoperative challenges. There were five cases(9%) that were complicated by intra-operative patellar tendon avulsion.CONCLUSION The findings support the use of TKA in patients with PDB. The post-operative functional outcomes are largely similar to other patients, however there are specific perioperative challenges that have been highlighted, in particular the high risk for patellar tendon avulsion.

A radiologic analysis of 136 cases of bone and joint lesions following burn

This paper reviewed 136 cases with definite bone and joint lesions selected froma total of 4286 burn patients.The clinical appearance,blood and urine biochemistry,blood cultures,gross and histological autopsy examination as well as surgical and biopsyspecimens were studied with emphasis on X-ray manifestations.The lesions were classi-fied,according to their X-ray appearances,into four types:alterations limited to thebone,alterations involving periarticular structures,changes of the joint and deformity ofthe bone and joint.The pathogenesis and radiological appearances of osteoporosis,mutila-tion of the fingers as well as incidence and pathogenesis of heterotopic para-articularossification were analysed and discussed.

Multilevel Cervicothoracic and Lumbar Pott’s Disease: About Three New and Unusual Cases in the Rheumatology Department of the Teaching Hospital of Cocody in Abidjan (Côte d’Ivoire)

Pott’s disease usually affects two contiguous vertebrae or two spinal levels. The involvement of the three cervicothoracic and lumbar levels is rarely described. Only three cases have been described in the literature to our knowledge. The authors report three new cases of tuberculous spondylodiscitis of cervicothoracic and lumbar site. Our three cases were characterized by symptoms similar to the other topographical forms of Pott’s disease. A predisposing factor is often identified like the infection with human immunodeficiency virus. The definitive diagnosis was made in two cases by identifying acid and alcohol-fast bacilli for one case and by histology for the other case. For the third case, there was a diagnostic presumption reinforced by the satisfactory outcome on tuberculosis chemotherapy for a period of 12 months. The multilevel nature of diseases does not influence the effectiveness of treatment of this form of spinal tuberculosis.

Study on the Microstructure of Human Articular Cartilage/Bone Interface

For improving the theory of gradient microstructure of cartilage/bone interface, human distal femurs were studied. Scanning Electron Microscope （SEM）, histological sections and MicroCT were used to observe, measure and model the micro- structure of cartilage/bone interface. The results showed that the cartilage/bone interface is in a hierarchical structure which is composed of four different tissue layers. The interlocking of hyaline cartilage and calcified cartilage and that of calcified car- tilage and subchondral bone are in the manner of＂protrusion-pore＂ with average diameter of 17.0 gm and 34.1 lam respectively. In addition, the cancellous bone under the cartilage is also formed by four layer hierarchical structure, and the adjacent layers are connected by bone trabecula in the shape of H, I and Y, forming a complex interwoven network structure. Finally, the simplified structure model of the cartilage/bone interface was proposed according to the natural articular cartilage/bone interface. The simplified model is a 4-layer gradient biomimetic structure, which corresponds to four different tissues of natural cartilage/bone interface. The results of this work would be beneficial to the design of bionic scaffold for the tissue engineering of articular cartilage/bone.

Association of vitamin D and knee osteoarthritis in younger individuals

BACKGROUND The incidence of primary osteoarthritis knee is gradually increasing among young individuals.The increasing prevalence of obesity,sedentary lifestyle,sporting activity,and vitamin D deficiency(VDD)has been hypothesized for this shifting disease trend.This study was designed to look for the association of serum vitamin D among these young arthritic patients.AIM To look for the association of serum vitamin D in younger knee osteoarthritis(KOA)patients.METHODS In a 2-year observational study,146 non-obese KOA patients of 35-60 years were evaluated clinically(Knee injury and Osteoarthritis Outcome Score,KOOS)and radiologically(Kellegren-Lawrence stage,KL).The serum 25(OH)D level of these patients and 146 normal healthy individuals of same age group were estimated.RESULTS Both the groups were comparable in terms of age and sex.The average serum 25(OH)D level in healthy individuals and KOA patients was 45.83 ng/mL and 34.58 ng/mL,respectively(P<0.001).Inadequate serum 25(OH)D level(<30 ng/mL)was found in 46.57%of KOA patients and 24%of normal healthy participants indicating a significant positive association(odds ratio 2.77,95%CI:1.67-4.54,P<0.001).The 25(OH)D level in KL grade I,II,III and IV was 43.40,30.59,31.56 and 33.93 ng/mL respectively(no difference,P=0.47).Similarly,the KOOS score in sufficient,insufficient and deficient groups were 65.31,60.36 and 65.31,respectively(no difference,P=0.051).CONCLUSION The serum 25(OH)D level is significantly low in younger KOA patients.However,the clinical and radiological severities have no association with serum vitamin D level.

Arthroscopic removal as an effective treatment option for intraarticular osteoid osteoma of the knee

BACKGROUND Intra-articular osteoid osteoma(iaOO)can be found in 5.2%up to 10%of cases.They may cause non-specific symptoms,mimicking degenerative or traumatic pathologies.If iaOO is left untreated,it may lead to severe muscle atrophy,tenderness,swelling,and limited range of motion.Therefore,surgical treatment is recommended.The main goal of surgical treatment is complete removal or destruction of iaOO.AIM To evaluate the efficiency of arthroscopic removal of iaOO of the knee in our cases and cases available in the literature.METHODS Analysis of available hospital records of four patients with iaOO of the knee treated by arthroscopic removal from August 2005 to December 2015 at our Department was performed.All patients had a diagnosis of iaOO confirmed by histopathologic analysis.Additional literature review of cases of iaOO of the knee available on PubMed and Google Scholar was made.All cases of iaOO of the knee treated by arthroscopic or arthroscopically assisted removal were reviewed in order to further evaluate the efficiency of the method.RESULTS The average age of patients included in our study was 23.2(range 16-37)years.The average duration of the symptoms prior to surgery was 14.2(range 6-24)months.All of the patients had persistent knee pain.Three patients reported worsening of pain during the night,while two reported worsening of pain during activity.Three patients reported alleviation of pain on non-steroidal anti-inflammatory drugs(NSAIDs),while one patient reported partial alleviation of pain on NSAIDs.No intraoperative complications were noted,and the postoperative period was uneventful in all patients.The patients reported immediate pain relief in the postoperative period.No recurrence of the disease was noted in any of the patients during the follow-up period of at least 24 mo.The literature review revealed 14 cases with an average age of 27.6(range 16-48)years and onset of symptoms 27.7(range 6-108)months prior to surgery,with recurrence of the disease noted in a single case.CONCLUSION Arthroscopic removal is an efficient treatment method that allows excision of iaOO that is neither insufficient nor excessive,thus avoiding disease recurrence while obtaining adequate material for histopathologic analysis.

Limb length discrepancy after total knee arthroplasty: A systematic review and meta-analysis

BACKGROUND Limb length discrepancy(LLD)after total knee arthroplasty(TKA)has been considered as one of the reasons for the unsatisfactory outcome.However,there is no consensus about the extent of LLD that can be considered as clinically relevant.AIM To evaluate the incidence of radiographic LLD and its impact on functional outcome following TKA.METHODS All randomized-controlled trial and observational studies on LLD in TKA,published till 22nd June 2020,were systematically searched and reviewed.The primary outcome was“limb lengthening or LLD after TKA”.The secondary outcomes included“assessment of LLD in varus/valgus deformity”and“impact of LLD on the functional outcome”.RESULTS Of 45 retrieved studies,qualitative and quantitative assessment of data was performed from eight studies and six studies,respectively.Five studies(n=1551)reported the average limb lengthening of 5.98 mm.The LLD after TKA was ranging from 0.4±10 mm to 15.3±2.88 mm.The incidence of postoperative radiographic LLD was reported in 44%to 83.3%of patients.There was no difference in the preoperative and postoperative LLD(MD-1.23;95%CI:-3.72,1.27;P=0.34).Pooled data of two studies(n=219)revealed significant limb lengthening in valgus deformity than varus(MD-2.69;95%CI:-5.11,0.27;P=0.03).The pooled data of three studies(n=611)showed significantly worse functional outcome in patients with LLD of≥10 mm compared to<10 mm(standard MD 0.58;95%CI:0.06,1.10;P=0.03).CONCLUSION Limb lengthening after TKA is common,and it is significantly more in valgus than varus deformity.Significant LLD(≥10 mm)is associated with suboptimal functional outcome.

Comprehensive meta-analysis of antibiotic-impregnated bone cement versus plain bone cement in primary total knee arthroplasty for preventing periprosthetic joint infection

Purpose:Antibiotic-loaded bone cement(ALBC)was usually used to prevent periprosthetic joint infection(PJI)in primary total knee arthroplasty(PTKA),but whether to use ALBC or plain bone cement in PTKA remains unclear.We aimed to compare the occurrence rate of PJI using two different cements,and to investigate the efficacy of different antibiotic types and doses administered in preventing surgical site infection(SSI)with ALBC.Methods:The availability of ALBC for preventing PJI was evaluated by using a systematic review and meta-analysis referring to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Existing articles until December 2021 involving PTKA patients with both ALBC and plain bone cement cohorts were scanned by searching"total knee arthroplasty","antibiotic-loaded cement","antibiotic prophylaxis","antibiotic-impregnated cement"and"antibiotic-laden cement"in the database of PubMed/MEDLINE,Embase,Web of Science and the Cochrane Library.Subgroup analysis included the effectiveness of different antibiotic types and doses in preventing SSI with ALBC.The modified Jadad scale was employed to score the qualities of included articles.Results:Eleven quantitative studies were enrolled,including 34,159 knees undergoing PTKA.The meta-analysis results demonstrated that the use of prophylactic ALBC could significantly reduce the prevalence of deep incisional SSI after PTKA,whereas there was no significant reduction in the rate of superficial incisional SSI.Moreover,gentamicin-loaded cement was effective in preventing deep incisional SSI,and the use of high-dose ALBC significantly reduced the rate of deep incisional SSI after PTKA.Besides,no significant adverse reactions and complications were stated during the use of ALBC in PTKA.Conclusion:The preventive application of ALBC during PTKA could reduce the rates of deep PJI.Furthermore,bone cement containing gentamicin and high-dose ALBC could even better prevent deep infection after PTKA.However,the existing related articles are mostly single-center and retrospective studies,and further high-quality ones are needed for confirmation.

Intra-articular injection of stromal vascular fraction for knee degenerative joint disease:a concise review of preclinical and clinical evidence

Autologous fat-derived stromal vascular fraction(SVF) is a mixed cell population that has been used for many years in regenerative plastic surgery.In terms of animal and clinical research,this concise review was performed to evaluate the efficacy of SVF in knee degenerative joint disease(KDJD),which could cause pain,disability and severely affect patients’ lives.Thirteen studies retrieved and screened from the databases were included,including six animal studies and seven clinical trials.The metaanalysis of clinical research shows that intra-articular injection of SVF,in combination with adjuvant surgery,could alleviate pain and improve early functional recovery for patients with KDJD at Kellgren-Lawrence(KL) grades Ⅱ–Ⅲ.

Clinical Application of Double-hand Needling Manipulation

Double-hand manipulation is a needling technique, with which No. 30 filiform needles of various lengths are selected and inserted into the affected part of the body in opposite directions or symmetrically upward-downward, rightward- leftward, anteriorly-posteriorly to the point, followed by needle twirling with both hands. When the two opposite needle tips are twirled to a certain degree, the soreness, warm, numbness, and distending needling sensation tends be connected in a line, forming a rather strong needling sensation. After such manipulation for some time, the needles are retained for 30 min., during which the needle manipulation is given 3-5 times at intervals. This needling treatment is given once daily. The author of this article has adopted this manipulation method in the acupuncture treatment of various diseases with quite satisfactory results. Some of the sample cases are listed as follows.

中药外敷联合复合超声关节治疗仪治疗膝骨关节炎的临床效果

目的探究中药外敷联合复合超声关节治疗仪在膝骨关节炎(KOA)中的应用效果。方法选取2022年8月至2023年8月就诊于安阳市中医院的99例KOA患者为研究对象,随机分为3组,每组33例。超声组接受超声关节治疗仪治疗,中药组接受中药外敷治疗,联合组接受中药外敷联合超声关节治疗仪治疗。对比3组疗效及治疗前后西安大略和麦克马斯特大学骨关节炎指数(WOMAC)、视觉模拟评分法(VAS)、奎森功能演算(Lequesne)指数评分、成纤维细胞生长因子2(FGF-2)、Ⅰ型胶原C-末端肽(CTX-I)、软骨寡聚基质蛋白(COMP)及不良反应。结果联合组总有效率[93.94%(31/33)]高于超声组[75.76%(25/33)]、中药组[72.73%(24/33)](P<0.05),超声组与中药组总有效率对比,差异无统计学意义(P>0.05);治疗3个疗程后联合组FGF-2高于超声组、中药组,CTX-1、COMP、Lequesne、WOMAC评分低于超声组、中药组(P<0.05),超声组、中药组组间对比,差异无统计学意义(P>0.05);治疗3个疗程后联合组静态、动态VAS评分<中药组<超声组(P<0.05);治疗期间3组均未出现不良反应。结论中药外敷与复合超声关节治疗仪联合治疗KOA患者效果确切,可有效调节骨代谢指标,有助于缓解患者疼痛感,恢复膝关节功能。

下肢洗剂治疗膝骨关节炎临床观察

目的探讨下肢洗剂治疗膝骨关节炎的效果。方法选择60例膝骨关节炎患者作为研究对象,将其随机分成试验组和对照组,各30例。对照组给予双氯芬酸二乙胺乳胶剂外用,试验组给予下肢洗剂外用,2组均持续治疗2周。观察2组的临床疗效,比较2组治疗前后西安大略大学和麦克马斯特大学骨关节炎指数(WOMAC)量表评分、膝关节综合评分、血清学指标变化情况,以及不良反应发生情况。结果试验组的愈显率为66.67%(20/30),高于对照组的50.00%(15/30),差异有统计学意义(P<0.05)。治疗后,2组患者的WOMAC量表评分、膝关节综合评分及白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)水平均有不同程度下降,且试验组下降程度大于对照组,差异有统计学意义(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)。结论下肢洗剂对于阳虚寒凝型膝骨关节炎具有治疗作用,可以很好地改善其临床症状,使血清炎性因子水平降低,在临床有一定的应用推广价值。

NLRP3炎症小体的激活在骨关节疾病中的研究进展

炎症是对多种刺激的关键反应,细胞因子等炎症分子在包括骨和关节疾病在内的多种疾病的发病机制中发挥核心作用。促炎性细胞因子主要由免疫细胞产生,介导炎症和先天免疫反应。炎症小体是新近公认的先天免疫的重要参与者。最典型的是NOD样受体蛋白3(NLRP3)炎症小体,NLRP3检测外源性致病性侵袭和内源性细胞损伤,并通过形成NLRP3炎症小体做出反应。NLRP3炎症小体的3个主要成分是NLRP3(捕获危险信号并募集下游分子)、半胱氨酸天冬氨酸蛋白水解酶-1[caspase-1,引起细胞因子白细胞介素-1β(IL-1β)和IL-18的成熟以介导细胞因子释放和焦亡]和含有半胱天冬酶募集结构域的细胞凋亡相关斑点样蛋白(ASC,是连接NLRP3和caspase-1的桥梁)。此外,促炎性细胞因子加速骨吸收和软骨破坏,导致骨和关节组织破坏。因此,促炎性细胞因子参与调节骨和关节疾病的发病机制。该文综述了近年来关于NLRP3炎症小体在骨关节疾病中激活和功能等方面的研究进展。

MRI诊断膝关节外伤性骨挫伤的效果

目的:分析MRI诊断膝关节外伤性骨挫伤的效果。方法:选取2023年2月—2024年3月天长市人民医院接诊的疑似膝关节外伤性骨挫伤患者79例作为研究对象,均接受CT、MRI检查。以关节镜及组织学检查结果为“金标准”,比较MRI和CT的灵敏度、特异度、准确度,对膝关节外伤性骨挫伤分型、损伤类型的检出率。结果:MRI诊断灵敏度、准确度高于CT,差异有统计学意义(P<0.05);MRI、CT诊断特异度比较,差异无统计学意义(P>0.05)。MRI和CT对膝关节外伤性骨挫伤分型的检出率比较,差异无统计学意义(P>0.05)。MRI韧带损伤、半月板损伤、积液、软组织肿胀检出率高于CT,差异有统计学意义(P<0.001)。结论:MRI诊断膝关节外伤性骨挫伤的灵敏度、准确度较高,对韧带损伤、半月板损伤、积液、软组织肿胀等损伤类型的检出率较高。

关节腔靶向注射臭氧联合中药外敷治疗早期类风湿关节炎膝关节病变的临床研究

目的:探究关节腔靶向注射臭氧联合中药外敷治疗早期类风湿关节炎膝关节病变的临床效果。方法:回顾性选取九江市第一人民医院2022年6月—2023年9月收治的80例早期类风湿关节炎膝关节病变患者,根据治疗方案将其分为联合组(n=47)和对照组(n=33),对照组采用临床常规治疗方案,即采用曲安奈德进行关节腔注射治疗,联合组采用关节腔靶向注射臭氧联合中药外敷治疗。均治疗3周。比较两组疗效;比较两组治疗前后的C反应蛋白(CRP)、抗环瓜氨酸多肽抗体(ACCP)、类风湿因子(RF)和甘露聚糖结合凝集素(MBL)水平;比较两组治疗前后的视觉模拟评分法(VAS)评分及关节超声评估情况。结果:联合组总有效率为93.62%,高于对照组的72.73%,差异有统计学意义(P<0.05)。治疗后,两组血清RF、CRP、ACCP水平均低于治疗前,且联合组均低于对照组;两组血清MBL水平均高于治疗前,且联合组高于对照组,差异均有统计学意义(P<0.05)。治疗后,两组髌上囊积液深度、髌上囊滑膜厚度、VAS评分均低于治疗前,且联合组均低于对照组,差异均有统计学意义(P<0.05)。结论:关节腔靶向注射臭氧联合中药外敷治疗早期类风湿关节炎膝关节病变的效果较好,可以显著改善患者的血清学指标和疼痛程度,并减轻膝关节病变。

根据首诊影像学表现构建模型预测低级别膝关节软骨下功能不全性骨折进展

目的根据膝关节软骨下功能不全性骨折(SIFK)首诊影像学因素构建模型,预测其进展。方法回顾性分析60例低级别(1级或2级)SIFK患者,根据1年后SIFK分级将其分为进展组(进展为3级或4级,n=30)及无进展组(仍为1级或2级,n=30);比较2组首诊临床及影像学资料。根据组间差异有统计学意义的首诊影像学表现建立多因素logistic回归模型,预测低级别SIFK进展;绘制受试者工作特征曲线,计算曲线下面积(AUC),评价模型预测价值,并与单一预测因素进行比较。结果组间胫骨内翻角、胫骨后倾角(PTS)、病变髁软骨损伤分级、内侧半月板挤压距离、内侧半月板后角根部损伤及撕裂类型差异均有统计学意义(P均<0.05)。根据首诊影像学所见PTS、病变髁软骨损伤分级和内侧半月板挤压距离构建的预测低级别SIFK进展的回归模型为Logit(P)=-0.561+0.300×PTS(°)+1.702×病变髁软骨损伤分级+0.874×内侧半月板挤压距离(mm),其AUC为0.962,高于任意单一预测因素(P均<0.05)。结论根据首诊影像学所见PTS、病变髁软骨损伤分级和内侧半月板挤压距离构建的回归模型预测低级别SIFK进展的价值良好。

多金属暴露与骨关节疾病的关联研究

目的探讨广东省居民多金属暴露与骨关节疾病的相关性。方法采用以社区为基础的横断面研究方法,从广东省11个地区招募3063名成年人,并测量了13种金属的血液浓度,以评估内暴露水平。运用多变量Logistic回归分析血液金属水平与骨关节疾病的关系。结果在单金属模型中,血铬、锌和铜浓度与骨关节疾病风险呈现显著剂量反应关系(All P_(-trend)≤0.05)。进一步通过多金属模型发现,与血铜和锌浓度处于低水平组(Q1)人群相比,最高水平组(Q4)血铜、锌浓度与骨关节疾病有关(OR=0.78,95%CI:0.53~0.93;OR=1.38,95%CI:1.07~1.34)。结论人群暴露环境铜和锌与骨关节疾病有关,研究结果需要在更大的人群研究中验证。

股骨内侧髁软骨下不全骨折与内侧半月板损伤模式及外突的相关性

目的观察股骨内侧髁软骨下不全骨折(SIF)与内侧半月板损伤模式及内侧半月板外突(MME)的相关性。方法回顾性分析经临床确诊的36例单侧股骨内侧髁SIF患者,根据SIF分级分为低级别组与高级别组。对比组间软骨损伤分级、半月板损伤及MME,分析SIF分级与软骨损伤、骨坏死体积(OV)及MME的相关性;比较不同半月板外突分级患者软骨损伤分级、OV及MME,分析其相关性。结果高、低级别组各含18、18例SIF。高级别组存在Ⅲ~Ⅳ级软骨损伤者占比高于,OV及MME值(内侧半月板外缘垂线至胫骨平台软骨边缘垂线的距离)均大于低级别组(P均<0.05);组间半月板后角损伤分级差异有统计学意义(P=0.007)。SIF级别与软骨损伤分级、OV、MME值均呈正相关(r_(s)=0.710、0.765、0.540,P均≤0.01)。MME值与半月板损伤程度、撕裂范围均呈正相关(r_(s)=0.502、0.520,P均<0.01)。MME分级0、1、2级分别为4、19、13例,不同MME分级间软骨损伤分级、OV、MME值差异均有统计学意义(P均<0.05)。MME值与软骨损伤分级及OV均呈正相关(r s=0.451、0.579,P均<0.01)。结论SIF患者OV及软骨损伤与内侧半月板损伤模式及MME均存在相关性。