关节假体置换术对四肢骨折患者疼痛程度及关节功能的影响

目的:探讨关节假体置换术对四肢骨折患者疼痛程度及关节功能的影响。方法:选择92例四肢骨折患者为研究对象,采用随机数字表法分为观察组48例及对照组44例,观察组采取关节假体置换术,对照组采取动力髋螺钉内固定术。比较两组患者疼痛程度、关节功能及并发症。结果:术后1d、7d、14d,观察组疼痛程度均明显低于对照组(P<0.05);术后3月、6月,观察组Harris、LKSS评分均明显高于对照组(P<0.05);并发症明显低于对照组(P<0.05)。结论:关节假体置换术有助于缓解患者术后疼痛程度,改善关节功能,减少术后并发症。

Alignment Techniques in Total Knee Arthroplasty:Where do We Stand Today?

Achieving optimal alignment in total knee arthroplasty(TKA)is a critical factor in ensuring optimal outcomes and long-term implant survival.Traditionally,mechanical alignment has been favored to achieve neutral post-operative joint alignment.However,contemporary approaches,such as kinematic alignments and hybrid techniques including adjusted mechanical,restricted kinematic,inverse kinematic,and functional alignments,are gaining attention for their ability to restore native joint kinematics and anatomical alignment,potentially leading to enhanced functional outcomes and greater patient satisfaction.The ongoing debate on optimal alignment strategies considers the following factors:long-term implant durability,functional improvement,and resolution of individual anatomical variations.Furthermore,advancements of computer-navigated and robotic-assisted surgery has augmented the precision in implant positioning and objective measurements of soft tissue balance.Despite ongoing debates on balancing implant longevity and functional outcomes,there is an increasing advocacy for personalized alignment strategies that are tailored to individual anatomical variations.This review evaluates the spectrum of various alignment techniques in TKA,including mechanical alignment,patient-specific kinematic approaches,and emerging hybrid methods.Each technique is scrutinized based on its fundamental principles,procedural techniques,inherent advantages,and potential limitations,while identifying significant clinical gaps that underscore the need for further investigation.

老年髋关节置换术应用不同麻醉方式的价值探析

目的探讨老年髋关节置换术应用不同麻醉方式的价值。方法回顾2016年1月—2017年2月84例老年髋关节置换术患者并分组。对照组用全麻方式,研究组用腰硬联合麻醉方式。比较两组老年髋关节置换术麻醉优良率;麻醉起效时间、麻醉后心率、血压变化;麻醉不良事件出现率。结果研究组老年髋关节置换术麻醉优良率高于对照组,P<0.05;研究组麻醉起效时间、麻醉后心率、血压变化优于对照组,P<0.05;研究组麻醉不良事件出现率低于对照组,P<0.05。结论老年髋关节置换术应用腰硬联合麻醉的价值高,可更快起效,稳定生命体征,减少并发症发生,安全和可行性高。

逆行交锁髓内钉结合CPM治疗股骨远端骨折24例

目的:总结应用逆行交锁髓内钉内固定结合膝关节功能康复器(CPM)治疗股骨远端骨折的疗效及经验。方法:应用逆行交锁髓内钉固定股骨远端骨折,术后配合CPM行患肢膝关节功能锻炼。结果:24例术后随访5～20月。骨折愈合时间为3～5月。膝关节功能恢复良好,优良率83.3%,无畸形愈合、不愈合、断钉、感染等并发症。结论:逆行交锁髓内钉结合CPM治疗股骨远端骨折固定坚强,并发症少,利于骨折愈合及关节功能恢复,是较理想的治疗方法。

Structure and function of aggrecan

Aggrecan is the major proteoglycan in the articular cartilage. This molecule is important in the proper functioning of articular cartilage because it provides a hydrated gel structure (via its interaction with hyaluronan and link protein) that endows the cartilage with load-bearing properties. It is also crucial in chondroskeletal morphogenesis during development. Aggrecan is a multimodular molecule expressed by chondrocytes. Its core protein is composed of three globular domains (G1, G2, and G3) and a large extended region (CS) between G2 and G3 for glycosaminoglycan chain attachment. G1 comprises the amino terminus of the core protein. This domain has the same structural motif as link protein. Functionally, the G1 domain interacts with hyaluronan acid and link protein, forming stable ternary complexes in the extracellular matrix. G2 is homologous to the tandem repeats of G1 and of link protein and is involved in product processing. G3 makes up the carboxyl terminus of the core protein. It enhances glycosaminoglycan modification and product secretion. Aggrecan plays an important role in mediating chondrocyte-chondrocyte and chondrocyte-matrix interactions through its ability to bind hyaluronan.

Effect of Gui Zhi decoction on enteric mucosal immune in mice with collagen-induced arthritis

AIM： To explore the effect of Gui Zhi decoction on enteric mucosal immune in type Ⅱ collagen-induced arthritis （CIA） in DBA mice. METHODS： Eighty DBA/1, weighing 18-22 g, were randomly divided into four groups with 20 in each group： control group, CIA group, treatment groups at high dosage and low dosage （GZH and GZL）. CIA was induced by immunization with type Ⅱ collagen （CII） emulsified with equal complete adjuvant at 0.1 mg CII each mouse. Blood lymphocyte suspension was screened for CD4 and CD8 expression using a flow cytometry, the CD4 and CD8 and secretory IgA （sIgA）-positive cells in enteric lamina propria tested with immunohistochemical staining. Tumor necrosis factor-alpha （TNF-α）, interleukin-1 （IL-1）-β, and IL-6 concentrations in serum were assayed with RIA. RESULTS： Gui Zhi decoction can lower the arthritic scores and decrease the occurrence of arthritis. The CD4, CD8, and sIgA-positive cells in CIA mice are less than in control mice, and in Gui Zhi decoction at high dosage could restore the lowered CD4- and CD8-positive cells in lamina propria, and at both high and low dosages could increase the lowered sIgA-positive cells in lamina propria, even still lower than in normal mice. In periphery, the CD4 cells in periphery are higher in CIA mice than in control mice, and Gui Zhi decoction at high and low dosages could decrease the CD4 and CD8 cells. Also, Gui Zhi decoction at high dosage could decrease the IL-6 and TNF-α concentration in serum. CONCLUSION： Gui Zhi decoction can lower the arthritic scores and decrease the incidence of CIA in mice, and the mechanism is in part regulating enteric mucosal immune.

The Influence of Transportation Revolution on Local Tourism Development--An Example of Puli Area of Taiwan

The purpose of this research is to explore the influence of transportation revolution on local tourism development. The study area--Pull area--is a place to stop along the way to the two most popular international destinations--Sun Moon Lake and Qing-Jing Farm of Central Taiwan. Pull area once was the tourism community providing dining and accommodation facilities for the travelers heading to the two international destinations, but since the availability of National Highway 6 more efficiently connects to National Highway 1 to the public, travelers get to the two international destinations becoming easier. Pull area definitely transformed its nodal function of tourism, and further reconstructed the new spatial relationships among the travel nodes of destinations after the transportation revolution. In this research, the author termed this phenomenon of travel nodes of secondary nodes or primary nodes emerging on rapidly in tourism development after transportation revolution to ＂vine effect＂.

Effects of electroacupuncture on the proprioception of athletes with functional ankle instability

Objective To observe the efficacy differences between electroacupuncture （EA） and physiotherapy （PT） on the proprioception of athletes with functional ankle instability （FAI）. Methods Fifty athletes with FAI were randomly divided into an EA group and a PT group. The EA group was treated with EA at Jiexi （解溪 ST 41）, Kunlun （昆仑 BL 60）, Qjuxu （丘墟 GB 40） and Ashi points, and the PT group was treated with low frequency electrical stimulation and infrared radiation at medial malleolus and lateral malleolus, thrice each week for consecutive 8 weeks. The joint position sense： active （JPSA）, joint position sense： passive （JPSP） and Kinaesthesia （KT） were assessed at the ankle by use of Biodex System isokinetic dynamometer to test the proprioception before and after the treatment. Results In the EA group, JPSA of 11.09°±3.1° and JPSP of 9.67°±2.8° before the treatment were reduced to 9.14°±4.0° and 6.89°±3.3° respectively after the treatment, and there were statistically significant differences in comparison between pre- and post-treatment （all P〈0.05）. Comparison between the EA group and the PT group, there were significant differences in JPSA and JPSP （all P〈0.05）, no significant difference in KT （P〉0.05）. There were no significant differences in the indices of JPSA, JPSP and KT in the PT group after the treatment than those before the treatment （all P〉0.05）. Conclusion EA can effectively improve the proprioception of athletes with FAI and achieve a better efficacy as compared with the conventional physiotherapy.

Influence of distal tibiofibular synostosis on ankle function

Objective： To study the influence of distal tibiofibular synostosis on ankle function. Methods： Prom October 1998 to October 2004, a total of 281 consecutive patients underwent operations because of ankle fractures or distal fractures of the tibia and fibula. Distal tibiofibular synostosis occurred after operation in 8 patients. The duration of follow-up averaged 20.6 months （14-44 months）. The ankle function was assessed on the basis of functional rating system described by Mazur. Results： According to Mazur＇s ankle evaluation system, 4 patients achieved an excellent result, 2 a good result and 2 a fair result. The dorsiflexion of the synostosis ankle reduced by 8.26 degrees as compared with that of the contralateral ankle, and there was little influence on the plantar flexion. All the patients had a normal gait. Conclusion： The distal tibiofibular synostosis after the operation of ankle fractures or distal fractures of the tibia and fibula usually gives rise to few symptoms and needs no specific treatment.

Clinical observation on tuina plus Baixiao moxibustion for temporomandibular joint dysfunction syndrome

Objective:To observe the clinical effect of tuina plus Baixiao moxibustion in the treatment of temporomandibular joint dysfunction syndrome(TJDS).Methods:A total of 70 TJDS patients who met the inclusion criteria were randomized into an observation group and a control group by flipping a coin,with 35 cases in each group.Patients in the observation group were treated with tuina plus Baixiao moxibustion,while patients in the control group received oral intake of diclofenac potassium(75 mg/pill),1 pill after every dinner.Both tuina and Baixiao moxibustion were done once a day during treatment.The therapeutic evaluation was evaluated after 10 treatments in both groups.The maximum mouth opening distanee and visual analog scale(VAS)were observed before and after treatment,and the therapeutic efficacy was also compared.Results:After treatment,the maximum mouth opening distanee and VAS improved in both groups(all P<0.05);both items in the observation group were superior to those in the control group(both P<00.05).The total effective rate was 91.4%in the observation group,versus 74.3%in the control group,and the between-group comparison of the total effective rate showed statistical significanee(P<0.05).Conclusion:Tuina plus Baixiao moxibustion can effectively improve TJDS patient's temporomandibular joint function and alleviate pain,with better efficacy than oral intake of diclofenac potassium.

Treatment of Temporomandibular Joint Dysfunction Syndrome by Acupuncture,Taiyi Moxa-cigar Plus Tuina

Summary： Fouty-five cases of temporomandibular joint dysfunction syndrome were diagnosed by Xray, excluding the organic diseases. The acupoints Xiaguan （ST 7）, Jiache （ST 6）, Yifeng （TE 17） and Hegu （LI 4） on the affected side were punctured first, after removal of needles, 5-7 layers of cotton cloth was placed on the above acupoints, then moxibustion with moxa-roll made of Chinese medicine was performed. Finally Dian-finger pressing, An-pressing and Rou stationary circular pressing with finger belly of the thumb were applied to the local region around the mandible joint for 3-5 min. After 1-2 courses of treatments, 45 cases all got effect.

Spiral CT arthrography of multiplanar reconstruction and virtual arthroscopy technique in diagnosis of knee with internal derangements

Objective:To evaluate the values of spiral CT arthrography with multiplanar reconstruction and virtual arthroscopy technique i n diagnosis of internal derangements of the knee. Methods:Ten bovine knees were used for experiment. The menisci , anterior and posterior cruciate ligaments and cartilage of these 10 bovine kne es were injured with a hook. Each of the joints was injected with 100 ml air, th en soon scanned with a PQ6000 spiral computed tomography scanner. The data obtai ned was input into the work station, and multiplanar reconstruction technique wa s used to illustrate lesions in the knees. The results of CT diagnosis were comp ared to those found by gross inspection of the specimens. Clinically, 10 knees o f 9 patients diagnosed as internal derangement were evaluated with the same meth od after 50-70 ml air was injected into each of the joints. Nine months later, the data of 2 patients were used for CT endoscopy reconstruction. The results we re compared with intraoperative findings. Results:Experimentally, the sensitivity and specificity were 88.9 % and 93.9 % by detection of meniscal abnormalities, 85.7 % and 10 0% by detection of cruciate ligament lesions, and 72.7 % and 100% by detectio n of cartilage damage, respectively. Clinically, the sensitivity and specificity were 90.0 % and 95.0 % by detection of meniscal lesion. As to ligament, t he figures were 85.7 % and 100% respectively. Images of virtual arthroscopy s imulated the images of real arthroscopy. Conclusions:Spiral CT arthrography of multiplanar reconstructi on technique offers fine images of internal structures of the knee, with clear b order and internal structure. It is an accurate method for detecting meniscal, cruciate and collateral ligament and cartilaginous lesions that cause internal d erangement of the knee. Virtual arthroscopy technique is a hopeful method for de tecting reasons of derangement of the knee.

Image formation of brain function in patients suffering from knee osteoarthritis treated with moxibustion

OBJECTIVES:Functional magnetic resonance imaging(fMRI) technology was used to study changes to the resting state blood flow in the brains of patients with knee osteoarthritis(KOA) before and after treatment with moxibustion at the acupoint of the left Dubi(ST 35) and to probe the cerebral mechanism underlying the effect of moxibustion.METHODS:The resting state brain function of 30 patients with left KOA was scanned with fMRI before and after treatment with moxibustion.The analytic methods of fractional amplitude of low frequency fluctuation(fALFF) and regional homogeneity(ReHo) were used to observe changes in resting state brain function.RESULTS:The fALFF values of the right cerebrum,extra-nucleus,left cerebellum,left cerebrum and white matter of patients after moxibustion treatment were higher than before treatment,and the fALFF values of the precentral gyrus,frontal lobe and occipital lobe were lower than before treatment(P<0.05,K≥85).The ReHo values of the thalamus,extra-nucleus and parietal lobe of patients were much higher than those before moxibustion treatment,and the ReHo values of the right cerebrum,left cerebrum and frontal lobe were lower than before treatment(P<0.05,K≥85).CONCLUSION:The influence of moxibustion on obvious changes in brain regions basically conforms to the way that pain and warmth is transmitted in the body,and the activation of sensitive systems in the body may be objective evidence of channel transmission.The regulation of brain function by moxibustion is not in a single brain region but rather in a network of many brain regions.

Effect of Xinfeng capsule on pulmonary function in a adjuvant arthritis rat model

OBjECTIVE:To observe the relationship between reduced pulmonary function and regulatory T cells(Tregs)and helper T cells(Th)1/Th2 drift in a rat model of adjuvant arthritis(AA),and to study the impact of Xinfeng capsule(XFC)on pulmonary function and investigate the mechanism of action.METHODS:Forty rats were randomly divided into normal control group(NC),model control group(MC),Tripterygium glycosides tablet group(TPT),and XFC group,with 10 in each.Except for the NCgroup,AA was induced in all rats by intracutaneous injection of 0.1 mL Freund's complete adjuvant in the right paw.On the 19th day after modeling,the NC and MC groups were given physiological saline(0.9%),while the TPT and XFC groups were given TPT(10 mg/kg)and XFC(2.4 g/kg),once daily,respectively.Thirty days after administration,changes in paw swelling,arthritis index(AI),pulmonary function,levels of serumγ-interferon(IFN-γ)and interleukin(IL)-4,Tregs in peripheral blood,and IFN-γ,IL-4,Forkhead box transcription factor 3(FoxP3)in lung tissue were observed by enzyme-linked immunosorbent assay,flow cytometry,polymerase chain reaction,and western blot.RESULTS:Compared with the NC group,paw swelling,AI,IFN-γ,and Th1/Th2 were increased,and pulmonary function parameters,IL-4,FoxP3 were decreased significantly in the MC group(P<0.05 or P<0.01).Pulmonary function parameters,Treg,IL-4,FoxP3(and mRNA)were higher,and paw swelling,AI,and IFN-γ(and mRNA)were lower in the XFC group than those in the MC group.The XFC group was also much better than theTPT group in improving pulmonary function,FoxP3 mRNA,IFN-γ,IL-4,Th1/Th2,and IL-10(P<0.05 or P<0.01).CONCLUSION:Xinfeng capsule can improve pulmonary function by regulating the levels of Tregs,inhibiting the activation of Th1 to Th2 cells,inducing drift,maintaining cell immune suppression,correcting the imbalance of Th1/Th2,and reducing inflammatory mediators.

Posterolateral rotatory instability of the elbow： a case report and literature review

Posterolateral rotatory instability of the elbow describes a condition that radial head subluxation or dislocation occurs when forearm rotates externally in relation to humerus. It is difficult to diagnose and treat. We reported a typical case which was confirmed by physical examination and MR images. Ligamentous insufficiency was confirmed under direct vision, and was reconstructed with triceps fascia as described by Gong et al with slight modification. Regain of full function was achieved one year after surgery.

Pathways related to mitochondrial dysfunction in cartilage of endemic osteoarthritis patients in China

In this paper, we present the first evidence of differences in the mitochondria-related gene expression profiles of adult articular cartilage derived from patients with Kashin-Beck disease and normal controls. The expression of 705 mitochondria-related genes was analyzed by mitochondria-related gene expression analysis and ingenuity pathways analysis. Mitochondria-related gene expression analysis identified 9 up-regulated genes in Kashin-Beck disease based on their average expression ratio. Three canonical pathways involved in oxidative phosphorylation, apoptosis signaling and pyruvate metabolism were identified, which indicate the involvement of mitochondrial dysfunction in the pathogenesis of Kashin-Beck disease.