TDP辐射治疗胸肋关节软骨炎疗效观察

胸肋关节软骨炎,是一种良性非化脓性疾病。本病主要特征为胸肋关节部隆起和胸痛,一般好发生在第2～4肋,胸肋关节中单一或多个部位,为门诊常见疾病。近几年来我科采用TDP辐射治疗,效果满意。报告如下:资料和方法70例中,白细胞计数及血沉测定均在正常范围内,部分病例做过胸肋关节x线检查也无异常发现。治疗期均停用其它疗法。分两组观察:TDP治疗组30例,男18例,女12例,年龄16～50岁,病程3天～3年,左侧发病20例,右侧10例。采用重庆硅酸盐研究所研制,解放军7448厂生产的TDP-Ⅱ型辐射器,额定功率250W。垂直辐射病变部位。

膝关节剥脱性骨软骨炎诊治进展

剥脱性骨软骨炎（osteochondritis dissecans,OCD）是指各种致病因素导致的局限性关节软骨及其软骨下骨病变,并逐渐与其周围正常骨分离、脱落的一种关节疾病。OCD的发病率为0.01～0.06%[1],其可发生于全身任何关节,但膝关节最常受累,据报道膝关节发病率为75%。根据远端股骨髁骺板的成熟状况,OCD可分为多发于10～15岁骺板尚未闭合的青少年型.

关节镜诊治膝关节剥脱性骨软骨炎的临床观察

剥脱性骨软骨炎是软骨病变的一种特殊类型，表现为局限性无菌性坏死。临床检查及影像学检查难以做出正确诊断。我科自1999-06／2000-10经关节镜下诊治29例(32膝)膝关节剥脱性骨软骨炎病例，疗效满意，现将诊治情况分析报告如下。

应用适当MRI作为依据对幼年和成年膝关节剥脱性骨软骨炎不稳定性进行诊断

目的回顾性分析前述MRI诊断标准检测幼年和成年膝关节剥脱性骨软骨炎（osteochondritis dissecans，OCD）不稳定性的敏感性和特异性，并与关节镜所见进行对照研究。材料与方法本研究符合HIPAA要求，并经学术审查委员会批准免除知情同意书。本研究包括32例骨骼未成熟病人（男25例，女7例，平均年龄14．4岁）的36个幼年性膝关节OCD，33例骨骼成熟病人（男25例，女8例，平均年龄26．2岁）的34个膝关节成年性OCD。所有病人均经MRI和关节镜检查。由2名放射医师回顾性分析MRI检查，在意见一致的条件下确定是否存在前述MR成像条件下不稳定OCD的表现（即高T2信号强度边缘，周围囊变，

肘关节镜下关节清理术治疗肘关节剥脱性骨软骨炎的疗效观察

目的:观察肘关节镜下关节清理术治疗肘关节剥脱性骨软骨炎的疗效。方法:选择我院2009年2月-2011年2月21例肘关节剥脱性骨软骨炎患者,均采用肘关节镜下关节清理术治疗。术后随访6-12个月,采用Mayo肘关节评分,观察观察所有肘关节剥脱性骨软骨炎患者治疗前后Mayo肘关节评分及肘关节屈曲角度。结果:治疗后21例患者Mayo肘关节评分大大高于治疗前,肘关节屈曲角度、肘关节伸直角度及肘关节活动范围均明显高于治疗前,治疗前后比较差异具有显著性,有统计学意义P<0.05。21例患者中优8例,良10例,中3例,优良率达85.71%。结论:肘关节镜下关节清理术是治疗肘关节剥脱性骨软骨炎的有效方法。

膝关节剥脱性骨软骨炎（附2例报告）

剥脱性骨软骨炎较少见，我们遇到2例病变发生于膝关节者，均在早期诊断并经手术病理证实，报告如下：

关节镜下微骨折手术方法治疗膝关节剥脱性骨软骨炎患者的临床效果

目的观察关节镜下微骨折手术方法治疗膝关节剥脱性骨软骨炎的效果。方法选取2014年3月至2017年3月就诊及治疗的50例膝关节剥脱性骨软骨炎患者,随机分组,其中对照组25例给予常规手术治疗,试验组25例给予关节镜下微骨折治疗,对比并分析两组的临床治疗效果、治疗前后的Tegner评分、不良反应情况及治疗满意度。结果试验组总有效率为96.0%,高于对照组的72.0%,差异有统计学意义(P<0.05);治疗后两组评分均有不同程度的增高,但试验组所呈现出的增高幅度优于对照组(P<0.05)。试验组胃部不适1例,不良反应率为4.0%;对照组发生6例,发生率为24.0%;试验组不良反应发生率低于对照组(P<0.05)。试验组护理满意度为96.0%,明显高于对照组的76.0%(P<0.05)。结论对膝关节剥脱性骨软骨炎患者实施关节镜下微骨折手术方法治疗的效果较好。

膝关节疾病的超声显象

膝关节是人体关节中负重多而运动量大的关节．其构造比较复杂，在股骨下端的内、外侧髁和胫骨上端的内外侧平台间有内、外侧半月板，使其分成股骨髁与半月板和半月板与胫骨平台的双层关节．关节中存在十字韧带，关节外由纤维囊包绕。关节的前方有股四头肌肌腱，该腱止于髌骨．后者与股骨构成髌股关节，髌骨远端有髌韧带伸出，

儿童髋关节剥脱性骨软骨炎

目的 探讨儿童髋关节剥脱性骨软骨炎的临床特点 ,提高诊治水平 ,避免误诊误治。方法 对 4例患儿 ,通过其临床表现、影像学检查、手术及病检结果作回顾性研究。结果 4例均经手术及病检才最后确诊 ,手术取除游离骨片 ,其中 1例行髋臼重建术 ,均获临床治愈。随访 1～ 6年无复发。结论 髋关节剥脱性骨软骨炎也可发生在儿童期 ,如能提高警惕 ,尽早确诊 ,恰当治疗 ,疗效满意 ,但远期疗效尚有待时间考验。

膝关节剥脱性骨软骨炎松动骨软骨块活力的研究

本研究目的为明确膝关节剥脱性骨软骨炎中松动骨软骨块内软骨组织是否存在活性。研究对象为5例经外科治疗的膝关节剥脱性骨软骨炎病例,所有病例均接受了关节镜下松动骨软骨块复位、固定治疗。

少年肘关节剥脱性骨软骨炎

剥脱性骨软骨炎（osteochondritis dissecans,OCD）常发生于少年,成人很少发生,OCD最早由Konig命名,其特点是由各种原因导致的关节面区域性关节软骨及其深层的骨质缺血坏死,从其周围健康骨骼缓慢分离,部分或完全脱落,最终形成关节内游离体.

Altered Gene Expression in Articular Chondrocytes of Smad3^(ex8/ex8) Mice, Revealed by Gene Profiling Using Microarrays

It has been previously reported that small mother against decapentaplegic 3 （Smad3） gene knockout （Smad3^ex8/ex8） mice displays phenotypes similar to human osteoarthritis, as characterized by abnormal hypertrophic differentiation of articular chondrocytes. To further clarify the crucial target genes that mediate transformation growth factor-β （TGF-β）/Smad3 signals on articular chondrocytes differentiation and investigate the underlying molecular mechanism of osteoarthritis, microarrays were used to perform comparative transcriptional profiling in the articular cartilage between Smad3^ex8/ex8and wild-type mice on day five after birth. The gene profding results showed that the activity of bone morphogenetic protein （BMP） and TGF-β/cell division cycle 42 （Cdc42） signaling pathways were enhanced in Smad3^ex8/ex8 chondrocytes. Moreover, there was altered gene expression in growth hormone/insulin-like growth factor 1 （Igfl） axis and fibroblast growth factor （Fgf） signaling pathway. Notably, protein synthesis related genes and electron transport chain related genes were upregulated in Smad3^ex8/ex8 chondrocytes, implying that accelerated protein synthesis and enhanced cellular respiration might contribute to hypertrophic differentiation of articular chondrocytes and the pathogenesis of osteoarthritis.

LIGUSTRAZINE REDUCES CARTILAGE DESTRUCTION IN MODEL OF OSTEOARTHRITIS IN RATS

Objective To study the effect and possible mechanism of Ligustrazine-a chinese traditional herbal medicine （CTM） on rat osteoarthritis （OA）. Methods OA model was surgically induced. Morphology of articular cartilage was done by HE staining and mankin score was calculated; interleukin-1 and TNFα activity of rat joints was determined by 3-（4,5 dimethylthiazol-2-yl）-2,5-diphenyl tetrazolium bromide （MTT） method; immunohistochemistry of MMP-13 and Cathepsin K was done by ABC method while the mRNA level for MMP-13, cathepsin K and tissue inhibitor of matrix metalloproteinase 1 （TIMP-1） was evaluated by RT-PCR method. ResultsLigustrazine （60 mg·kg^-1·d^-1 or 30 mg·kg^-1·d^-1 , but not 10 mg·kg^-1·d^-1 , im, ×8 weeks） reduced morphological changes of articular cartilage of OA rats. IL-1 and TNFα production of OA joints increases, together with MMP-13, cathepsine K and their mRNA levels in articular cartilage. The administration of Ligustrazine （60 mg·kg^-1·d^-1 -1 or 30 mg·kg^-1·d^-1 , im, ×8 weeks） reduced above changes significantly. At the same time, tissue inhibitor of metrix metalloprotease （TIMP1） mRNA level increased also in OA rats while Ligustrazine （60 mg·kg^-1·d^-1 , 30 mg·kg^-1·d^-1 or 10 mg·kg^-1·d^-1 , im, ×8 weeks） had no significant effect on it. Conclusion Ligustrazine （60 mg·kg^-1·d^-1 or 30 mg·kg^-1·d^-1 , but not 10 mg·kg^-1·d^-1 , im, ×8 weeks） effectively delays articular cartilage degradation of OA rats and could be a potential drug candidate for OA treatment.

Relationship between triphasic mechanical properties of articular cartilage and osteoarthritic grade

The purpose of this study was to explore the triphasic mechanical properties of osteoarthritic cartilage with different pathological grades.First,samples of cartilage from rabbits with different stages of osteoarthritis (OA) were graded.Following this,the cartilage was strained by a swelling experiment,and changes were measured using a high-frequency ultrasound system.The result,together with fixed charge density and water volume fraction of cartilage samples,was used to estimate the uniaxial modulus of the cartilage tissue,based on a triphasic model.For the control cartilage samples,the uniaxial elastic modulus on the cartilage surface was lower than those in the middle and deep layers.With an increase in the OA grade,the uniaxial elastic modulus of the surface,middle and deep layers decreased.A significant difference was found in the surface elastic modulus of different OA grades (P<0.01),while no significant differences were identified for OA cartilages of Grades 1 and 2 in the middle and deep layers (P<0.01).Compared with Grades 1 and 2,there was a significant reduction in the elastic modulus in the middle and deep layers of Grade 3 OA cartilage (P<0.05).Overall,this study may provide a new quantitative method to evaluate the severity of OA using the mechanical properties of cartilage tissue.

Clinical study of warm needling moxibustion plus intra-articular injection of sodium hyaluronate for chondromalacia patellae

Objective To observe the therapeutic efficacy of warm needling moxibustion plus intra-articular injection of sodium hyaluronate in treating chondromalacia patellae and its effect on inflammatory factors in knee joint fluid.Methods Sixty-eight patients with chondromalacia patellae were randomized into a control group and an observation group,with 34 cases in each group.The control group was treated with intra-articular injection of sodium hyaluronate,while the observation group was given additional warm needling moxibustion treatment.Before and after treatment,the two groups were scored using Western Ontario and McMaster Universities osteoarthritis index(WOMAC)and visual analog scale(VAS),examined by magnetic resonance imaging(MRI)and determined for the levels of nuclear factor-KB(NF-kB),tumor necrosis factor(TNF)-αand interleukin(IL)-1βin knee joint fluid.Clinical efficacy was estimated after treatment.Results The effective rate was higher in the observation group than in the control group(P<0.05).After treatment,the scores of pain,stiffness and daily activities,as well as the general score of WOMAC declined significantly in both groups(all P<0.05),and were lower in the observation group than in the control group(all P<0.05);the time cost for climbing up and down one staircase and VAS score decreased markedly in both groups(all P<0.05),and were shorter or lower in the observation group than in the control group(both P<0.05);the MRI grading showed no significant change in the control group after intervention(P>0.05),while the grading in the observation group showed notable improvement(P<0.05),and was better than that in the control group(P<0.05);the levels of NF-kB and IL-1βin knee joint fluid dropped significantly in the control group after treatment(both P<0.05),while the levels of NF-kB,TNF-αand IL-1βin knee joint fluid all decreased significantly in the observation group(all P<0.05)and were lower than those in the control group(all P<0.05).Conclusion Warm needling moxibustion plus intra-articular injection of sodium hyaluronate can produce definite efficacy in treating chondromalacia patellae;it can mitigate the clinical symptoms,improve the lesion extent of chondromalacia and down-regulate the levels of NF-kB,TNF-αand IL-1βin knee joint fluid.

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.