Anterolateral rotatory instability in vivo correlates tunnel position after anterior cruciate ligament reconstruction using bone-patellar tendon-bone graft

AIM To quantitatively assess rotatory and anterior-posterior instability in vivo after anterior cruciate ligament(ACL) reconstruction using bone-patellar tendon-bone(BTB) autografts, and to clarify the influence of tunnel positions on the knee stability.METHODS Single-bundle ACL reconstruction with BTB autograft was performed on 50 patients with a mean age of 28 years using the trans-tibial(TT)(n = 20) and trans-portal(TP)(n = 30) techniques. Femoral and tibial tunnel positions were identified from the high-resolution 3 D-CT bone models two weeks after surgery. Anterolateral rotatory translation was examined using a Slocum anterolateral rotatory instability test in open magnetic resonance imaging(MRI) 1.0-1.5 years after surgery, by measuring anterior tibial translation at the medial and lateral compartments on its sagittal images. Anterior-posterior stability was evaluated with a Kneelax3 arthrometer.RESULTS A total of 40 patients(80%) were finally followed up. Femoral tunnel positions were shallower(P < 0.01) and higher(P < 0.001), and tibial tunnel positions were more posterior(P < 0.05) in the TT group compared with the TP group. Anterolateral rotatory translations in reconstructed knees were significantly correlated with the shallow femoral tunnel positions(R = 0.42, P < 0.01), and the rotatory translations were greater in the TT group(3.2 ± 1.6 mm) than in the TP group(2.0 ± 1.8 mm)(P < 0.05). Side-to-side differences of Kneelax3 arthrometer were 1.5 ± 1.3 mm in the TT, and 1.7 ± 1.6 mm in the TP group(N.S.). Lysholm scores, KOOS subscales and reinjury rate showed no difference between the two groups.CONCLUSION Anterolateral rotatory instability significantly correlated shallow femoral tunnel positions after ACL reconstruction using BTB autografts. Clinical outcomes, rotatory and anterior-posterior stability were overall satisfactory in both techniques, but the TT technique located femoral tunnels in shallower and higher positions, and tibial tunnels in more posterior positions than the TP technique, thus increased the anterolateral rotation. Anatomic ACL reconstruction with BTB autografts may restore knee function and stability.

Bone marrow-derived mesenchymal stem cell-derived exosomeloaded miR-129-5p targets high-mobility group box 1 attenuates neurological-impairment after diabetic cerebral hemorrhage

BACKGROUND Diabetic intracerebral hemorrhage(ICH)is a serious complication of diabetes.The role and mechanism of bone marrow mesenchymal stem cell(BMSC)-derived exosomes(BMSC-exo)in neuroinflammation post-ICH in patients with diabetes are unknown.In this study,we investigated the regulation of BMSC-exo on hyperglycemia-induced neuroinflammation.AIM To study the mechanism of BMSC-exo on nerve function damage after diabetes complicated with cerebral hemorrhage.METHODS BMSC-exo were isolated from mouse BMSC media.This was followed by transfection with microRNA-129-5p(miR-129-5p).BMSC-exo or miR-129-5poverexpressing BMSC-exo were intravitreally injected into a diabetes mouse model with ICH for in vivo analyses and were cocultured with high glucoseaffected BV2 cells for in vitro analyses.The dual luciferase test and RNA immunoprecipitation test verified the targeted binding relationship between miR-129-5p and high-mobility group box 1(HMGB1).Quantitative polymerase chain reaction,western blotting,and enzyme-linked immunosorbent assay were conducted to assess the levels of some inflammation factors,such as HMGB1,interleukin 6,interleukin 1β,toll-like receptor 4,and tumor necrosis factorα.Brain water content,neural function deficit score,and Evans blue were used to measure the neural function of mice.RESULTS Our findings indicated that BMSC-exo can promote neuroinflammation and functional recovery.MicroRNA chip analysis of BMSC-exo identified miR-129-5p as the specific microRNA with a protective role in neuroinflammation.Overexpression of miR-129-5p in BMSC-exo reduced the inflammatory response and neurological impairment in comorbid diabetes and ICH cases.Furthermore,we found that miR-129-5p had a targeted binding relationship with HMGB1 mRNA.CONCLUSION We demonstrated that BMSC-exo can reduce the inflammatory response after ICH with diabetes,thereby improving the neurological function of the brain.

Mechanoresponsive MiR-138-5p Targets MACF1 to Inhibit Bone Formation

Mechanical stimuli play an essential role in maintaining bone remodeling and skeletal integrity.Meanwhile,bone can respond to the changes of mechanical condition to adjust its mass and architecture.Clinical studies discover that bedridden patients showed osteoporotic T-scores and low bone mineral density,and long-term immobilized patients presented reduced markers of bone formation.However,as bone formation mediated by osteoblast differentiation is a complex process,the underlying molecular mechanism of mechanical stimuli regulating bone formation is still unclear.Recent evidences show that microRNAs(miRNAs)are involved in mechanical stimuli regulating bone formation or osteoblast differentiation.Nevertheless,no direct evidence identifies mechanoresponsive miRNA in both human and animal bones,and clarifies its mechanoresponsive role under different mechanical conditions(e.g.mechanical unloading,reloading,loading).In the current study,we screened for differentially expressed miRNAs in bone specimens of bedridden patients with fractures,then identified that the expression of miR-138-5p,but not the other miRNAs,altered withbedridden time and was negatively correlated with the expression of the bone formation marker genes Alp(alkaline phosphatase).Moreover,miR-138-5p was up-regulated with reduced bone formation during unloading and down-regulated with increased bone formation during reloading in hind4imb unloaded mice.In addition,miR-138-5p was verified to be responsive to different mechanical unloading condition and cyclic mechanical stretch condition in primary osteogenic cells,respectively.Further in vitro data suggested that mechanoresponsive miR-138-5p directly targeted microtubule actin crosslinking factor 1(MACF1)to inhibit osteoblast differentiation.In vivo,we constructed an osteoblastic miR-138-5p transgenic mice model(TG138)with the Runx2promoter,and found that overexpression miR-138-5p supressed bone formation.Moreover,osteoblast-targeted inhibition of miR-138-5p sensitized bone anabolic response to mechanical loading in TG138 mice.Predominantly,the osteoblast-targeted inhibition of miR-138-5p could counteract bone formation reduction induced by hind limb unloading.Taken together,the mechanoresponsive miR-138-5p inhibited bone anabolic response for developing a novel bone anabolic sensitization strategy.

Comparisons between glucose analogue 2-deoxy-2-(^(18)F)fluoro-D-glucose and ^(18)F-sodium fluoride positron emission tomography/computed tomography in breast cancer patients with bone lesions

AIM: To compare 2-deoxy-2-(18F)fluoro-D-glucose(18F-FDG) and 18F-sodium (18F-NaF) positron emission tomography/computed tomography (PET/CT) accuracy in breast cancer patients with clinically/radiologically suspected or known bone metastases.METHODS: A total of 45 consecutive patients with breast cancer and the presence or clinical/biochemical or radiological suspicion of bone metastatic disease underwent 18F-FDG and 18F-fluoride PET/CT. Imaging results were compared with histopathology when available, or clinical and radiological follow-up of at least 1 year. For each technique we calculated: Sensitivity (Se), specificity (Sp), overall accuracy, positive and negative predictive values, error rate, and Youden’s index. McNemar’s χ2 test was used to test the difference in sensitivity and specificity between the two diagnostic methods. All analyses were computed on a patient basis, and then on a lesion basis, with consideration ofthe density of independent lesions on the co-registered CT (sclerotic, lytic, mixed, no-lesions) and the divergent site of disease (skull, spine, ribs, extremities, pelvis). The impact of adding 18F-NaF PET/CT to the work-up of patients was also measured in terms of change in their management due to 18F-NaF PET/CT findings.RESULTS: The two imaging methods of 18F-FDG and 18F-fluoride PET/CT were significantly different at the patient-based analysis: Accuracy was 86.7% and 84.4%, respectively (McNemar’s χ2 = 6.23, df = 1, P = 0.01). Overall, 244 bone lesions were detected in our analysis. The overall accuracy of the two methods was significantly different at lesion-based analysis (McNemar’s χ2 = 93.4, df = 1, P < 0.0001). In the lesion density-based and site-based analysis, 18F-FDG PET/CT provided more accurate results in the detection of CT-negative metastasis (P < 0.002) and vertebral localizations (P < 0.002); 18F-NaF PET/CT was more accurate in detecting sclerotic (P < 0.005) and rib lesions (P < 0.04). 18F-NaF PET/CT led to a change of management in 3 of the 45 patients (6.6%) by revealing findings that were not detected at 18F-FDG PET/CT.CONCLUSION: 18F-FDG PET/CT is a reliable imaging tool in the detection of bone metastasis in most cases, with a diagnostic accuracy that is slightly, but significantly, superior to that of 18F-NaF PET/CT in the general population of breast cancer patients. However, the extremely high sensitivity of 18F-fluoride PET/CT can exploit its diagnostic potential in specific clinical settings (i.e., small CT-evident sclerotic lesions, high clinical suspicious of relapse, and negative 18F-FDG PET and conventional imaging).

Mechanism of "Epimedium-Cistanche deserticola" in the treatment of breast cancer with bone metastasis

Objective:"Epimedium - Cistanche deserticola" is a kind of kidney tonifying drug commonly used in the treatment of breast cancer bone metastasis, which has good clinical effect, but the pharmacological mechanism has not been fully clarified. Methods: In this study, the network pharmacology and bioinformatics technology were used to explore the mechanism of "Epimedium - Cistanche deserticola" in the treatment of breast cancer bone metastasis. TCMSP, TCM database@Taiwan and TCMID databases were used to screen the main effective components of the drug. Swiss Target Prediction and STITCH databases were used to search the potential target of action of Epimedium and Cistanche deserticola. Genecards, OMIN and Drugbank databases were used to search the cause of bone metastasis of breast cancer. The target of action of the drug and the disease gene were mapped for GO and KEGG signal pathway analysis, A visualized network of "drug - component - target - signaling pathway" was constructed by using the software of Cytoscape 3.6.0, and the core genes were screened out. Results: The study found that there are 30 main effective components of Epimedium and Cistanche deserticola, and 544 genes are involved in the potential therapeutic targets, among which 101 genes are potential targets of Epimedium and Cistanche deserticola in the treatment of breast cancer bone metastasis. Through the analysis of GO and KEGG pathways, we found that the mechanisms involved in antitumor, osteoblast differentiation, osteoclast apoptosis and regulation of bone microenvironment, such as apoptosis, osteoclast differentiation, PI3K-Akt, HIF-1 signaling pathway, T cell receptor signaling pathway, etc. TP53, VEGFA, AKT1, EGFR, SRC, CCND1, MAPK3, ESR1 may be the key genes in the treatment of breast cancer bone metastasis. Conclusion: In this study, the network of "drug - component - target- signaling pathway" was constructed through network pharmacology, and it was found that the mechanism of "Epimedium - Cistanche deserticola" in the treatment of breast cancer bone metastasis involves multiple targets and pathways, which is conducive to guiding clinical medication.

Exosomes derived from microRNA-540-3p overexpressing mesenchymal stem cells promote immune tolerance via the CD74/nuclear factor-kappaB pathway in cardiac allograft

BACKGROUND Heart transplantation is a crucial intervention for severe heart failure,yet the challenge of organ rejection is significant.Bone marrow mesenchymal stem cells(BMSCs)and their exosomes have demonstrated potential in modulating T cells,dendtitic cells(DCs),and cytokines to achieve immunomodulatory effects.DCs,as key antigen-presenting cells,play a critical role in shaping immune responses by influencing T-cell activation and cytokine production.Through this modulation,BMSCs and their exosomes enhance graft tolerance and prolonging survival.AIM To explore the immunomodulatory effects of exosomes derived from BMSCs overexpressing microRNA-540-3p(miR-540-3p)on cardiac allograft tolerance,focusing on how these exosomes modulating DCs and T cells activity through the CD74/nuclear factor-kappaB(NF-κB)pathway.METHODS Rat models were used to assess the impact of miR-540-3p-enhanced exosomes on immune tolerance in cardiac allografts.MiR-540-3p expression was manipulated in BMSCs,and derived exosomes were collected and administered to the rat models post-heart transplantation.The study monitored expression levels of major histocompatibility complex II,CD80,CD86,and CD274 in DCs,and quantified CD4^(+)and CD8^(+)T cells,T regulatory cells,and cytokine profiles.RESULTS Exosomes from miR-540-3p-overexpressing BMSCs lead to reduced expression of immune activation markers CD74 and NF-κB p65 in DCs and T cells.Rats treated with these exosomes showed decreased inflammation and improved cardiac function,indicated by lower levels of pro-inflammatory cytokines(interleukin-1β,interferon-γ)and higher levels of anti-inflammatory cytokines(interleukin-10,transforming growth factorβ1).Additionally,miR-540-3p skewed the profiles of DCs and T cells towards immune tolerance,increasing the ratio of T regulatory cells and shifting cytokine secretion to favor graft acceptance.CONCLUSION Exosomes derived from BMSCs overexpressing miR-540-3p significantly enhance immune tolerance and prolong cardiac allograft survival by modulating the CD74/NF-κB pathway,which regulates activities of DCs and T cells.These findings highlight a promising therapeutic strategy to improve heart transplantation outcomes and potentially reduce the need for prolonged immunosuppression.

关节镜下同种异体骨-髌腱-骨双束重建膝关节前交叉韧带的临床比较研究

目的探讨关节镜下同种异体骨-髌腱-骨(bone-patellar tendon-bone,BPTB)移植物双束重建膝关节前交叉韧带(anterior cruciate ligament,ACL)的中期临床效果。方法 2003年7月～2007年7月,61例ACL断裂患者接受关节镜下BPTB重建ACL手术,按术式和移植物分为3组:异体BPTB双束组(20例),异体BPTB单束组(21例),自体BPTB单束组(20例)。3组平均随访时间分别为(41.6±3.0)、(42.3±3.9)、(42.5±2.7)月。通过膝关节查体、IKDC2000主观评分、Lysholm评分、Tegner评分、膝前痛、常规KT-2000、后推KT-2000及Biodex等速肌力测试系统评估手术效果。结果 3组间的IKDC2000、Lysholm、Tegner评分、大腿围度差值、肌力和常规KT-2000等指标差异无显著性(P>0.05)。异体双束组的Pivotshift阳性发生率(5%,1/20)是异体单束组的1/6(29%,6/21),自体单束组的1/4(20%,4/20)。异体双束组的后推KT-200030°位前移度(中位数15磅0.5 mm,20磅0.5 mm,30磅0.9 mm)明显低于其他两组(P<0.05)。异体双束组(15%,3/20)和异体单束组(10%,2/21)的膝前痛发生率明显低于自体单束组(75%,15/20)(χ2=24.201,P=0.000)。结论同种异体BPTB双束重建ACL能够更好地恢复膝关节整体前向及旋转稳定性,减少并发症,可以作为髁间窝较宽的患者ACL初次解剖重建的理想手术方法。

自体与同种异体骨-髌腱-骨重建前交叉韧带术后胫骨骨隧道演变过程的MRI对比研究

目的 利用MRI比较自体与同种异体骨 髌腱 骨(bone patellartendon bone ,B PT B)重建前交叉韧带(anteriorcruciateligament ,ACL)术后胫骨骨隧道的变化过程。方法 将5 0例B PT B重建ACL患者,分成A、B两组,A组为自体组2 0例,B组为同种异体组3 0例。分别于术后1、6周、3～4、5～6、7～8、9～10、12～13、15～16、18～19、2 1～2 2个月进行磁共振(magneticresonanceimage ,MRI)检查,采用胫骨骨隧道斜轴状位扫描技术,扫描序列包括:T1WI、T2WI、GE T1WI、GE STIR。动态观察骨隧道内的MRI信号变化,并比较术后6周、3～4、5～6个月骨隧道扩大情况。结果 术后6周骨隧道扩大增幅最为显著(P <0 0 5 )。术后3个时间段上比较两组骨隧道扩大程度均无显著性差异(P >0 0 5 )。MRI动态观察发现,A组术后5～8个月,移植物与骨隧道之间已发生骨性愈合;而B组将延迟到术后7～13个月。结论 MRI是准确评价骨隧道的一种无创手段;同种异体B PT B在胫骨骨隧道内的愈合相对延迟;自体组与同种异体组术后胫骨骨隧道扩大的程度基本相当。

同种异体骨-髌腱-骨组织移植重建前交叉韧带36例临床分析

目的：回顾性研究并评估采用同种异体骨-髌腱-骨组织移植重建前交叉韧带患者的临床疗效。方法：从2004年12月至2006年8月,对36例ACL损伤病例进行了同种异体骨-髌腱-骨组织移植重建。男性16例,女性20例;平均年龄28岁（15~56岁）;急性损伤11例,慢性损伤25例。对所有患者进行了主观评估（包括手术前后Lysholm评分、IKDC评分和症状改善情况）和客观评估（包括Lachman试验、轴移试验、KT-1000测量,以及关节活动范围）,并对比了患者术前以及术后的MR影像和关节镜手术探查影像,还对术后发热情况以及并发症进行了记录。结果：本组病例平均随访23.6个月（12~32个月）。主观评估：术前Lyshrolm评分为63.61±13.4分（46~90分）,术后最终评分为98.03±3.6分（85~100分）,与术前对比差异有统计学意义（P〈0.01）;术后IKDC评分总体优良率达到91.7%。客观评估：KT-1000测量结果：术前两侧胫骨前移的差别为7.05±2.15mm（2-11mm）,术后最终测量值为1.15±1.43mm（0-6mm）,与术前对比差异有统计学意义（P〈0.01）。所有患者均未出现明显的术后并发症以及病毒和细菌感染。1例患者移植物松弛度增加,给予固缩治疗后好转。另1例部分韧带磨损,但主观评估良好,给予清创和髁间窝成形术处理。结论：短期观察显示,采用同种异体骨-髌腱-骨组织移植重建ACL能够获得满意的临床疗效,具备有效性和安全性。

深低温处理对异种骨-髌腱-骨移植排斥反应的影响

目的:观察深低温处理对异种骨-髌腱-骨(BPB)移植排斥反应的影响。方法:采用大鼠股部肌袋模型法探讨深低温处理对异种BPB移植免疫反应的影响,通过观察外周血T细胞活化和植入物组织形态学变化情况来判定免疫反应程度。结果:新鲜未处理异种BPB移植后3 d CD4+/CD8+细胞CD25+表达率即显著升高,与自体移植组比较有显著差异(P<0.05),术后14 d达高峰,且维持该峰值至术后35 d仍无下降;深低温处理的异种BPB移植后CD4+/CD8+细胞CD25+的表达明显受到抑制,表达时间推迟,至术后14 d才有轻度升高,术后3 d起各时点与未处理组比较,均P<0.05。组织学检查发现,深低温处理组骨、腱组织周围见少量淋巴细胞浸润,但未侵入组织内,无组织坏死,腱束结构清楚,胶原排列规则;新鲜异种移植组可见大量斑片状淋巴细胞弥漫性浸润骨及胶原组织周围及其中,可见骨碎片,腱结构不清,胶原排列紊乱,部分切片可见较多的嗜酸性粒细胞和多核巨细胞等炎症细胞。结论:深低温处理能显著降低异种BPB免疫原性,抑制排斥反应发生。

兔髌骨-髌腱结合部新骨形成与大小预测其愈合程度

目的探讨髌骨-髌腱结合部愈合中新骨形成量和力学指标之间的关系。方法15只雌性成年兔,在一侧后肢的髌骨远端1/3处横行截骨,切除远端1/3髌骨。将髌腱与髌骨断端连接。分别于术后第8和16周取材进行生物力学、组织学和新骨形成情况(X线摄片测量和骨密度测定)检测,进行对比研究。结果髌骨-髌腱结合部新骨面积、新骨长度及骨矿密度在第8和16周之间仍未达到显著性水平,但在第16周时的拉断载荷、极限拉应力和拉断能量均明显大于第8周;新骨面积与拉断载荷及极限拉应力呈显著性相关。结论新骨面积与拉断载荷及极限拉应力间显著相关,通过临床无创X线影像学对新骨面积的定量,可有效评估髌骨部分切除后髌骨-髌腱结合部愈合状况,为术后主动康复提供参考。

肌腱-骨块自体复合移植物嵌压固定法重建前交叉韧带的实验研究

[目的]研究肌腱-骨块自体移植物嵌压固定法重建前交叉韧带的组织形态学转归。[方法]以8只山羊膝关节为实验模型,用阶梯状联合钻1次成形建立股骨隧道呈倒置瓶颈状,以髌腱-胫骨结节骨块为移植物,在股骨隧道内行嵌压固定;在胫骨端骨桥打结固定。术后4、8、12和16周取材,分别进行放射学、大体形态和组织切片检查,观察隧道宽度变化及移植物的组织学转归。[结果]术后各时间点放射检查未见隧道扩大;HE染色检查显示12周后有明显的腱-骨连接形成,移植骨块与隧道形成骨性愈合。[结论]嵌压固定法重建前交叉韧带有利于移植物的愈合。

MRI评价自体骨-髌韧带-骨与股四头肌腱行前交叉韧带重建后移植物成熟度及膝关节的功能

背景:前交叉韧带重建术中一般采用自体骨-髌韧带-骨、股四头肌腱或腘绳肌肌腱作为移植物,其中关节内移植物的成熟度是前交叉韧带重建后恢复患者运动的关键。目的:分析使用自体骨-髌韧带-骨与自体股四头肌腱行前交叉韧带重建后的移植物成熟度及患者膝关节功能差异。方法:选择2018年6月至2020年1月在佛山市中医院行前交叉韧带重建术的患者60例,其中男50例,女10例,年龄17-42岁,韧带重建使用自体骨-髌韧带-骨移植物者27例,使用自体股四头肌腱移植物者33例。韧带重建后3,6,12个月,比较两组移植物股骨端、中段、胫骨端3个区域的MRI信噪比;比较两组患者国际膝关节评分委员会膝关节评估量表(IKDC)评分、Lysholm主观评分及双侧膝关节KT-1000差值;对比两组患者韧带重建后12个月的膝关节步态差异。研究获得佛山市中医院医学伦理委员会批准,批准号:2018003。结果与结论:(1)韧带重建后3,6,12个月,两组间移植物股骨端、中段的MRI信噪比比较差异无显著性意义(P>0.05),股四头肌腱组移植物胫骨端MRI信噪比高于骨-髌韧带-骨组(P>0.05);(2)韧带重建后3,6,12个月,两组间的IKDC评分Lysholm主观评分及双侧膝关节KT-1000差值比较差异无显著性意义(P>0.05);(3)韧带重建后12个月,两组患者膝关节步态分析比较差异无显著性意义(P>0.05);(4)结果表明,使用自体骨-髌韧带-骨移植物行前交叉韧带重建后的移植物成熟度优于自体股四头肌腱,但成熟度不同并不影响患者韧带重建后的功能恢复。

兔髌骨-髌腱复合体中骨-骨愈合和骨-腱愈合的比较研究

目的 比较髌骨 -髌腱复合体中骨 -骨连接和骨 -腱连接愈合。方法 6 0只雌性成年兔。在一侧后肢的髌骨远端 1/ 3处横行截骨 ,在骨 -骨连接组中 ,将两髌骨骨折块重新连接 ;在骨-腱连接组中 ,切除远端 1/ 3髌骨。将髌腱与髌骨断端连接。分别于术后 8、12和 2 4周取材进行生物力学和组织学对比研究。结果 两组的拉断载荷没有显着性差异。但骨 -骨连接组第 8周和第2 4周的极限拉应力明显大于骨 -腱连接组 (P <0 .0 5 )。组织学研究表明骨 -骨愈合可通过愈合界面的软骨内化骨 ;在骨 -腱连接组中 ,大量瘢痕组织形成桥接愈合界面 ,并逐渐塑型重建 ,但没有形成典型的骨腱接点中的纤维软骨层。结论 髌骨 -髌腱复合体手术修复时 ,解剖学重建应该是首要考虑的问题 ,应尽可能采用骨折 (骨 -骨 )固定 。

股四头肌与骨-髌腱-骨自体移植对前交叉韧带重建的Meta分析

目的:通过Meta分析比较股四头肌与骨-髌腱-骨自体移植对前交叉韧带重建手术疗效的影响。方法:计算机检索建库至2019年5月PubMed、EMbase、Cochrane图书馆、万方数据库和中国知网发表的比较股四头肌、骨-髌腱-骨自体移植物的病例对照研究文献,根据纳入与排除标准进行文献筛选、质量评价及数据提取,采用Review Manager 5.3统计学软件对患膝与健膝前向移位差值、Lachman试验、轴移试验、Lysholm评分、IKDC(International Knee Documentation Committee)客观等级、膝前疼痛和移植失败率进行Meta分析。结果:共纳入6篇文献,915例患者,其中股四头肌自体移植495例,骨-髌腱-骨自体移植420例。Meta分析结果显示:股四头肌自体移植与骨-髌腱-骨自体移植在胫骨向前移位差值>3 mm[OR=1.53,95%CI(0.68,3.44),P=0.31],3~5 mm[OR=0.64,95%CI(0.31,1.35),P=0.24],>5 mm[OR=1.18,95%CI(0.33,4.22),P=0.80],Lachman试验阴性率[OR=0.88,95%CI(0.38,2.02),P=0.76],轴移试验阴性率[OR=0.63,95%CI(0.24,1.68),P=0.36]方面比较差异无统计学意义。两组在Lyshlom评分[MD=-0.56,95%CI(-2.00,0.89),P=0.45],IKDC客观等级A或B级[OR=0.87,95%CI(0.47,1.60),P=0.66]及移植失败率[OR=0.76,95%CI(0.28,2.02),P=0.58]方面比较差异无统计学意义;在减少膝前疼痛方面,股四头肌自体移植优于骨-髌腱-骨自体移植[OR=0.16,95%CI(0.09,0.29),P<0.00001]。结论:股四头肌自体移植的临床和功能结果以及移植物存活率与骨-髌腱-骨自体移植相当,且股四头肌自体移植可以明显减少膝前疼痛。对于前交叉韧带重建患者,股四头肌自体移植可作为前交叉韧带重建合适的移植替代物。

人体骨-髌腱-骨及半月板移植物浸提液的细胞毒性研究

目的:探讨ACL重建及半月板修复所用异体移植物的组织安全性。方法:分别以不同浓度梯度人体骨-髌腱-骨和半月板移植物浸提液培养NIH3T3细胞,光镜下观察细胞形态,MTT法检测受试物中存活细胞百分比,其结果与DMEM培养液(阴性对照组)及苯酚(阳性对照组)中存活细胞百分比进行比较。结果:光镜下各种浓度移植物浸提液培养的细胞形态均正常,存活率均大于97%,明显优于阳性对照组。结论:本实验中人体骨-髌腱-骨和半月板移植物未见细胞毒性。

芪蛭降糖胶囊对糖尿病肾病大鼠肾组织BMP-7及TGF-β_1/smads信号传导通路的影响

目的：观察芪蛭降糖胶囊对糖尿病肾病（diabetic nephropathy,DN）大鼠肾组织骨形成蛋白-7（bone morpho-genetic protein-7,BMP-7）及转化生长因子（transforming growth factor,TGF）-β1/Smads信号传导通路的影响。方法：48只清洁级雄性Wistar大鼠按体重随机抽取40只,采用切除右肾加腹腔注射链脲菌素（ streptozotocin,STZ）的方法制备DN模型,另外8只大鼠行右肾假切术。造模成功后按尿微量白蛋白（ microAlbumin,mAlb）高低,两头随机抽取分为模型组、缬沙坦对照组、芪蛭降糖胶囊低剂量组、芪蛭降糖胶囊高剂量组。成模2 d起各组给予相应浓度和剂量的药物,给药12周时观察DN大鼠尿mAlb、α1微球蛋白（α1-MG）和血清肌酐（ Scr）、尿素氮（ BUN）。然后,处死所有动物,肾组织行HE染色、PAS染色和Masson染色,观察肾组织病理变化并半定量计算肾小管损伤指数（tubulointerstitial injury index,TII）,免疫组化法检测BMP-7、TGF-β1、Smad2、Smad7在肾组织的表达。结果：给药12周后,模型组大鼠尿 mAlb、α1-MG较假手术组显著增多（ P 〈0.01）,3个治疗组DN大鼠尿mAlb、α1-MG较模型组明显减少（P〈0.01）,2个中药治疗组的上述4项指标亦较对照组降低（P〈0.05-0.01）,且呈剂量依赖性。模型组大鼠Scr、BUN亦较假手术组显著升高（P〈0.01）,对照组与模型组相比无明显变化（P〉0.05）,但2个中药治疗组较模型组明显降低（P〈0.05-0.01）。 HE染色显示,3个治疗组大鼠肾组织病理损害明显减轻,2个中药治疗组大鼠肾组织病理改善比对照组更明显；PAS染色进行TII评分发现,3个治疗组大鼠TII显著低于模型组（P〈0.01）,2个中药治疗组TII明显低于对照组（P〈0.05-0.01）；Masson染色观察发现,3个实验组大鼠肾小管间质病变明显轻于模型组,2个中药治疗组大鼠肾小管间质病变轻于对照组；免疫组化法染色并对其灰度值测定发现,3个治疗组大鼠TGF-β1、Smad2在肾组织的表达低于模型组（P〈0.01）,2个中药治疗组大鼠TGF-β1、Smad2在肾组织的表达低于对照组（P〈0.05-0.01）；3个治疗组大鼠BMP-7、Smad7在肾脏组织的表达高于模型组（P〈0.01）,2个中药治疗组大鼠BMP-7、Smad7在肾组织的表达高于对照组（P〈0.05-0.01）。结论：芪蛭降糖胶囊可能通过干预BMP-7/TGF-β1/Smads信号转导通路抑制了TGF-β1信号的细胞内转导,而对DN肾间质纤维化起到治疗作用。

关节镜下自体骨-髌腱-骨重建膝前交叉韧带

目的评价关节镜下用自体中1／3骨-髌腱-骨重建膝前交叉韧带的技术和效果。方法自2000年10月至2006年12月共65例经关节镜检查证实为前交叉韧带断裂，36例伴半月板撕裂，22例伴内侧副韧带损伤，7例伴后交叉韧带断裂。男45例，女20例；年龄20-45岁，平均29．13岁。左膝38例，右膝27例。急性损伤30例，陈旧性损伤35例。均于关节镜下行自体中1／3骨-髌腱-骨前交叉韧带重建术，采用Biofix生物可吸收界面螺钉解剖位固定重建韧带。同时，在关节镜下处理合并损伤。术后早期行CPM功能锻炼。结果术后早期均未发生严重并发症。所有患者获得随访，随访1～5年，平均3，8年。采用Lysholm评分标准评价膝关节功能，术前平均58．36分（45-80分），术后平均92．77分（70～100分）。术后与术前相比差异有显著性（P〈0．0001）。65例患者中，61例恢复伤前运动水平，4例运动水平较伤前减低。结论该手术创伤小、关节内环境影响小，可同时进行关节内其他手术，术后功能恢复快，是重建膝前交叉韧带的有效方法。

自体骨-髌腱-骨和腘绳肌腱单束重建前交叉韧带的愈合形态学和前向稳定性对比

目的探讨采用自体骨-髌腱-骨（bone-patellar tendon-bone,B-PT-B）和自体腘绳肌腱（hamstring tendon,HT）进行前交叉韧带（anterior cruciate ligament,ACL）单束重建后的移植物愈合形态和前向稳定性是否存在差异。方法 1996年7月~2005年5月,我所对134例急性ACL断裂施行膝关节镜下ACL单束重建,移植物分别为自体B-PT-B和HT,其中51例为去除金属内固定而二次入院手术（术后6~46个月,平均13.8月）,根据移植物种类将51例分为2组：B-PT-B组（n=14）和HT组（n=37）,比较关节镜下移植物愈合形态,采用膝关节韧带位移测量仪（KT-2000）分别在屈膝30°和90°时测量前向松弛度。结果 B-PT-B组和HT组重建韧带形态学表现如下：韧带完整分别占85.7%（12/14）和86.5%（32/37）,断裂〈1/2分别占14.3%（2/14）和13.5%（5/37）,2组无统计学差异（χ2=0.000,P=1.000）;滑膜完整分别占57.1%（8/14）和64.9%（24/37）,部分滑膜覆盖分别占28.6%（4/14）和27.0%（10/37）,无滑膜覆盖分别占14.3%（2/14）和8.1%（3/37）,2组无统计学差异（χ2=0.501,P=0.779）;滑膜内有血管形成分别占57.1%（8/14）和64.9%（24/37）,2组无统计学差异（χ2=0.259,P=0.611）;有＂独眼征＂（cyclops）形成分别占14.3%（2/14）和10.8%（4/37）,2组无统计学差异（χ2=0.000,P=1.000）。2组前向松弛度在屈膝30°时分别为（2.2±0.5）、（1.8±1.4）mm（t=1.039,P=0.304）,90°时分别为（1.2±0.6）、（1.1±0.7）mm（t=0.472,P=0.639）。结论急性期采用自体B-PT-B和HT单束重建ACL,在韧带愈合形态学表现和重建的前向稳定性方面均无显著性差异。

自体髌骨膜-髌韧带-骨瓣重建踝外侧韧带的应用解剖

目的为自体髌骨膜-髌韧带-骨瓣重建踝关节外侧韧带提供解剖学基础。方法在6侧经防腐固定的成人下肢标本及6侧新鲜标本上观测踝关节外侧韧带起止点及走行径路、髌韧带的解剖形态与起止点,在新鲜标本上摹拟重建手术。结果髌韧带位置恒定,解剖层次表浅,切取方便,髌骨膜-髌韧带-骨瓣的髌韧带长度(4.1±0.4)cm,距腓前韧带长度(2.4±0.5)cm,跟腓韧带长度(3.1±0.4)cm。结论 (1)髌骨膜-髌韧带-骨瓣的髌韧带具有足够的长度,可形成移植供体(;2)髌骨膜-髌韧带-骨瓣复合体两端分别与骨及软骨创面固定,容易成活和恢复功能(;3)采用自体髌骨膜-髌韧带-骨瓣重建踝外侧韧带具有可行性。