An intra-articular injectable phospholipids-based gel for the treatment of rheumatoid arthritis

Rheumatoid arthritis(RA)is a chronic inflammatory and destructive arthropathy with a high deformity rate.Despite numerous studies and clinical trials,no curative treatment is available for large weight-bearing joints.Intra-articular(IA)injections could deliver high concentrations of drug to the afflicted joint and improve the drug efficacy while reducing systemic toxicity.However,free drugs are rapidly cleared from synovial fluid and do not significantly halt the progression of joint disease.Herein,a phospholipids-based controlledrelease gel was prepared for sustained IA delivery of celastrol(CEL)and the therapeutic efficiencywas evaluated in a rheumatoid arthritis rabbitmodel.The CEL-loaded gel(CEL-gel)contained up to 70%phospholipids yetwas easy to inject.After injecting into the joint cavity,CEL-gel achieved sol to gel phase transition without special stimuli and gelling agent.In vitro release and in vivo pharmacokinetic studies evidenced the stable and sustained release action of CEL-gel.A single IA injection of CEL-gel could maintain therapeutic efficiency for about 25 d and showed much better anti-arthritic efficacy compared to repeated injections of free drug solution(CEL-sol).Furthermore,the IA injection of CEL-gel greatly reduced the systemic toxicity of CEL.With good biocompatibility and biodegradability,CEL-gel might be a promising IA drug delivery system.

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.

External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.

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.

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.

Effect of intramuscular calcitonin injection combined with intra-articular ozone injection on the expression of the IL family and MMPs family of knee osteoarthritis

Objective: To study the effect of intramuscular calcitonin injection combined with intra-articular ozone injection on the expression of the IL family and MMPs family of knee osteoarthritis. Methods: A total of 128 patients with knee osteoarthritis who were treated in the hospital between January 2015 and January 2017 were collected and divided into control group and observation group by random number table, each with 64 cases. Control group received intra-articular ozone injection therapy, and observation group received intramascular calcitonin injection combined with intra-articular ozone injection therapy. The differences in serum levels of IL family members and MMPs family members were compared between the two groups before and after treatment. Results: Before treatment, the differences in serum levels of IL family members and MMPs family members were not statistically significant between the two groups. 1 week after treatment, serum levels of IL family members IL-1β, IL-15, IL-17 and IL-18 as well as MMPs family members MMP-1, MMP-2, MMP-3 and MMP-13 of both groups of patients were significantly lower than those before treatment, and serum IL-1β, IL-15, IL-17, IL-18, MMP-1, MMP-2, MMP-3 and MMP-13 levels of observation group were significantly lower than those of control group. Conclusion: Intramuscular calcitonin injection combined with intra-articular ozone injection therapy can effectively inhibit the expression of IL family and MMPs family in patients with knee osteoarthritis.

关节腔内移植物长度测量在前交叉韧带全内重建的应用研究

目的:探讨关节镜下测量关节腔内移植物长度在前交叉韧带(anterior cruciate ligament,ACL)全内重建应用的临床疗效。方法:回顾性分析2020年1月至2022年1月收治的ACL损伤患者60例的资料,其中男37例,女23例,年龄22~44岁。按照手术方式的不同,分为传统手术组(常规组)和拉线测量组(测量组),每组各30例。常规组男20例,女10例,年龄(30.00±3.95)岁;身体质量指数(body mass index,BMI)为(22.58±1.41)kg·m^(-2);左侧9例,右侧21例;受伤至手术时间(3.00±1.35)d。测量组男17例,女13例,年龄(32.00±4.29)岁;BMI为(23.29±1.39)kg·m^(-2);左侧12例,右侧18例;受伤至手术时间(3.00±1.27)d。记录患者术前及术后6、12个月的临床资料。从术后视觉模拟评分法(visual analogue scale,VAS)、膝关节损伤与骨关节炎评分(knee injury and osteoarthritis outcome score,KOOS)、Lysholm评分、国际膝关节文献委员会(International Knee Documentation Committee,IKDC)膝关节评估表、膝关节稳定性(Lachman试验、前抽屉试验和轴移试验)、术后不同阶段CT测量骨隧道直径增宽程度和MRI评分系统等方面比较两种方法的临床疗效。结果:术后6个月两组VAS比较差异无统计学意义(P>0.05),术后12个月测量组VAS(2.23±1.01)分,低于常规组(3.30±1.02)分(P<0.001)。术后12个月,两组KOOS评分除症状评分差异无统计学意义(P=0.221),其余各项评分差异均有统计学意义(P<0.05)。术后6个月,测量组Lysholm总分和IKDC总分均高于常规组(P<0.05)。术后12个月,测量组Lachman试验、前抽屉试验和轴移试验和常规组比较,差异均无统计学意义(P>0.05);但是,整体膝关节不稳定性分析,测量组膝关节稳定性优于对照组(P=0.038)。术后2 d及术后6、12个月两组患者影像学评估结果显示,测量组股骨和胫骨的肌腱隧道直径增宽程度均较常规组术后减少(P<0.05);MRI评分测量组患者均高于常规组(P<0.05)。结论:关节镜下测量关节腔内移植物长度在全内技术ACL重建,肌腱利用率高,稳定性好,1年内膝关节功能恢复满意,疗效肯定。

Extracellular vesicles derived from mesenchymal stem cells mediate extracellular matrix remodeling in osteoarthritis through the transport of microRNA-29a

BACKGROUND Knee osteoarthritis(KOA)is a common orthopedic condition with an uncertain etiology,possibly involving genetics and biomechanics.Factors like changes in chondrocyte microenvironment,oxidative stress,inflammation,and immune responses affect KOA development.Early-stage treatment options primarily target symptom relief.Mesenchymal stem cells(MSCs)show promise for treatment,despite challenges.Recent research highlights microRNAs(miRNAs)within MSC-released extracellular vesicles that can potentially promote cartilage regeneration and hinder KOA progression.This suggests exosomes(Exos)as a promising avenue for future treatment.While these findings emphasize the need for effective KOA progression management,further safety and efficacy validation for Exos is essential.AIM To explore miR-29a’s role in KOA,we’ll create miR-29a-loaded vesicles,testing for early treatment in rat models.METHODS Extraction of bone marrow MSC-derived extracellular vesicles,preparation of engineered vesicles loaded with miR-29a using ultrasonication,and identification using quantitative reverse transcription polymerase chain reaction;after establi-shing a rat model of KOA,rats were randomly divided into three groups:Blank control group injected with saline,normal extracellular vesicle group injected with normal extracellular vesicle suspension,and engineered extrace-llular vesicle group injected with engineered extracellular vesicle suspension.The three groups evaluation,histological detection,and immunohistochemical detection to compare and evaluate the progress of various forms of arthritis.RESULTS General behavioral observation results showed that the extracellular vesicle group and engineered extracellular vesicle group had better performance in all four indicators of pain,gait,joint mobility,and swelling compared to the blank control group.Additionally,the engineered extracellular vesicle group had better pain relief at 4 wk and better knee joint mobility at 8 wk compared to the normal extracellular vesicle group.Imaging examination results showed that the blank control group had the fastest progression of arthritis,the normal extracellular vesicle group had a relatively slower progression,and the engineered extracellular vesicle group had the slowest progression.Gross histological observation results showed that the blank control group had the most obvious signs of arthritis,the normal extracellular vesicle group showed signs of arthritis,and the engineered extracellular vesicle group showed no significant signs of arthritis.Using the Pelletier gross score evaluation,the engineered extracellular vesicle group had the slowest progression of arthritis.Results from two types of staining showed that the articular cartilage of rats in the normal extracellular vesicle and engineered extracellular vesicle groups was significantly better than that of the blank control group,and the engineered extracellular vesicle group had the best cartilage cell and joint surface condition.Immunohistochemical detection of type II collagen and proteoglycan showed that the extracellular matrix of cartilage cells in the normal extracellular vesicle and engineered extracellular vesicle groups was better than that of the blank control group.Compared to the normal extracellular vesicle group,the engineered extracellular vesicle group had a better regulatory effect on the extracellular matrix of cartilage cells.CONCLUSION Engineered Exos loaded with miR-29a can exert anti-inflammatory effects and maintain extracellular matrix stability,thereby protecting articular cartilage,and slowing the progression of KOA.

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。

Additional comments on extracellular vesicles derived from mesenchymal stem cells mediate extracellular matrix remodeling in osteoarthritis

Recently,we read an article published by the Yang et al.The results of this study indicated that engineered exosomes loaded with microRNA-29a(miR-29a)alleviate knee inflammation and maintain extracellular matrix stability in Sprague Dawley rats.The study’s results provide useful information for treating knee osteoarthritis(KOA).This letter,shares our perspectives on treating KOA using engineered exosomes for miR-29a.

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。

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。

股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的应用效果

目的评价股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中的安全性和有效性。方法选择滨州医学院附属医院骨关节外科2022年1月至6月因半月板损伤、游离体、骨性关节炎计划行单侧膝关节镜手术患者120例,随机分为股神经阻滞联合关节腔浸润麻醉组(F/I组)和腰硬联合麻醉组(CSEA组),每组60例。F/I组中男32例,女28例,年龄(38.75±11.35)岁;CSEA组中男25例,女35例,年龄(37.80±10.85)岁。比较两组术中补救例数、术后视觉模拟评分法(VAS)评分、术后感觉恢复时间及首次下地活动时间、术后并发症、住院花费及住院天数等指标的差异。采用t检验、χ^(2)检验、Fisher确切概率法。结果F/I组术后6 h VAS评分低于CSEA组[(2.08±0.61)分比(2.54±0.64)分],差异有统计学意义(t=-2.484,P=0.018)。F/I组感觉恢复时间长于CSEA组[(6.25±0.40)h比(3.60±0.31)h,首次下地活动时间短于CESA组[(2.99±1.05)h比(8.14±1.88)h],差异均有统计学意义(t=14.095、-12.263,均P<0.001)。术后并发症:F/I组术中加用麻醉发生率3.3%(2/60)、尿潴留发生率0、下肢静脉血栓发生率1.7%(1/60)、恶心呕吐发生率3.3%(2/60),CSEA组术中加用麻醉发生率0、尿潴留发生率10.0%(6/60)、下肢静脉血栓发生率5.0%(3/60)、恶心呕吐发生率16.7%(10/60),两组尿潴留、恶心呕吐发生率比较差异均有统计学意义(均P<0.05)。F/I组住院时间为(3.90±0.63)d、住院费用为(9612.67±507.15)元,CESA组分别为(5.27±0.75)d、(11401.52±530.01)元,差异均有统计学意义(t=-8.862、-15.425,均P<0.001)。结论股神经阻滞联合关节腔浸润麻醉在膝关节镜手术中能够减少术后并发症、缩短住院时间、降低住院费用,并提供良好的麻醉效果。

关节腔注射治疗骨关节炎药物载体系统中的软骨靶向功能

背景:关节腔注射给药已经在骨关节炎治疗中占有重要地位,新型的药物递送系统的开发给予了更多选择。软骨靶向功能是针对治疗骨关节炎时药物附着或留置在软骨层中形成药库,达到缓释和精准药物递送。目的:综述关节腔注射治疗骨关节炎中各种软骨靶向生物材料和其特点。