Stem cell application for osteoarthritis in the knee joint: A minireview

Knee osteoarthritis is a chronic, indolent disease that will affect an ever increasing number of patients, especially the elderly and the obese. It is characterized by degeneration of the cartilage substance inside the knee which leads to pain, stiffness and tenderness. By some estimations in 2030, only in the United States, this medical condition will burden 67 million people. While conventional treatments like physiotherapy or drugs offer temporary relief of clinical symptoms, restoration of normal cartilage function has been difficult to achieve. Moreover, in severe cases of knee osteoarthritis total knee replacement may be required. Total knee replacements come together with high effort and costs and are not always successful. The aim of this review is to outline the latest advances in stem cell therapy for knee osteoarthritis as well as highlight some of the advantages of stem cell therapy over traditional approaches aimed at restoration of cartilage function in the knee. In addition to the latest advances in the field, challenges associated with stem cell therapy regarding knee cartilage regeneration and chondrogenesis in vitro and in vivo are also outlined and analyzed. Furthermore, based on their critical assessment of the present academic literature the authors of this review share their vision about the future of stem cell applications in the treatment of knee osteoarthritis.

Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis out

AIM To establish minimum clinically important difference(MCID) for measurements in an orthopaedic patient population with joint disorders.METHODS Adult patients aged 18 years and older seeking care for joint conditions at an orthopaedic clinic took the Patient-Reported Outcomes Measurement Information System Physical Function(PROMIS~? PF) computerized adaptive test(CAT), hip disability and osteoarthritis outcome score for joint reconstruction(HOOS JR), and the knee injury and osteoarthritis outcome score for joint reconstruction(KOOS JR) from February 2014 to April 2017. MCIDs were calculated using anchorbased and distribution-based methods. Patient reports of meaningful change in function since their first clinic encounter were used as an anchor.RESULTS There were 2226 patients who participated with a mean age of 61.16(SD = 12.84) years, 41.6% male, and 89.7% Caucasian. Mean change ranged from 7.29 to 8.41 for the PROMIS~? PF CAT, from 14.81 to 19.68 for the HOOS JR, and from 14.51 to 18.85 for the KOOS JR. ROC cut-offs ranged from 1.97-8.18 for the PF CAT, 6.33-43.36 for the HOOS JR, and 2.21-8.16 for the KOOS JR. Distribution-based methods estimated MCID values ranging from 2.45 to 21.55 for the PROMIS~? PF CAT; from 3.90 to 43.61 for the HOOS JR, and from 3.98 to 40.67 for the KOOS JR. The median MCID value in the range was similar to the mean change score for each measure and was 7.9 for the PF CAT, 18.0 for the HOOS JR, and 15.1 for the KOOS JR.CONCLUSION This is the first comprehensive study providing a wide range of MCIDs for the PROMIS? PF, HOOS JR, and KOOS JR in orthopaedic patients with joint ailments.

Synovial Neuronal Changes in Knee Joint Osteoarthritis

Purpose: The purpose is to study whether pain and inflammation in knee joint osteoarthritis (OA) are associated with local synovial neuronal changes. Methods: Synovial biopsies were harvested from the medial and lateral knee compartments from OA patients undergoing total joint replacement surgery. All patients had predominant pain at the medial joint compartment. Pain and knee joint function were evaluated by knee society score (KSS). Synovial inflammation was analyzed by histopathological analysis and expression of growth associated protein-43 (GAP-43), sensory (SP, CGRP) and autonomic (NPY, VIP, TH) neuropeptides was studied by single and double immunohistochemistry techniques. Results: We observed reduced KSS and increased inflammatory score in synovial membrane of medial knee compartment. A significant increase in GAP-43 [P = 0.001], SP [P = 0.05], CGRP [P = 0.05] and TH [P = 0.05] expression was observed and SP, CGRP and NPY were found to be co-existed predominantly with GAP-43 in synovial membrane collected from medial compared to the lateral knee compartment. Conclusions: Regenerating nerve fibers containing sensory and autonomic neuropeptides are associated with pain and inflammation in knee joint OA.

Progress of improvement of pain and joint function of knee osteoarthritis treated with thunder-fire moxibustion in the last five years

Objective:To summarize the clinical research of improvement of pain and joint function of knee osteoarthritis treated with thunder-fire moxibustion in the last five years,in order to provide more objective and scientific theoretical basis for the clinical use of thunderfire moxibustion in the treatment of knee osteoarthritis.Methods:By using"thunder-fire moxibustion"and"knee osteoarthritis"as keywords,the clinical literature on the treatment of knee osteoarthritis mainly by thunder-fire moxibustion in the past 5 years in PubMed,CNKI,WF and VIP were analyzed.Results:Thunderfire moxibustion and its compound therapy,including internal use of traditional Chinese medicine,external use of traditional Chinese medicine,drug injection,physical therapy,acupuncture,heat sensitive moxibustion,pricking collaterals,acupoint application and ozone,could relieve pain,improve joint function,improve joint activity,improve patients daily life ability and have less adverse reactions.Conclusion:Thunder-fire moxibustion was a safe,non-invasive and effective treatment for knee osteoarthritis.However,further research is necessary due to the non-rigidity of the current clinical trial design.

Expression changes and clinical significance of TLR-4 and IL-1β in serum and knee joint fluid of patients with knee osteoarthritis

Objective:To investigate the expression changes and clinical significance of Toll-like receptor-4(TLR-4)and interleukin-1β(IL-1β)in the serum and knee joint fluid in patients with knee osteoarthritis(KOA).Methods:From June 2017 to December 2018,220 cases of patients with KOA who were admitted in Department of Orthopedics of the Third Affiliated Hospital of Inner Mongolia Medical University(“our hospital”for short)were selected as the observation group.According to the severity of KOA,they were divided into the mild subgroup(n=98),the moderate subgroup(n=80)and the severe subgroup(n=42).In addition,60 cases of volunteers who received the physical examination in Health Medical Center of our hospital were selected as the control group.The levels of TLR-4 and IL-1βin the serum and knee joint fluid were detected by enzyme-linked immunosorbent assay,in order to analyze the correlation of TLR-4 and IL-1βlevels with the severity of KOA.Results:The levels of TLR-4 and IL-1βin the serum and knee joint fluid of the observation group were significantly higher than those of the control group,and the differences were statistically significant(all p<.05).The levels of TLR-4 and IL-1βin the serum and knee joint fluid of the severe subgroup were significantly higher than those of the mild subgroup and the moderate subgroup,and the levels of TLR-4 and IL-1βin the serum and knee joint fluid of the moderate subgroup were higher than those of the mild group.The differences were statistically significant(all p<.05).The levels of TLR-4 and IL-1βin the serum and knee joint fluid were positively correlated to the severity of KOA(r=.706,.729,.741,.715,all p<.05);in the serum,the level of TLR-4 was positively correlated to the level of IL-1β(r=.720,p<.05);in the joint fluid,the level of TLR-4 was positively correlated to the level of IL-1β(r=.736,p<.05).Conclusions:The levels of TLR-4 and IL-1βin the serum and knee joint fluid of KOA patients are abnormally increased,which is closely related with the severity of KOA.It can be used for clinical prediction,diagnosis and treatment of KOA.

Medium-term efficacy of arthroscopic debridement vs conservative treatment for knee osteoarthritis of Kellgren-Lawrence grades I-III

BACKGROUND Arthroscopic debridement is a mature treatment for knee osteoarthritis(KOA).Due to the differences in the research subjects,methods,and efficacy evaluation indexes,there are great differences in the surgical efficacy reported in the literature.AIM To compare the medium-term efficacy of arthroscopic debridement and conservative treatment for KOA of Kellgren-Lawrence grades I-III.METHODS Patients with KOA of Kellgren-Lawrence grades I-III who were admitted to the orthopedic clinic of our hospital from July 2018 to December 2018 and agreed to undergo arthroscopic surgery were included in an arthroscopic debridement group,and those who refused surgical treatment were included in a conservative treatment group.Gender,age,body mass index(BMI),side of KOA,American hospital for special surgery knee score(HSS score)before treatment,visual analogue scale(VAS)score during walking and rest before treatment,conservative treatment content,and surgical procedure were recorded.Outpatient visits were conducted at the 1st,3rd,6th,12th,and 24th mo after treatment in the two groups.The changes of HSS score and VAS score in each group before and after treatment were statistically analyzed,and the differences of HSS score and VAS score in different treatment stages between the two groups were also compared.RESULTS In the conservative treatment group,there were 80 patients with complete followup data,including 20 males and 60 females,aged 58.75±14.66 years old.And in the knee arthroscopic debridement group,there were 98 patients with complete follow-up data,including 24 males and 74 females,aged 59.27±14.48 years old.There was no statistically significant difference in the general data(gender,age,BMI,side of KOA,Kellgren-Lawrence grade distribution,HSS score,and VAS score)between the two groups before treatment.The HSS scores of the conservative treatment group at the 1st,3rd,6th,12th,and 24th mo after treatment were significantly higher than that before treatment(P<0.05).There was no statistical difference in HSS score of the conservative treatment group among the 1st,3rd,6th,12th,and 24th mo(P>0.05).The HSS score of the knee arthroscopic debridement group at the 1st mo after surgery was significantly higher than that before surgery(P<0.05).HSS scores of the knee arthroscopic debridement group at the 3rd,6th,12th,and 24th mo were significantly higher than those before surgery and at the 1st mo after surgery(P<0.05).There were no statistically significant differences in HSS scores at the 3rd,6th,12th,and 24th mo after surgery(P>0.05).HSS scores at the 3rd,6th,12th,and 24th mo were significantly higher in the arthroscopic debridement group than in the conservative treatment group(P<0.05).There was no statistical difference in HSS scores between the two groups before treatment and at the 1st mo of follow-up(P>0.05).VAS scores during walking and rest were significantly decreased in both groups,and the VAS score during rest was significantly lower in the arthroscopic debridement group than in the conservative treatment group,but there was no significant difference in the VAS score during walking between the two groups after treatment.CONCLUSION Compared with conservative treatment,arthroscopic debridement can significantly improve the knee resting pain and knee functional status of patients with KOA of Kellgren-Lawrence grades I-III within 2 years after treatment.

Therapeutic Effect of Chinese Massage Combined with Warm Acupuncture on Knee Osteoarthritis

Objective:To investigate the effect of Chinese massage combined with warm acupuncture on knee osteoarthritis.Methods:60 patients with knee osteoarthritis who were treated in our hospital from January 2017 to October 2019 were selected as the research subjects,and they were randomly divided into 2 groups of 30 patients each.The control group was treated with oral western medicine,and the observation group was treated with massage combined with warm acupuncture.The clinical efficacy and WOMAC index were compared between the two groups.Results:The total effective rate of the observation group was higher than that of the control group,and the WOMAC score was lower than that of the control group.The difference was statistically significant(P<0.05).Conclusion:Chinese massage combined with warm acupuncture is effective in treating knee osteoarthritis It can effectively alleviate the symptoms of pain and joint stiffness in patients,and improve joint mobility,which is worth for clinical promotion.

Clinical effect of Rehabmtation Treating combined with Intra-Articular Injection of Sodium Hyaluronate for Exercise induced knee osteoarthritis

Objective: To study the clinical effect of rehabmtation treating combined with intra-articular injection of sodium hyaluronate for exercise induced knee osteoarthritis, and to research the function, biomechanics of knee joint, and inflammatory factor in articular cavity. Method:Selecting 120 patients with exercise induced knee osteoarthritis, then they were randomly divided into control group (n=60) and intervene group (n=60). The patients in the control group were given conventional rehabmtation treating, and the intervene group were given intra-articular injection of sodium hyaluronate on this basic, they were treated 4 weeks. Evaluating the function of knee joint;conduct isokinetic muscle strength test (determination of the angIllar velocity were 60°/S, 180°/S);test the ratio of muscle peak torque and four muscles centripetal centripetal peak torque and peak torque, work load of femoral knee joints after (simultaneous determination of the angular velocity were 60°/S);detect the inflammatory factor in the joint fluid. Results: After the treatment, clinical effect in intervene group was superior to that in control group,but had no statistical significance;after the treatment, the score of function of knee joint in the two groups were higher than before treatment, and had statistical significance, and the score of function of knee joint in the intervene group were higher than control group, and the difference had statistical significance;Angular velocity of 60°/S and 180°/S the two groups peak torque, work load and the H/Q values were significantly increased, the intervene group were higher than control group, and the difference had statistical significance;inflammatory factor in the two groups were significantly decreased, the intervene group were lower than control group, and the difference had statistical significance.Conclusions: On the basic of rehabmtation treating, the treatment of intra-articular injection of sodium hyaluronate can improve the function of knee joint through improving the knee muscle strength, the level of their participation in the activities of the biomechanics of knee joint, and the inflammatory factor in the joint fluid.

Clinical Effective Evaluation of Tongren Dahuoluo Pill (同仁大活络丸) on Knee Osteoarthritis by Musculoskeletal Ultrasound

Objective:To evaluate the clinical effect of Tongren Dahuoluo Pill(同仁大活络丸)on knee osteoarthritis by musculoskeletal ultrasonography.Methods:From March 2019 to December 2019,45 patients with knee osteoarthritis were collected from the outpatient department of the First Medical Center of PLA General Hospital.Tongren Dahuoluo Pill(同仁大活络丸)was given oral treatment for 12 weeks.VAS score,Lequesne score and WOMAC score were recorded before and after treatment,and the changes of knee joint effusion and synovial hyperplasia were observed by musculoskeletal ultrasonography.Results:Among the 45 patients,18 were male and 27 were female,with the average age of(62.07±9.08)years old,and average disease course of(6.83±7.01)years.The VAS score,Lequesne score and WOMAC score were significantly reduced compared with before treatment,and the difference was statistically significant(P<0.01).We observed that joint effusion range and joint synovial hyperplasia thickness of knee osteoarthritis significantly reduced with Tongren Dahuoluo Pill(同仁大活络丸)treatment by musculoskeletal ultrasonography,and the difference were statistically significant(P<0.01).Conclusion:Tongren Dahuoluo Pill(同仁大活络丸)can not only relieve the clinical symptoms of knee osteoarthritis,but also effectively inhibit synovitis hyperplasia of knee joint.

Penetration of Topical Glucosamine Sulfate into the Synovial Fluid of Patients with Knee Osteoarthritis: A Nonrandomized, Open-Label, Single Dose, Bioavailability Study

Objective: This study aims to show that a proprietary topical cream can deliver glucosamine through the skin into the synovial fluid of osteoarthritic patients. This cream contains 10% w/w glucosamine sulfate. It also aims to determine the endogenous level of glucosamine in the synovial fluid of these patients. Therapeutic effectiveness of glucosamine is not addressed in this study. Design: This phase IV, open-label, nonrandomized study enrolled 240 patients. Participants from the Test group received a single dose treatment (2 g of cream), and synovial fluid samples were collected 1 - 3 hours post-treatment. Patients from the Control group were not subjected to any treatment but their synovial fluid was also sampled to establish a glucosamine concentration baseline for Time-0 (T0). Glucosamine concentrations were determined by HPLC analysis. Results: The mean glucosamine concentration in the synovial fluid of patients from the Test group (100.56 ng/ml, 95% CI 66.36 - 134.76, n = 117) was higher than in the Control group (17.83 ng/ml, 95% CI 7.42 - 28.24, n = 117) resulting in a significant between-group difference (p Conclusion: The results suggest that glucosamine can be topically delivered across the human skin into the synovial fluid using a proper vehicle. This suggests that other water-soluble molecules could similarly be delivered transdermally, alleviating the need for oral delivery in cases where oral administration is difficult, or when harmful side effects could ensue.

Effects of Activating Blood Circulation to Resolve Blood Stasis and Glucosamine Capsules Therapy on the Expression of Matrix Metalloproteinase in Post-traumatic Knee Osteoarthritis

[Objectives] To observe the clinical effects of activating blood circulation to resolve blood stasis and glucosamine hydrochloride capsules therapy on post-traumatic knee osteoarthritis treatment,to measure the expression of matrix metalloproteinase in post-traumatic knee osteoarthritis patients before and after treatment,and to explore its relevant molecular mechanisms. [Methods]A total of 60 patients with posttraumatic knee osteoarthritis in early stage in Affiliated Hospital of Shannxi University of Chinese Medicine from January 2015 to December2017 were selected and randomly divided into the control group( n = 30) and the observation group( n = 30). The control group was given oral administration of glucosamine hydrochloride capsules for 6 courses of the treatment. The observation group was using the activating blood circulation to resolve blood stasis therapy for 6 courses of treatment. The recovery of traumatic knee osteoarthritis and the symptom of traditional Chinese medicine( TCM) in 2 groups was compared before and after treatment. The symptoms and the quantitative assessment rating scale of knee osteoarthritis,the pain index of knee and the TCM symptom scores were recorded in both groups. And the synovial fluid and serum of patients were collected to detect the expression of matrix metalloproteinase. [Results]The symptoms and the quantitative assessment rating scale of knee osteoarthritis,the pain index of knee and TCM symptom scores of the 2 groups in the 1 st week,the 12 th week and the 24 th week after the treatment were significantly lower than those before the treatment,and the difference was statistically significant( P < 0. 05). Two therapeutic methods had certain therapeutic effects on the recovery from traumatic knee osteoarthritis,and could significantly improve the TCM syndrome. There were better therapeutic effects on oral decoction of traditional Chinese medicine than oral glycosaminoglycans hydrochloride capsules on treating traumatic knee osteogenesis( P < 0. 05). The expression level of MMP3 was decreased significantly in both groups( P <0. 001),while the expression level of MMP13 had no significant change in both groups( P >0. 05). The expression level of MMP1 was decreased significantly in the observation group( P < 0. 001),but there was no significant change in the control group after treatment( P >0. 05). [Conclusions]Two treatment methods have been effective in this clinical study. We found that the expression level of MMP3 was decreased significantly after treatment in 2 therapies,which can be clinically applied.

Detection and analysis of knee osteoarthritis in mice with gene expression profile

When gene expression profile is used for gene detection,the probe on the chip can emit fluorescence with different wavelengths.Under the action of confocal laser scanner,a clear gene change image can be obtained,by which the gene changes of the sample to be tested can be observed directly.First,the knee osteoarthritis(KOA)models of mice are established by the method of collateral ligament and meniscus resection(MLI-OA).Then,Bushen Huoxue formula is given by gavage,and ribonucleic acid(RNA)is routinely extracted and purified.Finally,the gene expression changes of KOA tissues of mice are detected by Agilent SurePrint G3 Mouse GE V2.0 gene expression profile.The results show that Bushen Huoxue formula has significant regulation effect on gene expression of KOA tissue.Among the genes with significant up-regulation effect of Bushen Huoxue formula,there are 56 genes of traditional Chinese medicine(TCM)groups up-regulated more than twice compared with model groups.Among the genes with significant down-regulation effect,there are 119 genes of TCM groups down-regulated more than twice compared with model groups.The experimental results indicate that Bushen Huoxue formula may promote the metabolism of arthritic factors and delay cartilage degeneration to treat KOA by regulating genes that are currently unknown in the pathological process of KOA.

Detection Algorithm of Knee Osteoarthritis Based on Magnetic Resonance Images

Knee osteoarthritis(OA)is a common disease that impairs knee function and causes pain.Currently,studies on the detection of knee OA mainly focus on X-ray images,but X-ray images are insensitive to the changes in knee OA in the early stage.Since magnetic resonance(MR)imaging can observe the early features of knee OA,the knee OA detection algorithm based on MR image is innovatively proposed to judge whether knee OA is suffered.Firstly,the knee MR images are preprocessed before training,including a region of interest clipping,slice selection,and data augmentation.Then the data set was divided by patient-level and the knee OA was classified by the deep transfer learning method based on the DenseNet201 model.The method divides the training process into two stages.The first stage freezes all the base layers and only trains the weights of the embedding neural networks.The second stage unfreezes part of the base layers and trains the unfrozen base layers and the weights of the embedding neural network.In this step,we design a block-by-block fine-tuning strategy for training based on the dense blocks,which improves detection accuracy.We have conducted training experiments with different depth modules,and the experimental results show that gradually adding more dense blocks in the fine-tuning can make the model obtain better detection performance than only training the embedded neural network layer.We achieve an accuracy of 0.921,a sensitivity of 0.960,a precision of 0.885,a specificity of 0.891,an F1-Score of 0.912,and an MCC of 0.836.The comparative experimental results on the OAI-ZIB dataset show that the proposed method outperforms the other detection methods with the accuracy of 92.1%.

Traditional Chinese medicine nursing protocols for knee osteoarthritis

ABSTRACT:Knee osteoarthritis(KOA),a complicated peripheral joint disorder,can be caused by non-modifiable and modifiable risk factors.At present,the treatment for osteoarthritis is mainly to manage symptoms and improve quality of life.Although some patients with osteoarthritis may choose pharmacological agents for pain relief,it has been confirmed that a variety of preparations and doses of pharmacological agents were ineffective.In recent years,Traditional Chinese medicine(TCM)has been shown unique superiorities in the treatment of osteoarthritis,including KOA.Therefore,this article primarily investigated the key points of common syndromes,TCM nursing methods and healthy guidance of KOA,aiming at maintaining and developing the strengths of TCM,improving its efficacy and standardizing its behavior.

关节镜下微创有限清理术治疗KOA 患者的效果观察

目的:探讨关节镜下微创有限清理术治疗膝骨性关节炎(KOA)的效果。方法:根据治疗方案将108例KOA患者分为两组,各54例。观察组行关节镜下微创有限清理术,对照组行关节镜下广泛清理术。比较两组临床疗效。结果:两组手术相关指标、血清指标、Toll样受体4(TLR4)/髓样分化因子88(MyD88)/核因子-κB(NF-κB)信号通路指标、动态足底受力时间指标、疼痛程度及膝关节功能方面比较,差异有统计学意义(P<0.05);两组术后并发症总发生率比较差异无统计学意义(P>0.05)。结论:关节镜下微创治疗KOA能优化手术流程,减轻炎症,改善膝关节功能,缓解患者疼痛,且安全性较高。

Comparison of Three Experimental Models for Rat Osteoarthritis Induction

Background: Osteoarthritis is a slowly progressive and debilitating disease with high prevalence in adult population. Knee is one of the joints most affected by this disorder. There are several models for animals’ osteoarthritis induction, however it is not identified any paper that compares these techniques. The present study was aimed to define the most appropriate model for rats osteoarthritis induction. Material and Methods: 40 Wistar rats were distributed into 4 groups of 10 animals each: normality group (NG);meniscectomy group (MG);quinolone group (QG) and iodoacetate group (IG). Radiographic images of the rat’s knees were analyzed as well as the amount of chondrocytes in the epiphyseal and articular cartilage. Results: In the radiographic analysis, there was a low correlation between the raters. Regarding the amount of chondrocytes in the epiphyseal cartilage, it was noticed that the IG and QG groups had fewer chondrocytes than NG, in contrast to MG that reported similar results to normality (p > 0.05). There was no significant difference between IG and QG groups (p > 0.05). Regarding the amount of chondrocytes in articular cartilage, it was noticed that the IG group showed fewer chondrocytes than NG (p 0.05). There was no significant difference between QG and MG groups (p > 0.05). Conclusion: Intraarticular injection of iodoacetate in rats is the model with greatest effect on reduction of chondrocytes amount.

电针对KOA大鼠关节软骨及软骨下骨降解相关蛋白表达的影响

目的:探讨电针对KOA大鼠关节软骨及软骨下骨降解相关蛋白表达的影响。方法:16只24月龄SD雄性大鼠随机分为老年组和电针组各8只,另8只6月龄SD雄性大鼠为青年组。电针组接受电针治疗(穴位:双侧“太溪”“足三里”“阳陵泉”“血海”;电针参数:疏密波,密波15Hz,疏波3Hz,电流1mA,每天1次,每次30min,每周5天,连续干预8周),其余两组不做处理。干预8周后取材,ELISA法检测血清Ⅱ型胶原C端肽(CTX-Ⅱ)含量;显微CT检测左侧胫骨软骨下骨微结构;番红-固绿染色在光镜下观察左胫骨平台软骨组织形态结构,改良Mankin’s评分评估关节软骨退变程度;RT-qPCR、Western blot检测aggrecanase-2、SIRT1 mRNA及蛋白表达水平。结果:(1)与青年组大鼠相比,老年组CTX-Ⅱ含量增高(P<0.05);番红-固绿染色显示老年组软骨表面结构破坏严重,出现裂层,软骨与软骨下骨分界不清,形态结构异常,染色不均;改良Mankin’s评分增加(P<0.05);骨密度、骨体积分数、骨小梁数量减少(P<0.05),骨小梁间距增大(P<0.05);aggrecanase-2 mRNA及蛋白表达升高(P<0.05),SIRT1 mRNA及蛋白表达降低(P<0.05)。(2)与老年组大鼠相比,电针组大鼠的CTX-Ⅱ含量降低(P<0.05);番红-固绿染色显示软骨表面平整,未见明显裂层,染色较均匀;改良Mankin’s评分降低(P<0.05);骨密度增加(P<0.05),骨小梁间距减少(P<0.05),骨体积分数、骨小梁数量有增加的趋势(P>0.05),aggrecanase-2 mRNA及蛋白表达降低(P<0.05),SIRT1 mRNA及蛋白表达升高(P<0.05)。结论:电针可通过促进SIRT1的表达,抑制关节软骨降解,改善软骨下骨骨微结构,从而保护关节软骨。

微创针刀“通阳柔筋”改善KOA中重度患者膝关节功能及调控膝周肌电信号的研究

目的 研究微创针刀“通阳柔筋”对改善膝骨关节炎(knee osteoarthritis,KOA)中重度患者膝关节功能的影响及对膝周肌电信号的调控作用。方法 选取山东第一医科大学第一附属医院疼痛科2020年1月至2023年1月收治的140例KOA中重度患者,采用随机数字表法分为对照组和观察组,每组70例。对照组采用膝部注射药物治疗,观察组加用微创针刀“通阳柔筋”法治疗。比较两组临床疗效、膝关节功能[西安大略和麦克马斯特大学骨关节炎指数(the Western Ontario and Mcmaster University osteoarthritis index,WOMAC)评分]、膝周肌电信号、血清葡萄糖-6-磷酸异构酶(glucose-6-phosphate isomerase,GPI)、硫酸软骨素846(chondroitin sulfate 846,CS846)、血小板反应蛋白-1(thrombospondin-1,TSP-1)水平、关节炎生活质量测量量表2-短卷(short-form arthritis impact measurement scales 2,AIMS2-SF)评分、膝关节肿胀程度、膝关节屈伸活动度。结果 观察组总有效率(95.71%)高于对照组(84.29%)(P<0.05)。治疗后,两组WOMAC评分均较治疗前下降(P<0.01),且观察组低于对照组(P<0.01)。治疗后,两组股外斜肌、股内斜肌的肌电信号均较治疗前升高(P<0.01),且观察组高于对照组(P<0.01);两组半腱肌的肌电信号均较治疗前降低(P<0.01),且观察组低于对照组(P<0.01)。治疗后,两组血清GPI、CS846、TSP-1水平均较治疗前下降(P<0.01),且观察组均低于对照组(P<0.01)。治疗后,两组AIMS2-SF评分均较治疗前升高(P<0.05,P<0.01),且观察组高于对照组(P<0.01)。治疗后,两组膝关节肿胀程度均较治疗前降低(P<0.01),且观察组低于对照组(P<0.01);两组膝关节屈伸活动度均较治疗前升高(P<0.01),且观察组高于对照组(P<0.01)。结论 微创针刀“通阳柔筋”治疗中重度KOA能提高疗效,改善膝周肌电信号,并可以降低血清GPI、CS846、TSP-1水平。

ABMSCs移植联合关节镜清理术对KOA患者疼痛程度、膝关节功能及炎性因子的影响

目的探讨应用自体骨髓间充质干细胞(ABMSCs)移植联合关节镜清理术治疗膝骨关节炎(knee osteoarthritis,KOA)的效果及对患者疼痛、膝关节功能、炎性因子的影响。方法选取我院2017年10月-2019年2月收治的110例KOA患者,据治疗方法不同分为观察组57例和对照组53例。两组均行关节镜清理术,观察组在此基础上联合ABMSCs移植治疗。治疗后半年比较两组疗效,治疗前及治疗后3、6个月采用视觉模拟评分法(visual analogue scale,VAS)评价两组疼痛程度和采用Lysholm膝关节评分量表(Lysholm knee score scale,LKSS)评价两组患膝关节功能恢复情况,以及两组治疗前及治疗后3、6个月患膝关节液白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)水平。结果观察组治疗总有效率为91.23%高于对照组的71.70%(P<0.01)。两组治疗后VAS评分及IL-1β、TNF-α逐渐降低,且观察组治疗后3、6个月VAS评分及IL-1β、TNF-α均低于对照组同时间,差异有统计学意义(P<0.05或P<0.01)。两组治疗后LKSS评分逐渐升高,且观察组治疗后3、6个月LKSS评分均高于对照组同时间,差异有统计学意义(P<0.05或P<0.01)。结论ABMSCs移植联合关节镜清理术治疗KOA效果显著,可显著缓解患者疼痛,促进患膝关节功能的恢复,有效抑制患膝关节液炎症介质释放,且安全性良好。

有限元分析技术在膝关节生物力学应用中的特点与优势

背景:有限元分析是一种先进的计算机工程技术,利用数学近似的方法对真实人体进行模拟,可以真实反映膝关节结构内部的生物力学特征,为理解膝关节疾病发病机制、优化手术方案以及开发新型植入材料提供了有效的工具。目的:对膝关节有限元模型的建立及其在膝关节疾病研究中的应用进行综述,并展望了未来的发展趋势。方法:第一作者于2024年4月以“Finite Element Analysis,FEA,knee joint,Finite Element Model,Knee Biomechanics,Knee Osteoarthritis,Knee Prosthesis,Knee Ligaments,Meniscus”为英文检索词在PubMed和EI数据库进行检索,以“有限元分析,有限元模型,膝关节,生物力学,骨关节炎,计算模型,膝关节假体,膝关节韧带,半月板”为中文检索词在中国知网和万方数据库进行检索,最终纳入75篇文献进行分析。结果与结论:①有限元分析法利用医学影像数据获得三维人体模型,将复杂的人体关节结构简化为有限且相互连接的单元,通过对模型施加外部载荷,直观地显示膝关节内部的应力分布。②研究者通过有限元分析深入研究膝关节在不同工况下的内部应力和应变分布,可发现膝关节内部载荷分配平衡改变时,关节软骨的过度载荷及部分区域的负荷下降,这种长期异常应力会引起软骨变形和磨损,最终缺失,对于理解生物力学因素如何引起膝关节退行性变至关重要。③有研究通过有限元分析评估膝骨关节炎患者采用太极拳、步态调整等物理治疗方法的效果,结果显示这些治疗方法减少了软骨的过度负荷,为临床治疗提供了科学理论依据。④临床医生通过有限元分析在手术前进行三维重建、数据测量和模拟手术,能够优化手术治疗策略;此外,还可以通过模拟不同假体的力学特征,改进假体的形状、材料和固定方式,减少患者的并发症,提高患者的治疗效果。⑤人工智能与有限元分析相结合使得有限元模型的构建更为精确和易于操作,极大提高了临床医生医疗实践的效率和患者的治疗效果。⑥有限元分析仅是数字化的模拟,与真实物理状态仍存在一定差异。