BACKGROUND Lumbar facet joint syndrome(LFJS)is a pain condition arising from lumbar facet joint diseases.Treatments of LFJS includes patient education,oral medication,bed rest,physical therapy,and procedural intervent...BACKGROUND Lumbar facet joint syndrome(LFJS)is a pain condition arising from lumbar facet joint diseases.Treatments of LFJS includes patient education,oral medication,bed rest,physical therapy,and procedural interventions.For some refractory cases that fail conservative therapies,dorsal ramus medial brunch radiofrequency ablation is warranted.However,as nerve fibers can regenerate,their efficacy is impermanent,and the recurrence rate is relatively high.Considering synovial impingement is a paramount pathogenesis of LFJS,in this case,we removed the culprit hyperplastic articular capsule and the articular process partially through a spinal endoscope.As the culprit hyperplastic joint capsule was excised,it is supposed to generate more prolonged efficacy and a lower recurrence rate than radiofrequency treatment.CASE SUMMARY A 40-year-old female patient was diagnosed with LFJS.She complained of low back pain and right buttock pain for half a year.The patient was placed in the prone position.After disinfection and draping,a 25-cm 18-gauge needle was inserted into the dorsal surface of the right L5 articular process.Subsequently,a guidewire,dilating tubes,and a working cannula was inserted successively.The spinal endoscope was positioned in the working cannula.Under the endoscope,the microvascular tissue,muscle tissue attached on the L5 inferior articular process and S1 superior articular process,as well as the capsule and minor portion of the inferior articular process were removed.After the joint space was clear and no bleeding points existed,the endoscope and working cannula were shifted,and the incision was sutured.After treatment,the symptoms were completely relieved.The patient was pain-free during the follow-up period of 6 mo.CONCLUSION The endoscopic partial joint capsule and articular process excision is an effective procedure for LFJS,especially for cases caused by synovial impingement.展开更多
For improving the theory of gradient microstructure of cartilage/bone interface, human distal femurs were studied. Scanning Electron Microscope （SEM）, histological sections and MicroCT were used to observe, measure ...For improving the theory of gradient microstructure of cartilage/bone interface, human distal femurs were studied. Scanning Electron Microscope （SEM）, histological sections and MicroCT were used to observe, measure and model the micro- structure of cartilage/bone interface. The results showed that the cartilage/bone interface is in a hierarchical structure which is composed of four different tissue layers. The interlocking of hyaline cartilage and calcified cartilage and that of calcified car- tilage and subchondral bone are in the manner of＂protrusion-pore＂ with average diameter of 17.0 gm and 34.1 lam respectively. In addition, the cancellous bone under the cartilage is also formed by four layer hierarchical structure, and the adjacent layers are connected by bone trabecula in the shape of H, I and Y, forming a complex interwoven network structure. Finally, the simplified structure model of the cartilage/bone interface was proposed according to the natural articular cartilage/bone interface. The simplified model is a 4-layer gradient biomimetic structure, which corresponds to four different tissues of natural cartilage/bone interface. The results of this work would be beneficial to the design of bionic scaffold for the tissue engineering of articular cartilage/bone.展开更多
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...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。展开更多
Background：Knee osteoarthritis （KOA） is a chronic joint disease that manifests as knee pain as well as different degrees of lower limb swelling,stiffness,and movement disorders.The therapeutic goal is to alleviate ...Background：Knee osteoarthritis （KOA） is a chronic joint disease that manifests as knee pain as well as different degrees of lower limb swelling,stiffness,and movement disorders.The therapeutic goal is to alleviate or eliminate pain,correct deformities,improve or restore joint functions,and improve the quality of life.This study aimed to evaluate the efficacy and safety of Zhuanggu joint capsules combined with celecoxib and the benefit of treatment with Zhuanggu alone for KOA.Methods：This multi-center,randomized,double-blind,double-dummy,parallel controlled trial,started from December 2011 to May 2014,was carried out in 6 cities,including Beijing,Shanghai,Chongqing,Changchun,Chengdu,and Nanjing.A total of 432 patients with KOA were divided into three groups （144 cases in each group）.The groups were treated,respectively,with Zhuanggu joint capsules combined with celecoxib capsule simulants,Zhuanggu joint capsules combined with celecoxib capsules,and celecoxib capsules combined with Zhuanggu joint capsule simulants for 4 weeks consecutively.The improvement of Western Ontario and McMaster Universities Osteoarthritis （WOMAC） index and the decreased rates in each dimension of WOMAC were evaluated before and after the treatment.Intergroup and intragroup comparisons of quantitative indices were performed.Statistically significant differences were evaluated with pairwise comparisons using Chi-square test （or Fisher＆#39;s exact test） and an inspection level ofα =0.0167.Results：Four weeks after treatment,the total efficacies of Zhuanggu group,combination group,and celecoxib group were 65%,80%,and 64%,respectively,with statistically significant differences among the three groups （P =0.005）.Intergroup pairwise comparisons showed that the total efficacy of the combination group was significantly higher than that of the Zhuanggu （P =0.005） and celecoxib （P =0.003）groups.The difference between the latter two groups was not statistically significant （P 〉 0.0167）.Four weeks after discontinuation,the efficacies of the three groups were 78%,95%,and 65%,respectively,with statistically significant differences （P 〈 0.0001）.Intergroup pairwise comparisons revealed that the efficacy of the combination group was significantly better than that of the Zhuanggu and the celecoxib groups （P 〈 0.0001）.The difference between the latter two groups was not statistically significant （P 〉 0.0167）.The incidences of adverse events in Zhuanggu group,combination group,and celecoxib group were 8.5%,8.5%,and 11.1%,respectively,with insignificant differences （P 〉 0.05）.Conclusions：Zhuanggu joint capsules alone or combined with celecoxib showed clinical efficacy in the treatment of KOA.The safety of Zhuanggu joint capsules alone or combined with celecoxib was acceptable.展开更多
文摘BACKGROUND Lumbar facet joint syndrome(LFJS)is a pain condition arising from lumbar facet joint diseases.Treatments of LFJS includes patient education,oral medication,bed rest,physical therapy,and procedural interventions.For some refractory cases that fail conservative therapies,dorsal ramus medial brunch radiofrequency ablation is warranted.However,as nerve fibers can regenerate,their efficacy is impermanent,and the recurrence rate is relatively high.Considering synovial impingement is a paramount pathogenesis of LFJS,in this case,we removed the culprit hyperplastic articular capsule and the articular process partially through a spinal endoscope.As the culprit hyperplastic joint capsule was excised,it is supposed to generate more prolonged efficacy and a lower recurrence rate than radiofrequency treatment.CASE SUMMARY A 40-year-old female patient was diagnosed with LFJS.She complained of low back pain and right buttock pain for half a year.The patient was placed in the prone position.After disinfection and draping,a 25-cm 18-gauge needle was inserted into the dorsal surface of the right L5 articular process.Subsequently,a guidewire,dilating tubes,and a working cannula was inserted successively.The spinal endoscope was positioned in the working cannula.Under the endoscope,the microvascular tissue,muscle tissue attached on the L5 inferior articular process and S1 superior articular process,as well as the capsule and minor portion of the inferior articular process were removed.After the joint space was clear and no bleeding points existed,the endoscope and working cannula were shifted,and the incision was sutured.After treatment,the symptoms were completely relieved.The patient was pain-free during the follow-up period of 6 mo.CONCLUSION The endoscopic partial joint capsule and articular process excision is an effective procedure for LFJS,especially for cases caused by synovial impingement.
基金This paper was supported by the National Natural Science Foundation of China （Grant No： 50875201） and the National Hi-Tech Program of China （Grant No： 2009AA043801）. The authors thank Professor Yiping Tang from Xi＇an Jiaotong University for improving the manuscript.
文摘For improving the theory of gradient microstructure of cartilage/bone interface, human distal femurs were studied. Scanning Electron Microscope （SEM）, histological sections and MicroCT were used to observe, measure and model the micro- structure of cartilage/bone interface. The results showed that the cartilage/bone interface is in a hierarchical structure which is composed of four different tissue layers. The interlocking of hyaline cartilage and calcified cartilage and that of calcified car- tilage and subchondral bone are in the manner of＂protrusion-pore＂ with average diameter of 17.0 gm and 34.1 lam respectively. In addition, the cancellous bone under the cartilage is also formed by four layer hierarchical structure, and the adjacent layers are connected by bone trabecula in the shape of H, I and Y, forming a complex interwoven network structure. Finally, the simplified structure model of the cartilage/bone interface was proposed according to the natural articular cartilage/bone interface. The simplified model is a 4-layer gradient biomimetic structure, which corresponds to four different tissues of natural cartilage/bone interface. The results of this work would be beneficial to the design of bionic scaffold for the tissue engineering of articular cartilage/bone.
文摘背景: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。
文摘Background：Knee osteoarthritis （KOA） is a chronic joint disease that manifests as knee pain as well as different degrees of lower limb swelling,stiffness,and movement disorders.The therapeutic goal is to alleviate or eliminate pain,correct deformities,improve or restore joint functions,and improve the quality of life.This study aimed to evaluate the efficacy and safety of Zhuanggu joint capsules combined with celecoxib and the benefit of treatment with Zhuanggu alone for KOA.Methods：This multi-center,randomized,double-blind,double-dummy,parallel controlled trial,started from December 2011 to May 2014,was carried out in 6 cities,including Beijing,Shanghai,Chongqing,Changchun,Chengdu,and Nanjing.A total of 432 patients with KOA were divided into three groups （144 cases in each group）.The groups were treated,respectively,with Zhuanggu joint capsules combined with celecoxib capsule simulants,Zhuanggu joint capsules combined with celecoxib capsules,and celecoxib capsules combined with Zhuanggu joint capsule simulants for 4 weeks consecutively.The improvement of Western Ontario and McMaster Universities Osteoarthritis （WOMAC） index and the decreased rates in each dimension of WOMAC were evaluated before and after the treatment.Intergroup and intragroup comparisons of quantitative indices were performed.Statistically significant differences were evaluated with pairwise comparisons using Chi-square test （or Fisher＆#39;s exact test） and an inspection level ofα =0.0167.Results：Four weeks after treatment,the total efficacies of Zhuanggu group,combination group,and celecoxib group were 65%,80%,and 64%,respectively,with statistically significant differences among the three groups （P =0.005）.Intergroup pairwise comparisons showed that the total efficacy of the combination group was significantly higher than that of the Zhuanggu （P =0.005） and celecoxib （P =0.003）groups.The difference between the latter two groups was not statistically significant （P 〉 0.0167）.Four weeks after discontinuation,the efficacies of the three groups were 78%,95%,and 65%,respectively,with statistically significant differences （P 〈 0.0001）.Intergroup pairwise comparisons revealed that the efficacy of the combination group was significantly better than that of the Zhuanggu and the celecoxib groups （P 〈 0.0001）.The difference between the latter two groups was not statistically significant （P 〉 0.0167）.The incidences of adverse events in Zhuanggu group,combination group,and celecoxib group were 8.5%,8.5%,and 11.1%,respectively,with insignificant differences （P 〉 0.05）.Conclusions：Zhuanggu joint capsules alone or combined with celecoxib showed clinical efficacy in the treatment of KOA.The safety of Zhuanggu joint capsules alone or combined with celecoxib was acceptable.
