Periosteum derived stem cells for regenerative medicine proposals: boosting current knowledge

Periosteum is a thin fibrous layer that covers most bones. It resides in a dynamic mechanically loaded environment and provides a niche for pluripotent cells and a source for molecular factors that modulate cell behaviour. Elucidating periosteum regenerative poten-tial has become a hot topic in orthopaedics. This review discusses the state of the art of osteochondral tissue engineering rested on periosteum derived progenitor cells(PDPCs) and suggests upcoming research direc-tions. Periosteal cells isolation, characterization and migration in the site of injury, as well as their differen-tiation, are analysed. Moreover, the role of cell mecha-nosensing and its contribution to matrix organization, bone microarchitecture and bone stenght is examined. In this regard the role of periostin and its upregulation under mechanical stress in order to preserve PDPC sur-vival and bone tissue integrity is contemplated. The re-view also summarized the role of the periosteum in the field of dentistry and maxillofacial reconstruction. The involvement of microRNAs in osteoblast differentiation and in endogenous tissue repair is explored as well. Fi-nally the novel concept of a guided bone regenerationbased on the use of periosteum itself as a smart mate-rial and the realization of constructs able to mimic the extracellular matrix features is talked out. Additionally, since periosteum can differentiate into insulin produc-ing cells it could be a suitable source in allogenic trans-plantations. That innovative applications would takeadvantage from investigations aimed to assess PDPCimmune privilege.

3D-printed,bi-layer,biomimetic artificial periosteum for boosting bone regeneration

Periosteum,a membrane covering the surface of the bone,plays an essential role in maintaining the function of bone tissue—and especially in providing nourishment and vascularization during the bone regeneration process.Currently,most artificial periostea have relatively weak mechanical strength and a rapid degradation rate,and they lack integrated angiogenesis and osteogenesis functions.In this study,a bi-layer,biomimetic,artificial periosteum composed of a methacrylated gelatin–nano-hydroxyapatite(GelMA-nHA)cambium layer and a poly(N-acryloyl 2-lycine)(PACG)-GelMA-Mg^(2+)fibrous layer was fabricated via 3D printing.The GelMA-nHA layer is shown to undertake the function of improving osteogenic differentiation of rat bone marrow mesenchymal stem cells with the sustainable release of Ca^(2+) from nHA nanoparticles.The hydrogen-bonding-strengthened P(ACG-GelMA-L)-Mg^(2+)hydrogel layer serves to protect the inner defect site and prolong degradation time(60 days)to match new bone regeneration.Furthermore,the released magnesium ion exhibits a prominent effect in regulating the polarization phenotype of macrophage cells into theM2 phenotype and thus promotes the angiogenesis of the human umbilical vein endothelial cells in vitro.This bi-layer artificial periosteum was implanted into a critical-sized cranial bone defect in rats,and the 12-week post-operative outcomes demonstrate optimal new bone regeneration.

Experiment study on combined free periosteum grafting and new reconstituted bone xenograft in repairing segmental defects

Objective: To study the efficacy of combined use of a new grafting material, new reconstituted bone xenograft (NRBX) and free periosteal graft in repair of segmental bony defects. Methods: NRBX was made by combining recombi- nant human BMP2(rhBMP2) and an antigen-free bovine cancellous bone (BCB) as a carrier. NRBX was used alone, in combination with free periosteal graft to repair a 1. 5 cm defect in the radius of rabbit. The defect-repairing capability for each of the treatment modalities was assessed with radiographical, biomechanical, densitometrical and histological methods. Results: NRBX used alone was capable of healing the defect in large by 16 weeks, with a similar repair process and mecha- nism seen with econstituted bone xenograft (RBX). Combined use of NRBX and free periosteal graft was superior in terms of increased and quality of the new bone formed at the early stage of the repair pass (within 12 weeks) to NRBX used alone, with the defect basically healed by 12 weeks. Conclusion: Both methods are effective in repairing segmental bone defects, but NRBX used in combination with free periosteal graft is preferred, because of the satisfactory osteogenesis, osteoconduction and osteoinduction.

Giant nodular fasciitis originating from the humeral periosteum:A case report

BACKGROUND Nodular fasciitis(NF)is a self-limiting tumor that mostly occurs in the subcutaneous superficial fascia.NF originating from the appendicular periosteum is extremely rare.A large NF lesion of periosteal origin can be misdiagnosed as a malignant bone tumor and may cause overtreatment.CASE SUMMARY A right axillary mass was found in a 46-year-old man and was initially diagnosed intraoperatively as low-grade sarcoma,but later diagnosed as NF after postresection histopathological evaluation.Furthermore,fluorescence in situ hybridization analysis revealed a USP6 gene rearrangement that confirmed the diagnosis.To the best of our knowledge,this is the first case of NF in the humeral periosteum.CONCLUSION NF poses a diagnostic challenge as it is often mistaken for sarcoma.Postoperative histopathological examination of whole sections can be combined with immunohistochemical staining and,if necessary,the diagnosis can be confirmed by molecular detection,and thus help avoid overtreatment.

Reconstruction of Hemipelvectomy Defect Using a Fillet Flap with Femoral Periosteum

Backgrounds: Reconstruction after hemipelvectomy is very important for rehabilitation into society. The pelvis plays an important role for support of the intra-abdominal organs. Methods: We operated 3 cases using fillet flaps with the femoral periosteum for reconstruction of hemipelvectomy defect. Results: It is useful to elevate the flap all around with the femoral periosteum, because the periosteum can be sutured to supporting pelvic structures with the aim to support intra-abdominal organs. Conclusion: Without alternative supports for the bony pelvis, pelvic reconstructions are at risk for hernia and it may be difficult for outpatients to fit their habiliments after radical cure. The rigid support for the intra-abdominal organs occurs in association with the suture pelvic and femoral periosteum.

Reconstruction of tracheal defect using the contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum

To reconstruct tracheal defect after tumor excision,we used the contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum.Methods The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum was used to reconstruct the tracheal defect when the blood supply to the ipsilateral sternocleidomastoideus was destroyed because of lymphonode clearing or radiotherapy.The pedicle of the musculo-periosteum flap was dissected adequately and the blood supply was protected carefully.Results All flaps survived with epithelization and osteogenesis.The endotracheal tubes were pulled out safely without trachea stenosis in all the patients.Conclusion The contralateral musculo-periosteum flap of the sternocleidomastoideus with clavicular periosteum could reconstruct the tracheal defect when the ipsilateral blood supply was damaged.This method extends the application of the musculo-periosteum flap.3 refs,4 figs.

Osteogenic potential of human periosteum-derived progenitor cells in PLGA scaffold using allogeneic serum

The use of periosteum-derived progenitor cells (PCs) combined with bioresorbable materials is an attractive approach for tissue engineering. The aim of this study was to characterize the osteogenic differentiation of PC in 3-dimensional (3D) poly-lactic-co-glycolic acid (PLGA) fleeces cultured in medium containing allogeneic human serum. PCs were isolated and expanded in monolayer culture. Expanded cells of passage 3 were seeded into PLGA constructs and cultured in osteogenic me- dium for a maximum period of 28 d. Morphological, histological and cell viability analyses of three-dimensionally cultured PCs were performed to elucidate osseous synthesis and deposition of a calcified matrix. Furthermore, the mRNA expression of type I collagen, osteocalcin and osteonectin was semi-quantitively evaluated by real-time reverse transcriptase-polymerase chain reac- tion (RT-PCR). The fibrin gel immobilization technique provided homogeneous PCs distribution in 3D PLGA constructs. Live-dead staining indicated a high viability rate of PCs inside the PLGA scaffolds. Secreted nodules of neo-bone tissue formation and the presence of matrix mineralization were confirmed by positive von Kossa staining. The osteogenic differentiation of PCs was further demonstrated by the detection of type I collagen, osteocalcin and osteonectin gene expression. The results of this study support the concept that this tissue engineering method presents a promising method for creation of new bone in vivo.

Irisin-loaded electrospun core-shell nanofibers as calvarial periosteum accelerate vascularized bone regeneration by activating the mitochondrial SIRT3 pathway

The scarcity of native periosteum poses a significant clinical barrier in the repair of critical-sized bone defects.The challenge of enhancing regenerative potential in bone healing is further compounded by oxidative stress at the fracture site.However,the introduction of artificial periosteum has demonstrated its ability to promote bone regeneration through the provision of appropriate mechanical support and controlled release of proosteogenic factors.In this study,a poly(L-lactic acid)(PLLA)/hyaluronic acid(HA)-based nanofibrous membrane was fabricated using the coaxial electrospinning technique.The incorporation of irisin into the core-shell structure of PLLA/HA nanofibers(PLLA/HA@Irisin)achieved its sustained release.In vitro experiments demonstrated that the PLLA/HA@Irisin membranes exhibited favorable biocompatibility.The osteogenic differentiation of bone marrow mesenchymal stem cells(BMMSCs)was improved by PLLA/HA@Irisin,as evidenced by a significant increase in alkaline phosphatase activity and matrix mineralization.Mechanistically,PLLA/HA@Irisin significantly enhanced the mitochondrial function of BMMSCs via the activation of the sirtuin 3 antioxidant pathway.To assess the therapeutic effectiveness,PLLA/HA@Irisin membranes were implanted in situ into critical-sized calvarial defects in rats.The results at 4 and 8 weeks post-surgery indicated that the implantation of PLLA/HA@Irisin exhibited superior efficacy in promoting vascularized bone formation,as demonstrated by the enhancement of bone matrix synthesis and the development of new blood vessels.The results of our study indicate that the electrospun PLLA/HA@Irisin nanofibers possess characteristics of a biomimetic periosteum,showing potential for effectively treating critical-sized bone defects by improving the mitochondrial function and maintaining redox homeostasis of BMMSCs.

静电纺丝聚偏氟乙烯压电仿生骨膜的生物相容性评价

背景:课题组前期研究发现,静电纺丝聚偏氟乙烯仿生骨膜具有良好的细胞相容性,但其生物相容性尚不清楚。目的:评价掺Zn2+、Mg2+聚偏氟乙烯仿生骨膜的生物相容性。方法:取前期研究采用静电纺丝技术制备的聚偏氟乙烯、掺1%Zn2+聚偏氟乙烯、掺1%Mg2+聚偏氟乙烯、掺1%Zn2++1%Mg2+聚偏氟乙烯仿生骨膜,制备各组仿生骨膜浸提液,选择SD大鼠为实验对象,进行溶血实验、短期全身毒性实验、热源实验,选择豚鼠为实验对象,进行皮肤致敏实验,检测4组仿生骨膜的生物相容性。结果与结论:①溶血实验结果显示,掺1%Zn2+聚偏氟乙烯、掺1%Mg2+聚偏氟乙烯、掺1%Zn2++1%Mg2+聚偏氟乙烯仿生骨膜及聚偏氟乙烯浸提液的溶血率分别为(0.130±0.013)%,(0.149±0.020)%,(0.466±0.018)%,(0.037±0.018)%,符合生物材料血液相容性性标准;②短期全身毒性实验结果显示,4组仿生骨膜浸提液灌胃干预后未引起SD大鼠体质量减轻、摄食量变化及呼吸困难等毒性体征,对大鼠的主要脏器无毒性作用;③热源实验结果显示,掺1%Zn2+聚偏氟乙烯、掺1%Mg2+聚偏氟乙烯、掺1%Zn2++1%Mg2+聚偏氟乙烯及聚偏氟乙烯仿生骨膜浸提液干预后,SD大鼠体温升高值分别为(0.133±0.058),(0.100±0.010),(0.300±0.010),(0.300±0.017)℃,均小于0.6℃,体温升高度数总和均小于1.4℃;④皮肤致敏实验结果显示,4组仿生骨膜浸提液干预后豚鼠皮下未见红斑与水肿。结果表明:聚偏氟乙烯与掺Zn2+、Mg2+聚偏氟乙烯仿生骨膜具有良好的生物相容性。

静电纺丝聚偏氟乙烯压电仿生骨膜的细胞相容性

背景:聚偏氟乙烯具有压电性能、良好的生物相容性和无毒性,使其成为骨膜修复合适的候选材料。目的:评价掺锌镁离子静电纺丝聚偏氟乙烯压电仿生骨膜的体外细胞毒性。方法:采用静电纺丝技术分别制备纯聚偏氟乙烯、掺锌离子聚偏氟乙烯、掺镁离子聚偏氟乙烯、掺锌镁离子聚偏氟乙烯压电仿生骨膜,依次命名为PVDF、PVDF-Zn、PVDF-Mg和PVDF-Zn-Mg,其中锌、镁离子的质量分数均为1%。将成骨细胞、血管内皮细胞分别与4组仿生骨膜共培养,通过碱性磷酸酶染色、CD31免疫荧光染色、扫描电镜观察与CCK-8法检测仿生骨膜的细胞相容性。结果与结论:①成骨细胞:培养7 d的碱性磷酸酶染色显示,PVDF-Zn组碱性磷酸酶分泌多于其他3组。扫描电镜下可见,培养1 d时,细胞在PVDF-Mg和PVDF-Zn-Mg仿生骨膜表面得到了一定的铺展,伪足向四周伸展;到3 d时,各组细胞边缘向材料伸出伪足;到第5,7天时,细胞铺展充分、生长形态良好且牢牢地覆盖在纤维表面,细胞伪足向四周及纤维空隙中伸展。CCK-8检测显示,随着时间的推移,各组仿生骨膜上的细胞增殖呈上升趋势,培养1,3,5,7 d的细胞相对增殖率均≥75%,细胞毒性≤1级。②血管内皮细胞:培养3 d的CD31免疫荧光染色显示,细胞在各组仿生骨膜上良好地黏附和铺展,彼此连接,其中PVDF-Zn-Mg组细胞数量多于其他3组。扫描电镜下可见,培养1,3 d时,细胞开始黏附在各组纤维表面;到5 d时,细胞在纤维表面均铺展良好并伸出明显的伪足;到7 d时,PVDF-Mg、PVDF-Zn-Mg仿生骨膜上的细胞呈复层生长,并伸展伪足至纤维空隙内。CCK-8检测显示,随着时间推移,各组仿生骨膜上的细胞增殖呈下降趋势,培养1,3,5,7 d的细胞相对增殖率均≥125%,细胞毒性为0级。③结果表明:掺锌镁离子静电纺丝聚偏氟乙烯压电仿生骨膜具有良好的细胞相容性。

Reconstruction of segmental bone defects in the rabbit ulna using periosteum encapsulated mesenchymal stem cells-loaded poly（lactic-co-glycolic acid） scaffolds

Background Repair of large bone defects remains a challenge for clinicians. The present study investigated the ability of mesenchymal stem cells （MSCs） and/or periosteum-loaded poly（lactic-co-glycolic acid） （PLGA） to promote new bone formation within rabbit ulnar segmental bone defects. Methods Rabbit bone marrow-derived MSCs （passage 3） were seeded onto porous PLGA scaffolds. Forty segmental bone defects, each 15 mm in length, were created in the rabbit ulna, from which periosteum was obtained. Bone defects were treated with either PLGA alone （group A）, PLGA ＋ MSCs （group B）, periosteum-wrapped PLGA （group C） or periosteum-wrapped PLGA/MSCs （group D）. At 6 and 12 weeks post-surgery, samples were detected by gross observation, radiological examination （X-ray and micro-CT） and histological analyses. Results Group D, comprising both periosteum and MSCs, showed better bone quality, higher X-ray scores and a greater amount of bone volume compared with the other three groups at each time point （P 〈0.05）. No significant differences in radiological scores and amount of bone volume were found between groups B and C （P 〉0.05）, both of which were significantly higher than group A （P 〈0.05）. Conclusions Implanted MSCs combined with periosteum have a synergistic effect on segmental bone regeneration and that periosteum plays a critical role in the process. Fabrication of angiogenic and osteogenic cellular constructs or tissue-engineered periosteum will have broad applications in bone tissue engineering.

细菌纤维素/羟基磷灰石@聚醚砜骨膜支架的制备及其性能研究

骨膜作为骨缺损修复过程中营养物质的来源及膜内成骨过程中的核心位点,其结构和功能的重建对大尺度骨缺损的修复起到极其重要的作用。基于此,为了模拟天然骨膜的结构和功能,将聚醚砜(PES)和羟基磷灰石(HAp)混合,通过静电纺丝制备HAp@PES静电纺纤维膜(HPES),然后通过膜液界面培养法与细菌纤维素(BC)复合,获得了具有微米―纳米结构的BC/HAp@PES(BC/HPES)支架。扫描电镜结果表明,该支架微米―纳米纤维交错分布,且HAp成功复合在微米纤维上。所制备的支架具有良好的力学性能。进一步研究表明,成骨细胞在支架表面表现出良好的增殖和铺展能力,不仅如此,该支架还具有良好的成骨分化诱导能力。因此,这种具有仿生微纳纤维结构且负载HAp的骨膜支架有望用于大尺度骨缺损修复领域。

Artificial periosteum in bone defect repair--A review

Periosteum is a thin membrane that encases the surfaces of most bones.It is composed of an outer fibrous layer contains longitudinally oriented cells and collagen fibers and an inner cambial layer that consists of multipotent mesenchymal stem cells（MSCs）and osteogenic progenitor cells.Periosteum has a function of regulating cell and collagen arrangement,which is important to the integrity,modelling and remodelling of bone,particularly during bone defect repair.Apart from autograft and allograft,artificial periosteum,or tissue-engineered periosteum mimicking native periosteum in structure or function,made up of small intestinal submucosa,acellular dermis,induced membrane,cell sheets,and polymeric scaffolds,and so on,has been developed to be used in bone defect repair.In this review,we classify the artificial periosteum into three approaches based on the material source,that is,native tissues,scaffoldfree cell sheets and scaffold-cell composites.Mechanisms,methods and efficacy of each approach are provided.Existing obstacles and enabling technologies for future directions are also discussed.

自体带骨膜髂骨移植与同种异体骨骨粉联合PRP治疗距骨骨软骨损伤的治疗效果比较研究

目的分析并对比自体带骨膜髂骨移植与同种异体骨骨粉联合富血小板凝胶(platelet rich gel,PRP)治疗HeppleⅤ型距骨骨软骨损伤(osteochondral injury,OLT)。方法选取浙江中医药大学附属金华中医院2018年10月至2022年10月收入的HeppleⅤ型OLT患者62例为研究对象,根据其治疗方式将其分为移植组(接受自体带骨膜髂骨移植治疗,31例)、联合组(接受同种异体骨骨粉联合PRP治疗,31例)。对患者进行术后12个月门诊随访研究,评估并比较两组患者术后12个月治疗效果、踝关节活动度(range of motion,ROM)、美国骨科足踝外科学会(American Society of Orthopedic Foot andAnkle Surgeons,AOFAS)踝-后足评分、疼痛评分、满意度、并发症发生率差异。结果移植组治疗总有效率(96.77%)与联合组(93.55%)相比,差异无统计学意义(P>0.05)。术后12个月两组ROM、AOFAS评分均改善(P<0.05),组间差异无统计学意义(P>0.05)。两组患者术后1个月、3个月、6个月、12个月,两组疼痛评分均较术前有所降低(P<0.05)。移植组患者主观总满意度(77.42%),低于联合组(96.77%,P<0.05)。移植组并发症总发生率(19.35%)与联合组(3.23%)相比,明显更高(P<0.05)。结论同种异体骨骨粉联合PRP可避免额外手术切口,患者主观满意度更高,术后并发症发生率低。

Effect of estrogen on gene expression of fatty acid synthase in periosteum

Background Estrogen deficiency contributes to postmenopausal osteoporosis. Periosteum might be a potential target of estrogen, but the underlying mechanism at gene level is far from being elucidated. The objective of this study was to investigate the correlation between estrogen and fatty acid synthase （FAS） expression in periosteum. Methods Human periosteum cells were cultured in vitro. Expressed genes in the substrated cDNA library were verified using semi-quantitative PCR and real-time PCR. The expression of FAS in periosteum of ovarectomized （OVX） SD rats was investigated. Results FAS gene was most significantly expressed in the subtracted cDNA library of periosteal cells screened by semi-quantitative PCR. Low FAS expression was verified by real-time PCR in the estrogen exposed human periosteum rather than in the control. The estradiol levels were （20.81±12.62） pg/ml, （19.64±4.35） pg/ml and （13.47±1.84） pg/ml in the sham group, the control, and the OVX group, respectively. The estradiol levels in the OVX group was significantly lower （P=-0.0386）. The FAS gene expression in periosteum in the OVX group, sham group, and control group was 3.09±1.97, 1.33±0.47 and 1.51±1.32, respectively. The gene expression in the OVX group was significantly higher （P=0.0372）. Conclusion Estrogen modulates FAS gene expression in in vitro human perisoteum as well as in in vivo rat periosteum.

Metal-phenolic networks modified polyurethane as periosteum for bone regeneration

Treatment of bone defects still poses a great challenge in orthopedic clinics, and the vital role of periosteum in such processes has attracted widespread attention. However, studies focusing on the oxidative stress micro-environment with an artificial periosteum at the site of defect have been scarce. The intrinsic anti-oxidative properties and therapeutic potential for bone defects of metal-phenolic networks(MPNs)have provided a potential solution to this. Herein, we have developed a protocatechualdehyde + zinc ion(PCA+Zn^(Ⅱ)) MPN coating on a thermoplastic polyurethane membrane with a one-pot method to fabricate a new-type of periosteum with meritorious biocompatibility and abilities of modulating oxidative stress condition and promoting osteogenesis and mineralization for better bone regeneration, which has shown to be a promising strategy for constructing artificial periosteum with various MPNs.

Free iliac crest grafts with periosteum for treatment of old acetabular defects

客观：在旧王牌上与骨膜调查免费的肠骨的冠接枝的治疗学的有效性平坦缺点。方法：从 1996 年 2 月到 2005 年 6 月， 9patients 与骨膜与免费的肠骨的冠接枝被对待重建旧 acetabulardefects。有 7 男性和 2 女性，平均年龄是 41。3 年。acetabulardefects 被交通事故在 3 种情况中在 6 种情况和秋天损害中引起。处理的从损害的时间是 4-13 月并且平均 8 个月。Intraoperatively，我们第一移开以后的墙的 theacetabular 破裂碎片。大腿骨的头当时是 reducted。骨头接枝与骨膜从肠骨的冠被收获，它与骨钳被雕刻遵循缺点。凹面(肠骨的窝) 接枝的方面被放向大腿骨的头。Thegraft 被二～三个腿螺丝钉安全地修理。结果：手术后的症候群没在任何盒子中被发现。哈里斯“ 20 个系统证明分数从 32 涨了。3 pointspreoperatively 手术后地指向 81。新潮的功能在 3 种情况中作为优秀被评估，在在 2 种情况中的 4 种情况和交易会中好。结论：尽管这个过程不能确切复制新潮的关节的解剖，它启用恢复以后的稳定性，为新潮的关节的 providebone 股票并且阻止大腿骨的头的脱臼。

适形骨片后壁重建技术在外耳道胆脂瘤术中应用探讨

目的 探讨自体乳突皮质骨制备适形骨片重建外耳道后壁治疗Ⅲ期外耳道胆脂瘤的手术效果。方法收集33例乳突气化良好的Ⅲ期外耳道胆脂瘤病例,行部分乳突切开+自体皮质骨外耳道后壁重建术,自体乳突皮质骨雕刻成适形骨片重建外耳道后壁,并以筋膜(骨膜)瓣覆盖完成外耳道成形。结果 33耳手术均顺利完成,共31耳一次手术实现干耳,随访无胆脂瘤复发、无重建外耳道后壁塌陷及狭窄闭锁;其中1例患者术后鼓膜穿孔,二次手术后鼓膜完整、愈合良好;1例患者术后重建的外耳道后壁出现窦道与乳突腔相通而导致间断耳漏,二次手术后干耳并恢复了外耳道的正常生理结构,共32耳干耳。另有1耳外耳道胆脂瘤复发,同时伴耳漏及耳道狭窄。结论部分乳突切开+自体皮质骨适形骨片外耳道后壁重建手术治疗Ⅲ期外耳道胆脂瘤,以筋膜(骨膜)瓣予以覆盖完成外耳道成形,可有效清除病变同时恢复接近正常外耳道的结构,可以进一步应用及深入研究。

骨膜压揉法对前斜角肌综合征患者的治疗效果分析

目的:探讨骨膜压揉法对前斜角肌综合征患者的治疗效果。方法:选取2020年1月—2021年12月北京交通大学医院收治的86例前斜角肌综合征患者作为研究对象,根据随机摸球法分为观察组与对照组,各43例。对照组采用常规针灸法治疗,观察组采用骨膜压揉法治疗。比较两组临床疗效、疼痛程度、上肢肌力、颈椎功能。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P=0.003)。治疗前,两组疼痛评分比较,差异无统计学意义(P=0.670);治疗后,两组疼痛评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组上肢肌力≥Ⅲ级者占比高于对照组,上肢肌力≤Ⅱ级者占比低于对照组,差异有统计学意义(P<0.05)。治疗前,两组颈椎功能障碍指数量表(NDI)评分比较,差异无统计学意义(P>0.05);治疗后,两组NDI评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论:前斜角肌综合征患者采用骨膜压揉法能够增强疗效,减轻疼痛程度,改善患者上肢肌力水平和颈椎功能。

独活寄生汤联合自体带骨膜髂骨移植治疗HeppleⅤ期距骨骨软骨损伤疗效观察

目的观察独活寄生汤联合自体带骨膜髂骨移植治疗HeppleⅤ期距骨骨软骨损伤(OLTs)的临床疗效。方法将100例OLTs患者按照随机数字表法分为对照组和治疗组,每组50例。对照组行自体带骨膜髂骨移植手术治疗,治疗组在对照组治疗基础上加用独活寄生汤。比较2组治疗前后炎症因子白细胞介素6(IL-6)、白细胞介素1β(IL-1β)、肿瘤坏死因子α(TNF-α)和超敏C反应蛋白(hs-CRP)水平,疼痛视觉模拟评分(VAS),踝关节活动度(ROM)。结果治疗后,2组IL-6、IL-1β、TNF-α和hs-CRP水平均较本组治疗前明显降低(P<0.05),且治疗组低于对照组(P<0.05)。治疗后,2组疼痛VAS均较本组治疗前降低(P<0.05),且治疗组低于对照组(P<0.05)。治疗后,2组踝关节ROM较本组治疗前无明显变化(P>0.05),且2组组间比较差异也无统计学意义(P>0.05)。结论独活寄生汤联合自体带骨膜髂骨移植治疗HeppleⅤ期距骨骨软骨损伤疗效确切,可明显减轻患者炎症反应、疼痛程度。