Clinical value of ankle flexion and extension exercises combined with a psychological intervention in knee osteoarthritis

BACKGROUND Considering the limited effectiveness of clinical interventions for knee osteoarthritis(KOA),it is necessary to continue to explore appropriate and effective treatment strategies to improve the condition of KOA patients.AIM To clarify the influence of ankle flexion and extension exercises combined with a psychological intervention on the psychological status and activities of daily living(ADLs)of patients with KOA.METHODS The research participants were 116 KOA patients admitted to The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between May 2019 and May 2022,including 54 patients receiving routine treatment,care and psychological intervention(control group)and 62 patients additionally treated with ankle flexion and extension exercises(research group).The two groups were comparatively analyzed in terms of psychological status(Self-rating Anxiety/Depression Scale,SDS/SAS),ADLs,knee joint function(Lysholm Knee Scoring Scale),pain(Visual Analog Scale,VAS),fatigue(Multidimensional Fatigue Inventory,MFI),and quality of life(QoL;Short-Form 36 Item Health Survey,SF-36).RESULTS After evaluation,it was found that the postinterventional SDS,SAS,VAS,and MFI scores in the research group were significantly reduced compared with the baseline(before the intervention)values and those of the control group,while the postinterventional Lysholm,ADL and SF-36 scores were markedly elevated.CONCLUSION Therefore,ankle flexion and extension exercises are highly effective in easing negative psychological status,enhancing ADLs,daily living ability,knee joint function and QoL,and relieving pain and fatigue in KOA patients,thus warranting clinical promotion.

Post-traumatic heterotopic ossification in front of the ankle joint for 23 years:A case report and review of literature

BACKGROUND Heterotopic ossification(HO)refers to the formation of new bone in non-skeletal tissues such as muscles,tendons or other soft tissues.Severe muscle and soft tissue injury often lead to the formation of HO.However,anterior HO of the ankle is rarely reported.CASE SUMMARY We report a patient with massive HO in front of the ankle joint for 23 years.In 1998,the patient was injured by a falling object on the right lower extremity,which gradually formed a massive heterotopic bone change in the right calf and dorsum of the foot.The patient did not develop gradual ankle function limitations until nearly 36 mo ago,and underwent resection of HO.Even after 23 years and resection of HO,the ankle joint was still able to move.CONCLUSION It is recommended that the orthopedist should be aware of HO and distinguish it from bone tumor.

Initial effects of inflammation-related cytokines and signaling pathways on the pathogenesis of post-traumatic osteoarthritis

The main pathological change in post-traumatic osteoarthritis （PTOA） is cartilage degeneration, which is closely related to inflammation and oxidative stress. Inflammation can cause degeneration of articular cartilage. Cartilage degeneration can also stimulate the progression of inflammation. It has been found that inflammatory cytokines can participate in the pathological process of cartilage degeneration through multiple signaling pathways, mainly mitogen-activated protein kinase, nuclear transcription factor kappa B, and Wnt-p-catenin signal transduction pathways. This review aimed at exploring the relationship between PTOA and inflammation-related cytokines by introducing the role of proinflammatory cytokines in chondrocyte destruction and extracellular matrix degradation.

Distraction arthroplasty in osteoarthritis of the foot and ankle

Post-traumatic osteoarthritis(PTOA)is a complex and painful problem in the foot and ankle.Ninety percent of osteoarthritis cases in the foot and ankle can be classified as post-traumatic.PTOA can affect any of the 33 joints in the foot and the ankle.Distraction arthroplasty is a method for treatment of early arthritic joints without fusing or replacing them and its effectiveness has been well documented.The purpose of this case series is to present our successful experiences and positive results using distraction arthroplasty to treat PTOA in the ankle,subtalar,first metatarsophalangeal,and second tarsometatarsal joints,and to present distraction arthroplasty as a viable alternative to invasive joint sacrificing procedures such as arthrodesis or arthroplasty.Distraction Arthroplasty effectively and safely treats PTOA and improves the stability of joints in the Foot and Ankle.Additionally,the use of bone marrow aspirate concentrate as an adjuvant can improve the long-term functional and structural outcomes of the joint,and can prolong the need for further,more aggressive surgical interventions such as fusion or arthroplasty.

How to establish an expected animal model of post-traumatic osteoarthritis?

Background：Animal models of osteoarthritis（OA）,including post-traumatic osteoarthritis and spontaneous osteoarthritis,have been established in many ways.In recent years,there have been many reports in various foreign academic journals,but animal models of post-traumatic osteoarthritis（distinct from spontaneous osteoarthritis） have rarely been established or summarized in these reports.Animal models of post-traumatic osteoarthritis show different characteristics depending on the animal species and modeling methods used,which is why we have written this article.Objective：To summarize the research progress and research status of animal models of post-traumatic osteoarthritis.Methods：A retrospective review of the animal model of post-traumatic osteoarthritis（OA） was conducted on the basis of reports retrieved from the PubMed database with the keywords for searching ＂animal model,post-traumatic osteoarthritis（PTOA）＂ from October 2006 to October 2016 and confided English language.A total of 80 academic articles on the study of animal models of traumatic osteoarthritis were retrieved,and 34 of them were included in this literature review after reading the free fulltext of them.Results：Different PTOA models based on different modeling methods and different animal species had their own characteristics.Different modeling methods should be selected according to different modeling animals.Conclusions：Considering the project funds,experimental objectives and technical conditions,appropriate experimental animal and modeling method should be selected based on synthetic considerations to obtain an appropriate PTOA model and ideal experimental results.

Ankle arthrodesis:A systematic approach and review of the literature

Ankle arthrodesis is a common treatment used for patients with end-stage ankle arthritis(ESAA). The surgical goal of ankle arthrodesis is to obtain bony union between the tibia and talus with adequate alignment [slight valgus(0°-5°)], neutral dorsiflexion, and slight external rotation positions) in order to provide a pain-free plantigrade foot for weightbearing activities. There are many variations in operative technique including deferring approaches(open or arthroscopic) and differing fixation methods(internal or external fixation). Each technique has its advantage and disadvantages. Success of ankle arthrodesis can be dependent on several factors, including patient selection, surgeons' skills, patient comorbidities, operative care, etc. However, from our experience, the majority of ESAA patients obtain successful clinical outcomes. This review aims to outline the indications and goals of arthrodesis for treatment of ESAA and discuss both open and arthroscopic ankle arthrodesis. A systematic step by step operative technique guide is presented for both the arthroscopic and open approaches including a postoperative protocol. We review the current evidence supporting each approach. The review finishes with a report of the most recent evidence of outcomes after both approaches and concerns regarding the development of hindfoot arthritis.

Arthroscopic vs open ankle arthrodesis:A prospective case series with seven years follow-up

BACKGROUND The osteoarthritis of the ankle,although less common than other joints,is associated with severe functional limitation.Surgical options are ankle arthroscopic debridement,osteotomies,ankle arthrodesis and ankle arthroplasty.Ankle arthroplasty is increasingly used thanks to the new implants design,but ankle arthrodesis still represents the most used technique and it can be performed arthroscopically or with an open procedure.AIM To compare mid-term results of arthroscopic vs open ankle arthrodesis of patients affected by end-stage ankle arthritis.METHODS This study enrolled 23 patients,which underwent ankle arthrodesis.The patients were divided into 2 groups:group A(open procedure;n=11)and group B(arthroscopic procedure,n=12),the two groups were homogeneous with regard to age and body mass index(P=0.347).The American Orthopaedic Foot and Ankle score(AOFAS),Freiburg Ankle score(FAS)and visual analogue scale for pain intensity were evaluated preoperatively,at six months and at final follow-up of 7.6 years in group A and 7.3 years in group B(P=0.364).RESULTS Patients in the arthroscopic group showed better results at six-month follow-up compared to the open group at the AOFAS(group A,62.2;group B,78.5;P<0.05)and the FAS(group A,61.1;group B,70.3;P=0.015)scores.Pain relief was achieved in both groups at six-month follow-up(group A,1.4;group B,0.9;P=0.162).Both open and arthroscopic groups showed improved clinical outcomes from baseline to final follow-up(P>0.05).Hospital stay was shorter in group B than in group A(P=0.001).More complications were reported in the open group than in the arthroscopic group(P=0.459).CONCLUSION The arthroscopic and the open arthrodesis are valid and safe options for the treatment of ankle arthritis on the basis of clinical outcomes at 7 years follow-up.Moreover,the arthroscopic treatment shows faster improvement at six-month follow-up in comparison with the open group.

Ankle Arthroscopy: A Complimentary Adjunct in the Diagnosis and Management of Ankle Fractures

Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the Lauge-Hansen fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, versus ORIF plus arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/- arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the Lauge-Hansen ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with an SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes.

THE RESULTING FUNCTIONAL DEFICIENCY OF ANKLE AFTER PARTIAL FIBULECTOMY

The fibula has been routinely used for reconstruction of skeletal defects inthe long bones. Its length, configuration, stability and predictable vascular pedicle makethe fibula an ideal donor. The literature is full of reports regarding fibula transfer forlarge bone defects associated with traumatic nonuion. However, the long-term effect offibulectomy on the donor leg are seldom mentioned. The purpose of this paper is to re-view its complications and results. The residual functional deficit of partial fibulectomywas documented with subjective assessment and clinical examination in 15 patients, 7 menand 8 women, with mean age of 24 years and 8 months. The length of time forevaluation after surgery averaged 8 years and 7 months. Four of the 7 patients with exci-sion of the proximal third of the fibula had no complaint, while the remainder complainedof mild pain and weakness of affected leg. If the middle third of the fibula was excised,patients would develop symptoms: four had moderate or severe pain and ankle swelling,and 2 patients incurred osteoarthritis of the ankle. There was severe instability of the an-kle if longer segment of fibula was excised. Three cases had persistent symptoms. Thedistal fibular remnant was osteoporotic and was displaced upward and lateraly. There werealso widening of the ankle mortics and talar tilt.

Radiographic assessment of leg alignment and grading of knee osteoarthritis:A critical review

Knee osteoarthritis(OA) is a progressive joint disease hallmarked by cartilage and bone breakdown and associated with changes to all of the tissues in the joint,ultimately causing pain,stiffness,deformity and disability in many people.Radiographs are commonly used for the clinical assessment of knee OA incidence and progression,and to assess for risk factors.One risk factor for the incidence and progression of knee OA is malalignment of the lower extremities(LE).The hipknee-ankle(HKA) angle,assessed from a full-length LE radiograph,is ideally used to assess LE alignment.Careful attention to LE positioning is necessary to obtain the most accurate measurement of the HKA angle.Since full-length LE radiographs are not always available,the femoral shaft-tibial shaft(FS-TS) angle may be calculated from a knee radiograph instead.However,the FS-TS angle is more variable than the HKA angle and it should be used with caution.Knee radiographs are used to assess the severity of knee OA and its progression.There are three types of ordinal grading scales for knee OA:global,composite and individual feature scales.Each grade on a global scale describes one or more features of knee OA.The entire description must be met for a specific grade to be assigned.The KellgrenLawrence scale is the most commonly-used global scale.Composite scales grade several features of knee OA individually and sum the grades to create a total score.One example is the compartmental grading scale for knee OA.Composite scales can respond to change in a variety of presentations of knee OA.Individual feature scales assess one or more OA features individually and do not calculate a total score.They are most often used to monitor change in one OA feature,commonly joint space narrowing.The most commonly-used individual feature scale is the OA Research Society International atlas.Each type of scale has its advantages;however,composite scales may offer greater content validity.Responsiveness to change is unknown for most scales and deserves further evaluation.

踝关节融合术的研究进展

踝关节骨关节炎(AOA)是一种常见的由多种不同病因引起的关节慢性进展性疾病,其伴随的疼痛和跛行等症状严重影响患者的生活质量,后期往往需行手术治疗。一直以来,踝关节融合术被认为是治疗终末期AOA最可靠的方法。围绕踝关节融合术的研究和争论主要集中在术式的选择、改良、微创化和并发症防治等方面。AOA病因复杂,在手术方式的选择上仍存在争议,临床需根据患者情况选择最合适的固定方式。因此,深入研究踝关节融合术的应用将为其临床术式的选择提供思路。

步态分析在踝骨性关节炎中的应用进展

踝骨性关节炎(Ankle Osteoarthritis,AOA)是一种严重影响中老年人生活质量的关节疾患,若不加以控制,病变的关节软骨可部分剥脱甚至完全消失,严重影响患者的步行能力。对于本病的诊断,多依靠临床症状与影像学检查,但本病起病较为隐匿,通过影像学技术难以准确发现早期的AOA。而步态分析可以通过生物力学和运动学手段,揭示步态异常的关键环节和影响因素,从而指导AOA的诊疗。本文就近年来针对AOA所进行的步态分析研究成果做一综述,旨在提供全面的对AOA患者步态的认识及分析方法,探讨AOA患者步态异常的原因,总结其临床应用价值,并提出步态分析在AOA诊疗中应用的展望。

胫骨结节远端单平面截骨对踝关节冠状面角度的影响

背景:胫骨结节远端单平面截骨作为一种内侧单间室膝骨关节炎的手术治疗方法,目前缺乏其对踝关节影响的研究。目的:观察胫骨结节远端单平面截骨对患者负重位下肢X射线片上踝关节冠状面角度的影响。方法:回顾分析2021年3月至2022年3月行胫骨结节远端单平面截骨的膝骨关节炎患者共40例(41膝),其中女31例,男9例;左膝20例,右膝21例;年龄49-75岁,平均(63.44±6.57)岁。收集术前及术后第2,48周的负重位下肢全长X射线片资料,测量髋-膝-踝关节角、距骨倾斜角、踝关节倾斜角、胫骨踝穴角、胫骨远端关节面角的术前术后变化。结果与结论:①髋-膝-踝关节角由术前的(-6.24±3.69)°改善为术后第2周的(2.59±3.49)°,至第48周为(2.15±3.49)°;踝关节倾斜角由术前的(-7.90±3.11)改变为术后第2周的(-2.51±2.59)°,至第48周为(-2.46±2.42)°,差异均有显著性意义(P<0.001);②距骨倾斜角、胫骨踝穴角及胫骨远端关节面角的术前、术后2次随访差异无显著性意义;③第2周与第48周各角度差异均无显著性意义;④提示胫骨结节远端单平面截骨在纠正膝内翻的同时,能够改善踝关节的角度异常,且在48周负重活动后该角度保持稳定。

踝关节骨关节炎的阶梯化治疗

踝关节骨关节炎(osteoarthritis, OA)是一种慢性退行性疾病,主要表现为关节软骨的持续退化,进而引起疼痛和活动能力下降。踝关节OA患者比膝关节OA患者更年轻,对于活动能力的需求相对更多,早期治疗尤为关键。虽然踝关节OA不如膝关节和髋关节OA常见,但终末期踝关节OA对患者生活质量的影响不亚于终末期髋关节OA。因此,踝关节OA的阶梯化治疗至关重要,包括早期的非手术治疗,保守治疗无效后的保踝手术,终末期的全踝关节置换术或踝关节融合术。

关节内截骨治疗伴有内侧穹隆顶骨缺损的内翻型踝关节炎的疗效分析

目的 探讨关节内截骨治疗伴有内侧穹隆顶骨缺损的内翻型踝关节炎的临床疗效。方法 回顾分析2012年1月至2021年1月中国人民解放军北部战区总医院采用关节内截骨治疗的16例伴有内侧穹隆顶骨缺损的内翻型踝关节炎患者的临床资料。其中,男12例,女4例,平均年龄48.3岁(39~65岁)。根据Takakura分期:Ⅱ期5例,Ⅲa期8例,Ⅲb期3例。记录术后并发症、骨愈合时间及内固定失效情况,比较踝关节屈伸活动度及影像学指标变化,包括胫骨前方关节面角(tibial anterior surface angle, TAS)、胫骨侧方关节面角(tibial lateral surface angle, TLS)、距骨倾斜角(talar tilt angle, TT)及踝穴角(tibiocrural angle, TC),并采用Takakura踝关节评分和美国足踝外科协会(American Orthopedic Foot and Ankle Society, AOFAS)踝与后足功能评分评价临床疗效。结果16例患者均获得术后随访,平均随访时间为33.8个月(12~60个月)。2例术后切口延迟愈合,无血管、神经及肌腱损伤发生。16例患者均获骨愈合,平均愈合时间4.4个月(3~6个月)。2例因骨关节炎加重或畸形复发行踝关节融合术。末次随访时无内固定失效发生。患者末次随访的TT低于术前、TC高于术前,差异有统计学意义(P<0.05);末次随访的TAS、TLS和踝关节屈伸活动度与术前比较,差异无统计学意义(P>0.05)。患者的末次随访的Takakura踝关节评分、AOFAS评分高于术前,差异有统计学意义(P<0.05)。结论 对于伴有内侧穹隆顶骨缺损的内翻型踝关节炎患者,关节内截骨可以有效缓解疼痛、改善关节功能,临床疗效满意。

带血供腓骨瓣与空心螺钉胫距跟融合治疗终末期踝关节炎

背景:既往研究报道腓骨瓣支撑结合空心螺钉行胫距跟融合治疗踝关节骨性关节炎有确切效果,但所用腓骨瓣未带血供,在一定程度上影响局部血运恢复。此次研究利用腓骨远端良好血运,对腓骨瓣支撑结合空心螺钉胫距跟融合进行改良,探讨改良术式治疗踝关节骨性关节炎的临床效果。目的:探讨经腓骨门入路带血供腓骨瓣结合空心螺钉行胫距跟融合治疗终末期踝关节骨性关节炎的临床疗效,以及对患肢生物力学的影响。方法:回顾分析2018年1月至2020年10月大连市第二人民医院收治的30例终末期踝关节骨性关节炎患者,均择期实施经腓骨门入路带血供腓骨瓣结合空心螺钉行胫距跟融合治疗。术后接受12个月随访,观察术后腓骨远端局部血运状况及切口Ⅰ期愈合情况;术后复查踝关节CT,评估骨愈合时间;应用步态分析仪及足底压力测量系统评估术后恢复情况,掌握术后并发症。结果与结论:①患者术后均接受12个月随访,无失访病例;术后多普勒血管探测仪及下肢血管CT血管造影复查显示,患肢血管蒂和腓后动脉穿支及伴行静脉吻合,局部血运良好,切口均为Ⅰ期愈合;②术后复查踝关节CT,融合处骨性愈合时间为8-13周,平均(10.70±2.13)周;③术后3个月患者的步长、步速及步频均较术前显著提升,差异有显著性意义(P<0.05);④通过足底压力测量系统测定分析,术后6个月患者自然行走中,患侧足底第2-4跖骨区、中足、足跟内侧、足跟外侧、全足底的压力值均低于术前,差异有显著性意义(P<0.05);⑤术后随访,1例患者出现腓肠神经损伤症状,在对症治疗后消失;⑥患者踝关节功能恢复优良率为100%;⑦提示经腓骨门入路带血供腓骨瓣结合空心螺钉行胫距跟融合治疗终末期踝关节骨性关节炎,可有效改善局部血运,提高融合效果,促进患肢踝关节功能恢复,有重要的临床意义。

踝关节牵张术联合PRP关节注射治疗踝关节骨性关节炎

目的 评估踝关节牵张术联合PRP关节注射治疗踝关节骨性关节炎的疗效。方法 回顾性分析2017年1月-2019年2月收治的44例踝关节骨性关节炎患者临床资料,采用随机数字表法分为观察组23例,行踝关节牵张术联合PRP关节注射治疗;对照组21例,仅行踝关节牵张术治疗。采用SF-36生活质量(QOL)量表评估患者生活质量;采用美国矫形足踝协会踝后足(AOFAS)评分和踝骨关节炎量表(AOS)评分、关节活动范围(ROM)进行功能评价;对胫骨前表面(TAS)角、距骨倾斜(TT)角、胫骨内踝(TMM)角、距骨(TC)角、胫骨外表面(TLS)角和后脚对中(HFA)角进行评估。结果两组AOFAS评分、AOS疼痛和功能评分、SF-36评分均显著改善(P<0.05),观察组改善效果显著优于对照组,差异均有统计学意义(P<0.05);两组治疗后TAS、TT、TC、TLS和HFA角度均较术前显著改善(P<0.05),但治疗后组间比较TAS、TT、TC、TLS和HFA差异均无统计学意义(P>0.05)。结论 牵引关节成形术结合PRP关节注射可以恢复创伤后踝关节功能、缓解疼痛,是治疗终末期复杂性踝关节骨性关节炎值得推广的一种手术方式。

踝上弧形截骨联合关节牵伸治疗内翻型踝关节炎

目的评估踝上弧形截骨联合关节牵伸治疗内翻型踝关节炎的临床效果。方法回顾性分析2009年12月至2021年4月北京市垂杨柳医院骨二科治疗的8例内翻型踝关节炎病人的临床资料,男5例,女3例,年龄为(35.2±9.1)岁(27~45岁)。其中有踝部骨折史者5例,骨骺损伤后遗踝内翻畸形3例。应用踝上胫腓骨弧形截骨矫正踝内翻后安装Ilizarov踝关节牵伸器,术后行踝关节牵伸,维持关节间隙至5~8 mm行走3个月以上。根据病人手术前后胫骨远端关节面角(tibial articular surface angle,TAS)及美国足踝外科医师协会(American Orthopaedic Foot and Ankle Society,AOFAS)踝与后足功能评分评估临床治疗效果。结果8例病人随访时间为(31.5±17.9)个月(12~72个月),外固定佩戴时间为(29.4±5.1)周(20~32周)。拆除外固定时截骨处均达到临床骨愈合标准,末次随访时AOFAS评分为(82.0±7.7)分(76~90分),TAS角度为91.1°±2.4°(89.6°~95.0°),与术前比较[(47.6±3.7)分(41~65分),82.9°±4.7°(72°~87°)],差异有统计学意义(P<0.05)。8例术后均出现局部针道感染,5例给予局部酒精敷料缠绕包扎,3例拔出感染固定针后感染控制。2例固定针折断,去除外固定装置时给予拔除,无其他严重并发症。结论踝上弧形截骨术联合踝关节牵伸成形治疗内翻型踝关节炎,矫正踝内翻效果满意,避免植骨内固定,截骨愈合良好。结合Ilizarov外固定牵伸,允许术后全负重行走锻炼,显著改善病人足踝功能,值得临床推广应用。

有限元建模分析牵开成形治疗踝关节骨性关节炎的生物力学响应

背景:目前踝关节骨性关节炎的手术方式包括关节置换和关节融合,但2种方式均存在一定问题,因此保踝治疗成为踝关节骨性关节炎初期治疗的首选方式。牵开成形是一种重要的保踝治疗术式,有利于缓解踝关节疼痛和改善功能,有助于关节软骨的自我修复,但现在仍缺乏确切的生物力学证据。目的:通过有限元建模探究踝关节牵开成形治疗早中期无明显力线改变的踝关节骨性关节炎的力学因素,为临床治疗提供力学证据。方法:将1名27岁志愿者足踝CT扫描数据DICOM文件导入有限元软件中,进行三维重建及曲面拟合,再进行网格划分,建立含有骨骼、韧带、肌腱和软骨的精细足踝有限元模型,对比踝骨关节炎组、外固定架组分别在中立0°、跖屈20°、背屈20°3种不同工况下的胫距关节面应力、距骨应力及距骨应变的生物力学响应。结果与结论:(1)经过有限元仿真计算发现,从踝关节整体受力来说,两组模型在中立位0°时最小,从中立位逐渐跖屈或背屈时,随着踝关节活动发生变化,应力值也逐渐增加,且在同等屈曲的条件下,背屈要比跖屈的整体应力增幅明显;(2)从胫距关节的应力峰值来说,踝骨关节炎组的胫距关节面应力峰值较正常组增幅明显,外固定架组的胫距关节面应力峰值降幅明显;(3)针对踝关节整体形变,踝骨关节炎组在中立位状态时整体形变增幅最大,而外固定架组整体变形降幅最大;(4)从距骨应力来说,踝骨关节炎组3种工况下距骨应力均有不同程度的增加,外固定架组距骨应力有所降低,尤其在中立位时降幅明显;(5)就关节距骨前移距离而言,踝骨关节炎组距骨前移距离相对正常组明显减小,外固定架组距骨前移距离增幅不明显;(6)提示经过踝关节2种模型不同工况下的有限元仿真分析,证实临床应用踝关节牵开成形能够改变踝关节骨性关节炎患者胫距关节面及距骨的机械应力,改善关节局部的力学分布,延缓踝骨性关节炎的发展。

踝关节骨关节炎动物模型构建的研究与进展

背景:踝关节骨关节炎作为极大影响患者生活质量的疾病,正越来越得到人们重视。踝骨关节炎的临床及实验研究尚不及膝关节研究完备,目前缺乏关于动物模型较为系统的综述。目的:探讨踝骨关节炎各实验模型的造模方法,阐述各模型的特点,为踝骨关节炎的实验研究的改进提供理论依据。方法:检索2009-2022年中国知网、万方数据平台、维普期刊平台、PubMed、Embase数据库发表的相关文献,中文检索词“踝关节;骨关节炎;动物模型;创伤后骨关节炎”,英文检索词“Ankle Joint;Osteoarthritis;Animal models;Post-Traumatic Osteoarthritis”,共纳入49篇文章进行系统性综述。结果与结论:①踝骨关节炎的动物模型中,对于创伤性关节炎的造模方式包括慢性踝关节不稳模型和关节内骨折模型;非创伤性动物模型的造模方式包括关节内药物注射诱导模型、软骨萎缩模型、关节衰老模型以及特定品系骨关节炎易感物种的自发性骨关节炎模型。②虽然创伤性踝骨关节炎的发病率很高,但与膝骨关节炎相比,目前对于踝骨关节炎的研究相当有限。基于踝关节与膝关节结构及关节特性的差异,膝关节的研究成果在踝关节并不完全适用。对其动物模型的研究,更有利于对当前研究盲区进行深度探究。