关节镜联合富血小板血浆对膝关节半月板损伤患者膝关节功能和生活质量的影响

目的:探讨关节镜联合富血小板血浆对膝关节半月板损伤患者膝关节功能和生活质量的影响。方法:选取2017年12月-2019年9月期间我院收治的膝关节半月板损伤患者80例,根据随机数字表法分为对照组(n=40)和研究组(n=40),对照组予以关节镜下修整手术治疗,研究组在对照组基础上联合富血小板血浆治疗,比较两组患者优良率、生活质量及视觉模拟评分量表(VAS)、Lysholm评分量表、美国西安大略和麦克马斯特大学关节炎指数(WOMAC)评分。记录两组治疗期间不良反应情况。结果:研究组治疗后3个月的膝关节功能优良率高于对照组(P0.05)。两组治疗前、治疗后1个月、治疗后3个月VAS、WOMAC评分均逐步降低,Lysholm评分逐步升高(P0.05);研究组治疗后1个月、治疗后3个月VAS、WOMAC评分低于对照组,Lysholm评分高于对照组(P0.05)。两组治疗后3个月SF-36各维度评分均较治疗前升高,且研究组高于对照组(P0.05)。两组不良反应发生率对比未见统计学差异(P0.05)。结论:关节镜联合富血小板血浆治疗膝关节半月板损伤患者,可促进膝关节功能的恢复,可有效缓解手术治疗后的疼痛症状,改善患者生活质量,具有较好的临床应用价值。     

不同目标力线设定对开放性楔形胫骨高位截骨术治疗膝关节骨性关节炎疗效的影响

目的:探讨开放性楔形胫骨高位截骨术(OWHTO)中采用不同目标力线对单间室膝关节骨性关节炎(KOA)疗效的影响。方法:回顾性分析本院收治的2016年9月～2018年9月采用OWHTO治疗单间室KOA患者41例的临床资料,根据不同目标力线分为固定力线组和个体化力线组,固定力线组19例患者采用统一调目标力线至Fujisawa点治疗,个体化力线组22例根据术中关节软骨Outerbridge分级、个体化调定目标力线治疗,对比两组术前及术后1.5个月、3个月、6个月、12个月的疼痛视觉模拟评分(VAS)及美国特种外科医院膝关节(HSS)评分变化,并对比术前和12个月时MRI及关节镜影像。结果:术后所有患者VAS评分、HSS评分均较术前改善(P0.05),其中个体化力线组术后1.5个月、3个月时VAS评分优于固定力线组,差异有统计学意义(P0.05)。MRI及关节镜显示两组患者均有不同程度软骨再生。结论:采用OWHTO治疗单间室KOA,根据患者不同软骨磨损情况制定个体化目标力线方案有利于患者早期疼痛的改善,但其长期功能的恢复及软骨再生与固定力线方案无明显差异。     

右美托咪定复合罗哌卡因对膝关节置换术后镇痛镇静效果、睡眠质量及应激反应的影响

目的:探讨右美托咪定复合罗哌卡因对膝关节置换术后的临床效果。方法:选取2015年2月～2018年12月期间在武警陕西省总队医院择期行膝关节置换术患者103例,根据随机数字表将患者分成对照组(n=51)和研究组(n=52),对照组股神经阻滞时给予罗哌卡因,研究组在对照组基础上联合右美托咪定。比较两组患者镇痛镇静效果、睡眠质量、应激反应以及不良反应。结果:研究组术后12 h、术后24 h、术后48 h视觉模拟评分(VAS)低于对照组(P0.05),Ramsay镇静评分则高于对照组(P0.05)。研究组术后24 h、术后48 h阿森斯失眠量表(AIS)评分均低于术前,且呈先降低后升高趋势(P0.05)。研究组术后24 h、术后48 h AIS评分低于对照组(P0.05)。两组患者手术开始即刻、术毕的去甲肾上腺素(NE)、肾上腺素(E)水平均上升,且呈先升高后降低趋势(P0.05);研究组手术开始即刻、术毕的NE、E水平低于对照组(P0.05)。两组不良反应发生率对比无统计学差异(P0.05)。结论:右美托咪定复合罗哌卡因方案应用于膝关节置换术,镇痛镇静效果确切,可减轻术中应激反应,有效改善睡眠质量,且不增加不良反应发生率,临床应用价值较高。     

Lower limb kinematics in individuals with chronic low back pain during walking

Several investigators have suggested the presence of a link between Chronic Low Back Pain (CLBP) and lower limbs kinematics that can contribute to functional limitations and disability. Moreover, CLBP has been connected to postural and structural asymmetry. Understanding the movement pattern of lower extremities and its asymmetry during walking can provide a basis for examination and rehabilitation in people with CLBP. The present study focuses on lower limbs kinematics in individuals with CLBP during walking. Three-dimensional movements of the pelvic, hip, knee and ankle joints were tracked using a seven-camera Qualysis motion capture system. Functional dada analysis (FDA) was applied for the statistical analysis of pelvic and lower limbs motion patterns in 40 participants (20 CLBP and 20 controls). The CLBP group showed significantly different hip motion pattern in the transvers plane, altered knee and ankle motion pattern in the sagittal plane on the dominant side and different hip motion pattern in the transvers and frontal planes on the non-dominant side in comparison with the control group over the stance phase. In terms of symmetry, in the CLBP group, hip and knee moved through a significantly different motion patterns in the transvers plane on the dominant side in comparison with the non-dominant side. In the control group, knee moved through a significantly different motion pattern in the transvers plane on the dominant side in comparison with the non-dominant side. In conclusion, low back pain lead to altered movement patterns of the main joints of lower limbs especially on the dominant side during stance phase. Therefore, care should be taken to examine dominant lower limb movement pattern in CLBP to make a better clinical decision.     

3.0 T磁共振T2×mapping成像技术定量评估膝关节骨性关节炎的临床价值及与WOMAC评分的相关性分析

摘要 目的：研究3.0 T磁共振T2×mapping成像技术定量评估膝关节骨性关节炎（OA）的临床价值及与西安大略和麦克马斯特大学骨关节炎指数（WOMAC）评分的相关性。方法：将我院于2017年4月～2019年12月期间收治的膝关节OA患者80例纳入研究。根据K-L分级标准将膝关节OA患者分成轻度组（K-L分级为Ⅰ～Ⅱ级）32例,重度组（K-L分级为Ⅲ～Ⅴ级）48例。另取同期于我院进行体检的健康者30例作为对照组。所有受试者均接受3.0 T磁共振T2×mapping扫描,比较各组膝关节不同部位软骨T2值、WOMAC评分以及血清炎症因子水平,以Pearson相关性分析膝关节OA患者膝关节不同部位软骨T2值和WOMAC评分的关系。结果：重度组膝关节不同部位软骨T2值均高于轻度组以及对照组,且轻度组膝关节不同部位软骨T2值均高于对照组（均P＜0.05）。重度组各项WOMAC评分及总分均高于轻度组以及对照组,且轻度组各项WOMAC评分及总分均高于对照组（均P＜0.05）。经Pearson相关性分析发现：膝关节OA患者膝关节不同部位软骨T2值和各项WOMAC评分及总分均呈正相关（均P＜0.05）。重度组血清白介素-1β（IL-1β）、白介素-18（IL-18）、肿瘤坏死因子α（TNF-α）均高于轻度组以及对照组,且轻度组血清IL-1β、IL-18、TNF-α均高于对照组（均P＜0.05）。结论：3.0 T磁共振T2×mapping成像技术定量评估膝关节OA的临床价值较高,且患者膝关节不同部位软骨T2值与WOMAC评分密切相关。     

探讨肠道菌群对膝骨关节炎治疗的影响

膝骨关节炎是一种中老年人常见的慢性疾病,因其发病率及致残率高,严重影响患者的生存质量。膝骨关节炎不仅增加了患者及其家庭乃至社会的经济压力,而且还加重了心理负担。治疗方案虽然多,但目前尚无根治方法,而且疗效也参差不齐。肠道菌群作为人体巨大的微生物宝库,拥有着很大的潜力,这使之成为了科研领域一个新的研究热点,其对膝骨关节炎的影响也成为了人们关注的焦点。本文通过查阅相关文献,从慢性炎症、代谢性疾病、成骨细胞以及破骨细胞这四个方面来阐述和总结肠道菌群与膝骨关节炎的关系,以期为临床上治疗膝骨关节炎提供新的方法与思路。     

Increased hip internal abduction moment and reduced speed are the gait strategies used by women with knee osteoarthritis

The purpose of this study was to identify the gait strategies in women with mild and moderate knee osteoarthritis (OA). Forty women diagnosed with OA of the knee and 40 healthy women participated in the study. Toe-out progression angle, trunk lateral lean, hip internal abduction moment and gait speed were measured using Qualisys ProReflex System and two force plates. Principal component analysis was applied to extract features from the gait waveforms data that characterized the waveforms main modes of temporal variation. Discriminant analysis with a stepwise model was conducted to determine which strategies could best discriminate groups. According to the discriminant model, the PC2 of the internal abduction moment of the hip and the gait speed were the most discriminatory variables between the groups. The OA group showed decreased gait speed, decreased hip internal abduction moment during the loading response phase, and increased hip internal abduction moment during the mid and terminal stance phases. Interventions that may increase hip internal abduction moment, such as the strengthening of the hip abductors muscles, may benefit women with knee OA. Training slower than normal gait speeds must be considered in light of potential adverse implications on overall physical function, daily tasks, and safety.     

Muscle fatigue and metabolic responses following three different antagonist pre-load resistance exercises

PurposePreload of antagonist muscles can be achieved by reciprocal actions (RAs) or by opposing muscle actions. However, evidence concerning neuromuscular and fatigue responses are scarce.ObjectiveTo compare the effects of different knee flexor (KF) preload methods on knee extension (KE) vastus medialis muscle fatigue, based on EMG-spectral index (FI), load range (LR), total work (TW), blood lactate (LAC) and biceps femoris co-activation (BFc) during resistance exercise.MethodsTwenty-four healthy men (23.5 ± 3.6 yrs) performed three antagonist pre-load isokinetic exercises (4 sets, 10 repetitions, 60° s^?1, 1 min rest between sets): RA (KF contraction immediately followed by KE); Superset (SS; one KF set immediately followed by one KE set); Multiple Set (MS; four KF sets followed by four KE sets).ResultsTotal work was significantly greater in RA. There was no significant decrease in LR between sets in RA. The BFc did not differ between protocols (p = 0.063). However, RA presented greater biceps femoriscoactivation. The FI was greater during SS compared to RA and MS (p < 0.05). The SS had greater LAC when compared to MS and RA (p = 0.005 and p = 0.007, respectively).ConclusionIt is suggested that the RA protocol is more neuromuscular and metabolic efficient during the performance of knee extension resistance exercise.     

Investigation of the Molecular Nature of Low-molecular-mass Cobalt(II) Ions in Isolated Osteoarthritic Knee-joint Synovial Fluid

High field ¹H NMR spectroscopy demonstrated that addition of Co(II) ions to osteoarthritic knee-joint synovial fluid (SF) resulted in its complexation by a range of biomolecules, the relative efficacies of these complexants/chelators being citrate ? histidine ～ threonine?glycine ～ glutamate ～ glutamine ～ phenylalanine ～ tyrosine > formate > lactate?alanine > valine > acetate > pyruvate > creatinine, this order reflecting the ability of these ligands to compete for the available Co(II) in terms of (1) thermodynamic equilibrium constants for the formation of their complexes and (2) their SF concentrations. Since many of these SF Co(II) complexants (e.g. histidinate) serve as powerful ^?OH scavengers, the results acquired indicate that any of this radical generated from the Co(II) source in such complexes via Fenton or pseudo-Fenton reaction systems will be “site-specifically” scavenged. The significance of these observations with regard to cobalt toxicity and the in vivo corrosion of cobalt-containing metal alloy joint prostheses (e.g. CoCr alloys) is discussed.     

Inertial sensor based method for identifying spherical joint center of rotation

The miniaturized wireless inertial measurement unit (IMU) technology and algorithms presented herein promote rapid and accurate predictions of the center-of-rotation (CoR) for ball/spherical joints. The algorithm improves upon existing IMU-based methods by directly utilizing the measured acceleration and angular velocity provided by the IMU to deduce the CoR in lieu of relying on error-prone velocity and position estimates. Results demonstrate that this new method resolves the position of the CoR to within a 3 mm sphere of the true CoR determined by a precision coordinate measuring machine. Such accuracy may render this method attractive for broad use in field, laboratory and clinical settings requiring non-invasive and rapid estimates of joint CoR.