骨性关节炎病因的研究进展

骨性关节炎是影响人类健康及生活质量的最常见关节疾病之一,是一种以骨关节软骨退行性变和继发性周围骨质增生为特点的慢性关节疾病,又被称为退行性关节炎.多发于中老年人群,常累及全身骨关节中的脊柱、髋关节和膝关节等负重较大的关节,导致受累关节僵硬、变形,从而使关节功能受到严重影响,影响患者的生活质量。常见症状为受累关节疼痛,活动受限,休息后缓解及晨起关节僵硬感。由于人口老龄化加重,导致其发病率连年增加。但由于其病因及病机复杂多样,目前医学界还没有确切的结论,导致缺乏有效的治疗手段,本文就近几年来文献中提及的骨性关节炎病因及病机做一综述,有利于我们继续探索,早日认清这种疾病,治愈这种疾病,提高患者生活质量。     

骨性关节炎生物学标志物研究进展

骨性关节炎(oseteoarthritis,OA)是一种随着年龄增长发病率明显升高的退行性变,常累及脊柱、髋、膝等人体负重关节,以关节缓慢发展的疼痛、肿胀,伴功能障碍为临床表现,主要有滑膜增生、软骨破坏、软骨下骨骨化及骨赘形成等一系列病理表现。OA对人类的健康和生活质量影响很大,随着老龄化社会的到来,本病的发病率日趋升高,其研究已成为医学领域中的重要课题。目前,OA的早期诊断、病变监测和有效防治仍是骨科领域亟待解决的疑难问题。随着分子生物学的发展和研究手段的提高,许多研究者都在试图寻找用于临床评价OA的生物学标志物。本文将就OA研究中所使用的主要标志物进行综述,为深入研究OA提供方便。     

关节镜手术在膝关节骨性关节炎患者中的综合应用价值

目的:研究关节镜手术在膝关节骨性关节炎患者中的综合应用,为膝关节骨性关节炎的临床治疗提供依据。方法:选取50例单膝关节骨性关节炎患者,行常规关节镜手术,术后注射透明质酸钠并指导患者进行康复训练。在关节镜手术前后对患者进行LKSS评分,评定患者膝关节功能;对患膝的屈肌、伸肌力进行等速测定;在术前及术后2周测定外周血及患膝关节液IL-6、TNF-α、MMP-3表达水平。结果:与术前相比,患者术后LKSS评分及关节活动度均显著提高(P0.05),关节功能得到较好的恢复;患膝伸肌PT、STW及TAE值均得到显著提高(P0.05),屈肌PT、STW及TAE值无统计学意义;患者外周血及关节液中IL-6、TNF-α及MMP-3表达水平均显著降低(P0.05)。结论:采用关节镜手术治疗骨性关节炎可明显降低机体的炎症状态,改善关节的功能,增加患膝的伸肌力。     

骨性关节炎软骨细胞凋亡的研究

骨性关节炎是一种以软骨下骨改变和软骨退化为特征的关节退行性疾病.研究证实软骨细胞凋亡在骨性关节炎发生发展中起到关键作用.因此,研究骨关节炎软骨细胞凋亡机制及研发或筛选抗软骨细胞凋亡的药物必将给骨关节炎的防治开辟一条崭新的途径.     

针灸治疗膝关节骨性关节炎的临床研究进展

膝关节骨性关节炎是目前临床上最常见的骨性关节炎之一,且发病率逐年增高.但其发病机理至今尚未完全明了,因此对该病并没用一个确切规范的诊疗方法,临床多以缓解症状,控制疾病发展速度为主要目的.目前,有许多报道显示,针灸尤其是以电针为主治疗膝骨性关节炎已经取得了较好的临床疗效.     

uPA系统与骨性关节炎治疗的研究进展

尿激酶型纤溶酶原激活系统(uPA)在骨性关节炎的病理过程中发挥着重要的调控作用.其与骨性关节炎的发病,发展以及结局息息相关;骨性关节炎的治疗也是围绕其展开.近年来.围绕着uPA系统探索骨性关节炎的发病机制及治疗已成为基础和临床研究的热点.本文将uPA系统在骨性关节炎中的作用及骨性关节炎的治疗予以综述.     

氧化应激反应与膝关节骨性关节炎的相关性探究

目的:了解膝关节骨性关节炎患者机体的氧化应激状态,探讨氧化应激反应与膝关节骨性关节炎发生、发展的关系。方法:收集膝关节骨性关节炎患者及健康人群的血清,采用分光光度法测定和比较其SOD、GSH-Px、MDA水平。结果:与健康对照人群相比,膝关节骨性关节炎患者体内SOD、GSH-Px酶类抗氧化剂活力显著增强(P0.05);MDA脂质过氧化损伤产物明显降低(P0.05)。结论:膝关节骨性关节炎患者体内氧化还原状态发生了改变,可能处于抗氧化应激的慢性代偿状态;氧化应激反应参与了骨性关节炎的发生、发展过程。     

膝关节骨性关节炎临床实施臭氧治疗的疗效分析

目的:探讨对膝关节骨性关节炎患者采用臭氧治疗的临床效果.方法:收集从我院2010年7月至2012年7月门诊收治的膝关节骨性关节炎患者病例96例,并对收集的病例进行分类.治疗组患者进行刺穿后采取臭氧治疗的方式,有55例;对照组患者采用利多卡因、0.9％氯化钠溶液、曲安奈德混合液的治疗方式,有41例.对两组患者进行2个疗程的治疗后,对治疗前后的WAS及WOMAC进行评分,以比较两组的治疗效果.结果:经过2个疗程的治疗后,治疗组和对照组都取得了明显的效果,治疗组的治愈率为70.90％,总有效率为98.18％;对照组的治愈率为63.41％,总有效率为92.68％.结论:对膝关节骨性关节炎患者实施臭氧治疗方式能够获得良好的近期临床效果.     

膝骨性关节炎关节镜下分级治疗的临床应用

目的:探索膝关节骨性关节炎关节镜下分期及治疗的临床意义及效果。方法:将74例81膝骨性关节炎应用自行设计的关节镜下分级方法分为4级,并分别手术进行术后疗效观察。结果:1级21膝,优良率100%;2级23膝,优良率78.26%;3级25膝,优良率56%;4级12膝,优良率33.33%。结果 Wilcoxon秩检验,T=4.84,P<0.05,差异有显著性。结论:膝骨关节炎关节镜下分级,对于关节镜治疗膝关节骨性关节炎疗效差异显著。有助于手术适应症掌握,规范程序,避免手术盲目性及不必要损伤。     

老年膝关节骨性关节炎保守治疗与置换术的疗效对比分析

目的：比较老年膝关节骨性关节炎予以保守治疗以及外科膝关节置换手术的治疗效果,以探讨其合理的干预方法。方法：选 取我院2009 年1 月-2013 年12 月间收治的50 例临床资料完整的老年膝关节骨性关节炎疾病患者,将其根据治疗方式的不同分 为保守治疗组17 例以及外科手术治疗组33 例,手术方法为膝关节置换术。比较术后的KSS 评分情况,HSS评分、膝关节优良率。 结果：治疗后手术治疗组患者的KSS 评分较治疗前明显改善,P<0.05。治疗后外科手术组患者的HSS 各项评分均明显优于保守治 疗组,治疗后手术组患者的膝关节功能优良率达到了100 %（33/33）,明显优于保守治疗组35.29 %（6/17）的优良率,组间比较有统 计学差异,P<0.05。结论：对于老年膝关节骨性关节炎进行保守治疗可能不会对疾病的进展起到干预作用,而明确诊断的患者行全 膝关节置换术可以有效改善膝关节功能,提高生活质量。     

Instrumentation of off-the-shelf ultrasound system for measurement of probe forces during freehand imaging

Ultrasound is a popular and affordable imaging modality, but the nature of freehand ultrasound operation leads to unknown applied loads at non-quantifiable angles. The purpose of this paper was to demonstrate an instrumentation strategy for an ultrasound system to measure probe forces and orientation during freehand imaging to characterize the interaction between the probe and soft-tissue as well as enhance repeatability. The instrumentation included a 6-axis load cell, an inertial measurement unit, and an optional sensor for camera-based motion capture. A known method for compensation of the ultrasound probe weight was implemented, and a novel method for temporal synchronization was developed. While load and optical sensing was previously achieved, this paper presents a strategy for potential instrumentation on a variety of ultrasound machines. A key feature was the temporal synchronization, utilizing the electrocardiogram (EKG) feature built-in to the ultrasound. The system was used to perform anatomical imaging of tissue layers of musculoskeletal extremities and imaging during indentation on an in vivo subject and an in vitro specimen. The outcomes of the instrumentation strategy were demonstrated during minimal force and indentation imaging. In short, the system presented robust instrumentation of an existing ultrasound system to fully characterize the probe force, orientation, and optionally its movement during imaging while efficiently synchronizing all data. Researchers may use the instrumentation strategy on any EKG capable ultrasound systems if mechanical characterization of soft tissue or minimization of forces and deformations of tissue during anatomical imaging are desired.     

高频超声对乳腺导管内乳头状瘤的诊断价值分析

目的探讨高频彩色多普勒超声对导管内乳头状瘤的诊断价值。方法回顾性分析36例39个病变经手术和病理证实为导管内乳头状瘤的超声图像表现及特征,并与病理结果比较。结果高频超声对Ⅰ型导管内乳头状瘤的诊断准确率为92.8%,Ⅱ型为90.9%,Ⅲ型为50%,Ⅳ型为80%,Ⅴ型为60%。结论高频多普勒超声可作为导管内乳头状瘤首选的检查方法之一。     

关节腔内注射细胞制剂治疗骨关节炎的临床研究进展

关节腔内注射细胞制剂是治疗骨关节炎(OA)的新趋势,且展现了良好的临床效果、安全性及可行性。细胞制剂有多种类型,包括血小板、干细胞和单个核细胞(MNCs)。血小板制剂倾向于基层医疗机构应用和早期OA患者的治疗;MNCs较适用于不具备干细胞培养条件的医疗机构和中期OA患者应用;而干细胞制剂较适合高级别医疗机构和晚期OA患者应用。虽然腔内注射细胞产品治疗OA进行了大量临床研究,但亦有不足;因此制定腔内注射治疗OA不同细胞制剂的质量控制标准、临床应用标准和进行大样本多中心随机对照临床试验势在必行。探索外泌体、外周血MNCs治疗OA的临床研究及其分子机制,是研究的新切入点。     

超声在桥本甲状腺癌术前诊断中的应用价值

目的 分析桥本甲状腺癌的声像图特征,探讨超声在桥本甲状腺癌术前诊断中的应用价值.方法 对82例术后有明确病理诊断的桥本甲状腺癌患者与术前进行的超声检查对比分析,总结桥本甲状腺癌的声像图特点.结果 桥本甲状腺癌有如下特点:结节多呈低回声,无明显包膜,边缘不规整;多伴有砂砾样钙化;有的局部腺体回声明显减低,伴有弥漫性的砂砾样钙化.结论 桥本甲状腺癌在超声图像上有其明显的特征性表现,通过超声检查多可以在术前做出明确的诊断,为临床诊治提供确切的信息.超声检查是此疾病术前诊断的首选.     

3D ultrasound imaging of the human corpus luteum

The aim of this article was to present the extent to which the state-of-the art ultrasonographic imaging can be used to visualize the features of the human corpus luteum (CL). In the late 1970s, the first ultrasonographic images of human CLs were published. The advent of transvaginal, high-resolution transducers has greatly improved the quality of imaging as did the subsequent introduction of color Doppler and 3D ultrasonography. In the present technical note, the examples of the various technical and imaging modalities used to examine the human CLs are shown. CL is a short-lived structure with a highly variable morphological appearance and the 3D ultrasonographic technique is an ideal tool to perform standardized measurements on the CL. The introduction of new imaging techniques in clinical reproductive medicine can only be successful if operators are properly trained.     

超声造影在早期动脉粥样硬化疾病的研究进展

动脉粥样硬化一直是心血管医学面临的长期而严峻的挑战,随着代谢性危险因素的日益增多,动脉粥样硬化性疾病带来的危害日益突出;超声成像作为一种良好的无创、实时检查手段,一直作为动脉粥样硬化疾病诊断的首选诊断方法;近30年来超声影像学快速发展,从过去单纯对发生粥样硬化损伤的血管结构进行成像,经过各方面技术的发展,如今其对动脉粥样硬化组织内的结构以及病理过程的显像已成为可能。在本文中,将对近年来超声造影在早期AS疾病的诊治及疗效评价方面的进展作简要综述。     

The use of 2D ultrasound elastography for measuring tendon motion and strain

The goal of the current study was to investigate the fidelity of a 2D ultrasound elastography method for the measurement of tendon motion and strain. Ultrasound phantoms and ex vivo porcine flexor tendons were cyclically stretched to 4% strain while cine ultrasound radiofrequency (RF) data and video data were simultaneously collected. 2D ultrasound elastography was used to estimate tissue motion and strain from RF data, and surface tissue motion and strain were separately estimated using digital image correlation (DIC). There were strong correlations (R²>0.97) between DIC and RF measurements of phantom displacement and strain, and good agreement in estimates of peak phantom strain (DIC: 3.5±0.2%; RF: 3.7±0.1%). For tendon, elastographic estimates of displacement profiles also correlated well with DIC measurements (R²>0.92), and exhibited similar estimated peak tendon strain (DIC: 2.6±1.4%; RF: 2.2±1.3%). Elastographic tracking with B-Mode images tended to under-predict peak strain for both the phantom and tendon. This study demonstrates the capacity to use quantitative elastographic techniques to measure tendon displacement and strain within an ultrasound image window. The approach may be extendible to in vivo use on humans, which would allow for the non-invasive analysis of tendon deformation in both normal and pathological states.     

Validation of method for analysing mechanics of unloader brace for medial knee osteoarthritis

Unloader braces are one non-invasive treatment of knee osteoarthritis, which primarily function by applying an external abduction moment to the joint to reduce loads in the medial compartment of the knee. We developed a novel method using brace deflection to estimate the mechanical effect of valgus braces and validated this model using strain gauge instrumentation.Three subjects performed static and walking trials, in which the moment applied by an instrumented brace was calculated using the deflection and strain methods. The deflection method predicted average brace moments of 8.7 Nm across static trials; mean error between the deflection model predictions and the gold-standard strain gauge measurements was 0.32 Nm. Mean brace moment predictions throughout gait ranged from 7.1 to 8.7 Nm using the deflection model. Maximum differences (MAE) over the gait cycle in mean and peak brace moments between methods were 1.50 Nm (0.96) and 0.60 Nm (0.42).Our proposed method enables quantification of brace abduction moments without the use of custom instrumentation. While the deflection-based method is similar to that implemented by Schmalz et al. (2010), the proposed method isolates abduction deflection from the 3 DOF angular changes that occur within the brace. Though the model should be viewed with more caution during swing (MAE = 1.16 Nm), it was shown that the accuracy is influenced by the uncertainty in angle measurement due to cluster spacing. In conclusion, the results demonstrate that the deflection-based method developed can predict comparable brace moments to those of the previously established strain method.