仙灵骨葆胶囊联合透明质酸钠对膝骨关节炎患者关节功能、炎症因子及生活质量的影响

目的:观察仙灵骨葆胶囊联合透明质酸钠对膝骨关节炎(KOA)患者关节功能、炎症因子及生活质量的影响,为临床用药提供依据。方法:选取我院骨科于2014年12月-2016年12月间收治的72例KOA患者作为研究对象。采用随机数字表法将患者分为透明质酸钠组(采用透明质酸钠治疗,n=36)和联合组(采用仙灵骨葆胶囊与透明质酸钠联合治疗,n=36)。检测并比较两组患者治疗前及治疗1个月后的超敏C反应蛋白(hs-CRP)水平、肿瘤坏死因子-α(TNF-α)水平。分别于治疗前、治疗1个月后以及治疗6个月后采用生活质量调查表(SF-36)中文版评价患者生活质量,同时采用视觉模拟评估法(VAS)以及膝关节功能评定量表(Lysholm)对膝关节功能进行综合评定。治疗结束后随访半年,观察患者不良反应发生情况。结果:治疗1个月后,两组患者hs-CRP、TNF-α水平均明显下降,且联合组患者hs-CRP、TNF-α水平明显低于透明质酸钠组患者(P0.05)。两组治疗6个月后的VAS评分明显低于治疗1个月后的VAS评分,Lysholm评分均明显高于治疗1个月后的Lysholm评分(P0.05)。治疗1个月后和治疗6个月后,联合组患者VAS评分均明显低于透明质酸钠组患者同期VAS评分,而Lysholm评分均明显高于透明质酸钠组患者同期Lysholm评分(P0.05)。两组治疗6个月后SF-36量表各维度评分均高于治疗1个月后的评分(P0.05)。联合组患者治疗1个月后及治疗6个月后的躯体功能、躯体角色功能、躯体疼痛、总体健康、社会功能和心理健康评分均明显高于透明质酸钠组(均P0.05)。两组均无严重不良反应发生,且不良反应发生情况无明显差异(P0.05)。结论:仙灵骨葆胶囊联合透明质酸钠治疗膝骨关节炎对患者炎症反应、关节功能及生活质量有持续的改善作用,同时安全可靠,值得推广应用。     

伤筋擦剂外用联合关节腔注射透明质酸钠治疗膝骨关节炎的临床疗效

目的:观察伤筋擦剂外用联合关节腔注射透明质酸钠治疗膝骨关节炎(KOA)的临床疗效及安全性。方法:选择2012年2月~2014年2月我院收治的KOA患者114例,随机分为研究组与对照组各57例。对照组于关节腔内注射透明质酸钠治疗,研究组在此基础上应用伤筋擦剂治疗,疗程均为5周。观察两组临床疗效,不良反应及治疗前后血清白细胞介素1β(IL-1β)及一氧化氮(NO)变化。结果:研究组的总有效率为96.49%,显著高于对照组的84.21%(P0.05);研究组治疗后血清IL-1β及NO水平显著低于治疗前且低于对照组(均P0.05);两组不良反应对比无明显差异(P0.05)。结论:伤筋擦剂外用联合关节腔注射透明质酸钠治疗KOA疗效显著,两药优势互补,可以有效降低关节内炎症因子水平且安全可靠,适于临床应用与推广。     

咬合运动与注射醋酸泼尼松龙治疗滑膜炎的疗效比较

目的:比较咬合运动和关节下腔注射醋酸泼尼松龙治疗颞下颌关节滑膜炎的临床效果。方法:选择牙列完整、无第三磨牙阻生、符合颞下颌关节滑膜炎诊断标准的120例患者,随机分为实验组和对照组,每组60例。实验组行咬合运动,每次3-4个循环,每日3-4次,治疗周期为12个月;对照组给予醋酸泼尼松龙0.0125g+0.5ml2%利多卡因关节下腔注射一次,比较两种方法的治疗效果。结果:实验组的60例患者均在治疗后1-2w疼痛消失,追踪3-12个月无复发。对照组的60例患者,2个周后有18例无效,无效率为30%,两组比较其结果有显著性差异(P<0.001);3个月后有22例无效,无效率为36.67%,两组比较其结果有显著性差异(P<0.001)。结论:咬合运动组的治疗效果显著高于醋酸泼尼松龙注射组,咬合运动能有效的治疗滑膜炎并减少患者的治疗痛苦。     

盐酸氨基葡萄糖片联合玻璃酸钠治疗颞下颌关节骨关节炎的疗效观察

目的:研究盐酸氨基葡萄糖片联合玻璃酸钠治疗颞下颌关节骨关节炎(TMJOA)的临床疗效,为临床治疗提供依据。方法:选取2012年11月到2015年11月我院收治的TMJOA患者60例,按照随机数字表法将患者分为研究组和对照组,每组30例,两组均给予玻璃酸钠关节腔注射,研究组在此基础上给予盐酸氨基葡萄糖片治疗,应用视觉模拟评分法(VAS)评价关节疼痛情况,比较两组临床疗效和不良反应,比较治疗前后两组最大张口度、张口VAS评分和张口偏斜。结果:研究组总有效率为83.33%(25/30),显著高于对照组的56.67%(17/30),比较差异具有统计学意义(P0.05);治疗后两组张口VAS评分和张口偏斜显著降低,最大张口度显著增高,且研究组显著优于对照组,比较差异具有统计学意义(P0.05);两组不良反应发生率比较差异无统计学意义(P0.05)。结论:盐酸氨基葡萄糖片联合玻璃酸钠治疗TMJOA具有较好的临床疗效,能有效改善患者关节功能。     

咬合运动与注射醋酸泼尼松龙治疗滑膜炎的疗效比较

目的：比较咬合运动和关节下腔注射醋酸泼尼松龙治疗颞下颌关节滑膜炎的临床效果。方法：选择牙列完整、无第三磨牙阻生、符合颞下颌关节滑膜炎诊断标准的120例患者,随机分为实验组和对照组,每组60例。实验组行咬合运动,每次34个循环,每日3-4次,治疗周期为12个月;对照组给予醋酸泼尼松龙0．0125g＋0．5m12％利多卡因关节下腔注射一次,比较两种方法谛治爿效果。结果：实验组的60例患者均在治疗后1-2W疼痛消失,追踪3．12个月无复发。对照组的60例患者,2个周后有18。例无效,无效率为30％,两组比较其结果有显著性差异（P〈O．001）;3个月后有22例无效,无效率为36．67％,两组比较其结果有显著性差异（P〈0．001）。结论：咬合运动组的治疗效果显著高于醋酸泼尼松龙注射组,咬合运动能有效的治疗滑腱炎并减少患者的治疗痛苦。     

关节腔注射强力霉素对兔膝骨关节炎模型的影响

目的:研究关节腔内注射强力霉素对兔制动性骨关节炎模型的影响.方法:30只新西兰大白兔随机分成正常组6只及实验组24只,试验组左膝关节伸直位石膏固定4周随机选取6只处死左膝关节取材证实造模成功后剩余18只为左膝骨关节炎模型,随机分为治疗组、阴性对照组和模型对照组,治疗组每日给予1.33%的强力霉素0.3毫升左膝关节腔内注射,阴性对照组每日给予生理盐水0.3毫升左膝关节腔注射,模型对照组不做处理,于8周处死取材.观察指标包括关节软骨大体形态,软骨Mankin's评分,软骨细胞基质金属蛋白酶-3(MMP-3)表达及滑膜细胞白介素-1(IL-1)表达.结果:强力霉素治疗组软骨面退变明显轻于模型组及生理盐水对照组,软骨大体评分,Mankin评分,MMP-3表达及滑膜IL-1表达亦显著降低.结论:强力霉素关节腔内注射对兔制动性骨关节炎模型软骨退变有明显的缓解作用.     

牵张成骨联合正颌正畸技术治疗颞下颌关节强直的效果分析

目的：探讨联合采用牵张成骨以及正颌正畸技术治疗颞下颌关节强直的效果。方法：选取我院收治的50 例颞下颌关节强直 继发小下颌畸形患者,根据不同的手术方式将其分为观察组以及对照组,对照组仅采取正颌正畸治疗,观察组一期通过关节成形 术解除关节强直,完成正畸治疗后,二期采用牵张成骨以及颏成形术矫治小下颌畸形伴随OSAHS,术后进行8-35 月的随访,评价 治疗效果。结果：观察组的牵张距离、颏前移距离以及术后张口度均明显大于对照组,且最大张口度均大于20 mm,平均最大张口 度由术前的3.2 mm增加至术后的36.7 mm,P<0.05,观察组术后能够恢复正常咬合关系和咀嚼功能,两组患者术后的平均睡眠紊 乱指数（AH1）、LAST、后气道间隙（PAS）以及SNB 角度比较有统计学差异,P<0.05,观察组术后患者的OSAHS 症状均得到显著 的改善,未出现OSAHS复发情况。结论：牵张成骨联合正颌正畸技术治疗颞下颌关节强直可以获得满意的效果,可以很好的矫治 牙额面畸形,且能够有效改善伴发的OSAHS 症状。     

玻璃酸钠联合臭氧关节腔内注射对创伤性踝关节炎患者血清hs-CRP、IL-1β、IL-6和TNF-α水平的影响

目的:探讨玻璃酸钠联合臭氧关节腔内注射对创伤性踝关节炎患者血清超敏C反应蛋白(hs-CRP)、白介素(IL)-1β、IL-6和肿瘤坏死因子(TNF)-α水平的影响。方法:选择2013年1月至2016年8月我院接诊的92例创伤性踝关节炎患者作为本次研究对象,通过随机数表法分为观察组(n=46)和对照组(n=46)。对照组在关节腔给注射玻璃酸钠治疗,观察组联合臭氧治疗,均1次/周,连续治疗5次。比较两组治疗前后视觉模拟评分法(VAS)、Mc Guire踝关节评分以及血清hs-CRP、IL-1β、IL-6和TNF-α的变化及治疗后临床疗效优良率。结果:治疗前,两组VAS评分、Mc Guire踝关节评分、血清hs-CRP、IL-1β、IL-6和TNF-α水平比较差异均无统计学意义(P0.05)。治疗后,两组VAS评分、Mc Guire踝关节评分均较治疗前显著改善(P0.05),且观察组VAS评分明显低于对照组,Mc Guire踝关节评分明显高于对照组(P0.05);两组血清hs-CRP、IL-1β、IL-6和TNF-α水平较治疗前均显著降低(P0.05),且观察组血清hs-CRP、IL-1β、IL-6和TNF-α比较均明显低于对照组(P0.05);观察组临床疗效优良率明显高于对照组(P0.05)。结论:关节腔内注射玻璃酸钠联合臭氧治疗创伤性踝关节炎患者的临床效果优于单用关节腔注射玻璃酸钠,可有效缓解疼痛,改善关节功能,可能与其有效降低血清hs-CRP、IL-1β、IL-6和TNF-α水平有关。     

间充质干细胞对颞下关节炎患者血清PRG4 及TGF-beta1 的软骨生成作用比较研究

目的：探讨间充质干细胞对颞下关节炎患者血清PRG4 及TGF-beta1 的软骨生成作用。方法：选取我院颞下颌关节炎患者72 例，随机分为实验组和对照组。对照组予盐酸氨基葡萄糖片口服1 个月，玻璃酸钠注射液颞下颌关节腔每周1 次，注射4 次治疗。 实验组予间充质干细胞培养、自体移植，生理盐水0.5 mL稀释细胞5× 105个关节腔内注射，3 天后再次相同剂量及方式注射。两 组患者分别测定血清TGF-beta1、IL-1alpha和PRG4 蛋白表达，最大张口度测试及疼痛程度评分，并通过影像学检查，评估两组患者关 节组织损伤修复时间。结果：①与对照组相比实验组TGF-beta1 和PRG4 蛋白表达上升更迅速且维持在较高水平，IL-1alpha下降更显 著，差异有统计学意义（P＜0.05）；②与对照组比较，实验组最大张口度增加、张口时疼痛评分下降，差异有统计学意义（P＜0.05）； ③与对照组比较，实验组受损关节组织均修复时间更短，差异有统计学意义（P＜0.05）。结论：间充质干细胞可通过调节血清 TGF-beta1、IL-1alpha水平和PRG4 蛋白表达，促进软骨的生成，对改善预后，提高患者生活质量有重要意义。     

关节镜术联合透明质酸钠可有效治疗膝关节骨性关节炎

为探讨关节镜联合透明质酸钠治疗膝关节骨性关节炎(KOA)的效果,本研究选取2015年8月至2017年1月本院骨科诊治的114例KOA患者进行回顾性分析。根据治疗方法,将患者分为联合组和对照组,每组57例,其中联合组患者接受关节镜清理术和透明质酸钠注射液治疗,而对照组仅接受关节镜手术治疗。通过对比两组患者的手术效果和手术前后的血清Ⅱ型胶原羧基端端肽(CTX-Ⅱ)、骨寡聚基质蛋白(COMP)、白细胞介素-1 (IL-1)、一氧化氮(NO)、白细胞介素-6 (IL-6)和肿瘤坏死因子-α(TNF-α)的水平,本研究发现,治疗前,联合组和对照组的疼痛、僵硬、关节功能、WOMAC总积分差异无显著差异(p0.05);治疗1个月后,两组患者的疼痛、僵硬、关节功能、WOMAC总积分较本组治疗前均显著降低(p0.05),同时,联合组均低于对照组(p0.05);另外,治疗前联合组和对照组的血清CTX-Ⅱ、COMP、IL-1、NO、IL-6、TNF-α水平差异均无统计学意义(p0.05),治疗1个月后,两组患者的血清CTX-Ⅱ、COMP、IL-1、NO、IL-6、TNF-α水平较本组治疗前均显著降低(p0.05);同时,联合组均低于对照组(p0.05)。本研究表明,关节镜联合透明质酸钠治疗KOA患者的同时应该注意在治疗过程中护理干预,能够改善患者的预后,增加治疗效果。     

Tumor necrosis factor-alpha in temporomandibular joint synovial fluid predicts treatment effects on pain by intra-articular glucocorticoid treatment

The aim of this study was to investigate the influence of tumor necrosis factor-alpha (TNF-alpha) in temporomandibular joint (TMJ) synovial fluid and blood on the treatment effect on TMJ pain by intra-articular injection of glucocorticoid in patients with chronic inflammatory TMJ disorders. High pretreatment level of TNF-alpha in the synovial fluid was associated with a decrease of TNF-alpha and elimination of pain upon maximal mouth opening. Elimination of this TMJ pain was accordingly associated with decrease in synovial fluid level of TNF-alpha. There was also a significant decrease of C-reactive protein and TMJ resting pain after treatment. In conclusion, this study indicates that presence of TNF-alpha in the synovial fluid predicts a treatment effect of intra-articular injection of glucocorticoid on TMJ movement pain in patients with chronic TMJ inflammatory disorders.     

糖皮质激素联合玻璃酸钠关节腔内注射治疗膝关节骨性关节炎的临床研究

目的:探究糖皮质激素联合玻璃酸钠关节腔内注射治疗膝关节骨性关节炎的临床疗效。方法:选取2012年6月至2014年6月期间我院接收的120例患有膝关节骨性关节炎的患者,并按照随机数字数表法分为观察组和对照组,每组60例,均给予膝关节腔内注射2.5 m L玻璃酸钠,在治疗第一周给予观察组患者膝关节腔内注射1 m L复方倍他米松,对照组给予相同剂量的注射用水;分别对治疗前、治疗后1周、2周、1个月、3个月、5个月时患者膝关节Lequence评分,并对比两组治疗效果。结果:治疗后,两组膝关节Lequence评分均显著低于治疗前,且观察组降低更明显,差异均有统计学意义(P0.05);观察组患者治疗后1周、2周、1个月、3个月、5个月总有效率均高于对照组,且差异具有统计学意义(P0.05)。结论:糖皮质激素联合玻璃酸钠关节腔内注射治疗膝关节骨性关节炎具有良好的临床疗效,为临床治疗提供了新的思路。     

A Comparative Study between Use of Arthroscopic Lavage and Arthrocentesis of Temporomandibular Joint Based on Computational Fluid Dynamics Analysis

Arthroscopic lavage and arthrocentesis, performed with different inner-diameter lavage needles, are the current minimally invasive techniques used in temporomandibular joint disc displacement (TMJ-DD) for pain reduction and functional improvement. In the current study, we aimed to explore the biomechanical influence and explain the diverse clinical outcomes of these two approaches with computational fluid dynamics. Data was retrospectively analyzed from 78 cases that had undergone arthroscopic lavage or arthrocentesis for TMJ-DD from 2002 to 2010. Four types of finite volume models, featuring irrigation needles of different diameters, were constructed based on computed tomography images. We investigated the flow pattern and pressure distribution of lavage fluid secondary to caliber-varying needles. Our results demonstrated that the size of outflow portal was the critical factor in determining irrigated flow rate, with a larger inflow portal and a smaller outflow portal leading to higher intra-articular pressure. This was consistent with clinical data suggesting that increasing the mouth opening and maximal contra-lateral movement led to better outcomes following arthroscopic lavage. The findings of this study could be useful for choosing the lavage apparatus according to the main complaint of pain, or limited mouth opening, and examination of joint movements.     

Simultaneous total correction of temporomandibular ankylosis and facial asymmetry

Ankylosis of the temporomandibular joint not only prevents mouth opening and chewing, but also affects the growth and position of the mandible. This produces progressive facial distortion with devastating psychosocial effects compounding the already difficult problem of not being able to open the mouth. Over the past 6 years, 18 patients in Canada and Taiwan were treated by excision of a large block of bone at the ankylosis and repositioning of the jaw, with the addition of osteotomies as necessary to produce a symmetrical face with good occlusion. Bilateral cases were treated at one operation in a similar way. The temporomandibular joint and absent ramus were constructed with a costochondral graft taken from the opposite chest. Some patients were treated with intermaxillary fixation for 8 weeks, while others had no fixation, but there was no difference in the effectiveness of correction of the ankylosis.     

Preliminary histopathological study of intra-articular injection of a novel highly cross-linked hyaluronic acid in a rabbit model of knee osteoarthritis

Osteoarthritis is a degenerative joint disease mostly occurring in the knee and commonly seen in middle-aged and elderly adults. Intra-articular injection of hyaluronic acid has been widely used for treatment of knee osteoarthritis. The aim of this study was to evaluate the efficacy of intra-articular injection of a novel highly cross-linked hyaluronic acid, alone or in combination with ropivacaine hydrochloride and triamcinolone acetonide, on knee articular cartilage in a rabbit model of collagenase-induced knee osteoarthritis. After induction of experimental osteoarthritis by intra-articular injection of collagenase, adult New Zealand white rabbits (n = 12) were divided into 3 groups. Group 1 (control group) received 0.3 ml phosphate buffered saline into the right knee joint. Group 2 received 0.3 ml cross-linked hyaluronic acid (33 mg/ml) into the right knee joint. Group 3 received a mixture of 0.15 ml cross-linked hyaluronic acid (33 mg/ml), 0.05 ml ropivacaine hydrochloride 1 % and 0.1 ml triamcinolone acetonide (10 mg/ml) into the right knee joint. Intra-articular injections were given 4 weeks after first collagenase injection and were administered once a week for 3 weeks. Gross pathology and histological evaluation of rabbits’ knee joints were performed after 16 weeks following initial collagenase injection. Histological analysis of sections of right knee joints at lesion sites showed a significant decrease in Mankin’s score in groups treated with hyaluronic acid alone or in combination with ropivacaine hydrochloride and triamcinolone acetonide versus control group (p < 0.05 and p < 0.01 respectively). This evidence was consistent with strong articular degenerative changes in control right knee joints (grade III osteoarthritis), while the treated groups revealed less severe articular degenerative changes (grade II osteoarthritis). The present results show that cross-linked hyaluronic acid, alone or in combination with ropivacaine hydrochloride and triamcinolone acetonide, produces a significant improvement in knee articular cartilage degeneration in a rabbit model of collagenase-induced osteoarthritis.     

Intra-articular injection of collagenase in the knee of rats as an alternative model to study nociception associated with osteoarthritis

Introduction

Animal models currently used in osteoarthritis-associated pain research inadequately reproduce the initiating events and structural pathology of human osteoarthritis. Conversely, intra-articular injection of collagenase is a structurally relevant model, as it induces articular degeneration both by digesting collagen from cartilage and by causing articular instability, thereby reproducing some of the main events associated with osteoarthritis onset and development. Here, we evaluated if the intra-articular injection of collagenase can be an alternative model to study nociception associated with osteoarthritis.

Methods

Osteoarthritis was induced by two intra-articular injections of either 250 U or 500 U of collagenase into the left knee joint of adult male Wistar rats. A six weeks time-course assessment of movement- and loading-induced nociception was performed by the Knee-Bend and CatWalk tests. The effect of morphine, lidocaine and diclofenac on nociceptive behaviour was evaluated in animals injected with 500 U of collagenase. Joint histopathology was scored for both doses throughout time. The expression of transient receptor potential vanilloid 1 (TRPV1) in ipsilateral dorsal root ganglia (DRG) was evaluated.

Results

An increase in nociceptive behaviour associated with movement and loading of affected joints was observed after intra-articular collagenase injection. With the 500 U dose of collagenase, there was a significant correlation between the behavioural and the histopathological osteoarthritis-like structural changes developed after six weeks. One week after injection of 500 U collagenase, swelling of the injected knee and inflammation of the synovial membrane were also observed, indicating the occurrence of an early inflammatory reaction. Behavioural changes induced by the 500 U dose of collagenase were overall effectively reversed by morphine and lidocaine. Diclofenac was effective one week after injection. TRPV1 expression increased six weeks after 500 U collagenase injection.

Conclusion

We conclude that the intra-articular injection of 500 U collagenase in the knee of rats can be an alternative model for the study of nociception associated with osteoarthritis, since it induces significant nociceptive alterations associated with relevant osteoarthritis-like joint structural changes.     

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。     

采用载距突螺钉固定技术治疗膝关节内骨折的疗效分析

目的:探讨载距突螺钉固定术治疗膝关节内骨折的疗效。方法:选取我院骨科收治的膝关节内骨折的患者80例,根据患者骨折固定方法而分为实验组(40例)与对照组(40例)。实验组采用载距突螺钉固定技术进行治疗,对照组采用开口后观察骨折程度,并对关节周围平整性进行修复,如需固定可借助克氏针,部分可运用牵引手法等进行修复。两组患者术后均予以常规抗炎治疗。比较两组患者膝关节功能恢复情况、疗效及并发症情况。结果:与对照组相比,实验组总有效率较高,并发症发生率较低(P0.05);HSS评分比较,实验组HSS评分明显高于对照组(P0.05)。结论:载距突螺钉固定技术能够提高膝关节内骨折患者的临床疗效,降低并发症的发生率,改善膝关节的功能活动。