关节镜下多种移植物联合重建膝关节前、后交叉韧带

目的：评估关节镜下膝关节前交叉韧带（ACL）与后交叉韧带（PCL）同时重建的技术和临床效果。方法：自2003年6月～2009年10月,27例病人（28膝）经MRJ检查及关节镜检查证实ACL和PCL均断裂,其中9膝伴内侧副韧带损伤（MCL）,8膝伴后外侧角损伤（PLC）,5膝伴内侧半月板破裂,4膝伴外侧半月板损伤。27例患者于伤后3～10周在关节镜下行膝关节前、后交叉韧带联合重建。结果：本组术后早期均未发生严重并发症。术后随访12-88个月,平均（42．67±3．34）个月,Lysholm膝关节功能评分为78-93分,平均（86．67±5．21）分。国际膝关节文件编制委员会（mDC）综合评定由术前显著异常（D级）28膝,改进为随访时正常（A级）9膝、接近正常（B级）16膝、异常（C级）3膝。结论：关节镜下膝关节前交叉韧带（ACL）与后交叉韧带（PCL）同时重建创伤小、手术操作精细,术后膝关节功能恢复满意。     

关节镜下多种移植物联合重建膝关节前、后交叉韧带

目的:评估关节镜下膝关节前交叉韧带(ACL)与后交叉韧带(PCL)同时重建的技术和临床效果。方法:自2003年6月～2009年10月,27例病人(28膝)经MRI检查及关节镜检查证实ACL和PCL均断裂,其中9膝伴内侧副韧带损伤(MCL),8膝伴后外侧角损伤(PLC),5膝伴内侧半月板破裂,4膝伴外侧半月板损伤。27例患者于伤后3～10周在关节镜下行膝关节前、后交叉韧带联合重建。结果:本组术后早期均未发生严重并发症。术后随访12～88个月,平均(42.67±3.34)个月,Lysholm膝关节功能评分为78～93分,平均(86.67±5.21)分。国际膝关节文件编制委员会(IKDC)综合评定由术前显著异常(D级)28膝,改进为随访时正常(A级)9膝、接近正常(B级)16膝、异常(C级)3膝。结论:关节镜下膝关节前交叉韧带(ACL)与后交叉韧带(PCL)同时重建创伤小、手术操作精细,术后膝关节功能恢复满意。     

不同频率电针治疗膝骨性关节炎的临床疗效观察

目的:通过临床研究探讨电针治疗膝关节骨性关节炎的最佳参数,为临床提供更加规范性的治疗,进一步提高电针疗效。方法:将符合膝关节骨性关节炎诊断标准的73例单膝患者随机分为电针疏波组、密波组两组,均针刺患侧膝眼穴,疏波组接2Hz连续波治疗,密波组接40Hz连续波治疗,采用WOMAC评分对两组治疗后疼痛、僵硬、躯体功能进行评估,同时判断1个疗程及3个疗程治疗效果。结果:经统计学处理,完成第一疗程后,两组疼痛评分比较,P均<0.01,说明两组在疼痛疗效上存在差异。而两组僵硬和躯体功能评分的比较,P>0.05,显示两组没有统计学意义。第3疗程后,两组WOMAC总分比较,P均<0.01,具有极显著性差异,第3疗程症状积分低于第1疗程,说明第3疗程后症状改善优于第1疗程。结论:电针疏波组在改善疼痛上优于密波组;第3疗程后,总体症状改善情况优于第1疗程。     

Synovial fluid and plasma selenium, copper, zinc, and iron concentrations in patients with rheumatoid arthritis and osteoarthritis

In recent years, a great number of studies have investigated the possible role of trace elements in the etiology and pathogenesis of rheumatoid arthritis (RA) and osteoartritis (OA). We studied synovial fluid and plasma concentrations of selenium (Se), zinc (Zn), copper (Cu), and iron (Fe) in patients with RA and OA and compared them with sex- and age-matched healthy subjects. Plasma albumin levels were measured as an index of nutritional status. Plasma Se, Cu, and Zn concentrations were determined by atomic absorption spectrophotometry and Fe concentrations were determined by the colorimetric method. Although plasma and synovial fluid Se concentration were found to be significantly lower (p<0.05, and p<0.05, respectively), Cu concentrations were significantly higher in patients with RA than those of healthy subjects and OA (p<0.05 and p<0.05, respectively). There were no significant differences in plasma and synovial fluid Zn concentrations and albumin levels among three groups (p>0.05). On the other hand, synovial fluid Cu and Fe concentrations were significantly higher in patients with OA than those of healthy subjects (p<0.05). There was a significantly positive correlation between synovial fluid Se−Cu values and Zn−Fe values in patients with RA. Our results showed that synovial fluid and plasma trace element concentrations, excluding Zn, change in inflammatory RA, but not in OA. These alterations in trace element concentrations in inflammatory Ra might be a result on the changes of the immunoregulatory cytokines.     

Devil’s Claw (<Emphasis Type="Italic">Harpagophytum procumbens</Emphasis>): An Anti-Inflammatory Herb with Therapeutic Potential

Extracts of the secondary roots of the southern African plant, Devil’s Claw (Harpagophytum procumbens) provide a herbal drug with a variety of traditional indications. One area of its use that has become very popular in recent years is in the treatment of inflammatory disorders of the musculoskeletal system and of low back pain. There have been several clinical studies recently published that generally support its use in treating osteoarthritis although more studies are required in order to establish this drug as a definite therapeutic option. Here in this review, the pharmacological properties of Devil’s Claw are reviewed in detail and the clinical evidence is briefly summarised. There is good in vitro and in vivo pharmacological evidence of the anti-inflammatory and analgesic properties of this drug, although some negative findings have also been reported. Generally, the pharmacological properties of Devil’s Claw is supportive of its therapeutic potential, but more evidence from clinically relevant models, as well as at the cellular and molecular level, should be sought. Such studies may provide evidence in support of additional indications, both traditional and novel. The clinical data on Devil’s Claw is also very promising.     

Matrilin-3 Induction of IL-1 receptor antagonist Is required for up-regulating collagen II and aggrecan and down-regulating ADAMTS-5 gene expression

Introduction

Deletion or mutation of the gene encoding the cartilage extracellular matrix (ECM) protein matrilin-3 (MATN3) results in the early onset of osteoarthritis (OA), suggesting chondroprotective properties of MATN3. To understand the mechanisms underlying these properties, we determined the effects of MATN3 protein on the expression of several key anabolic and catabolic genes involved in chondrocyte homeostasis, and the dependence of such regulation on the anti-inflammatory cytokine: IL-1 receptor antagonist (IL-1Ra).

Methods

The effects of recombinant human (rh) MATN3 protein were examined in C28/I2 immortalized human chondrocytes, primary human chondrocytes (PHCs), and primary mouse chondrocytes (PMCs). Messenger RNA levels of IL-1Ra, COL2A1, ACAN, MMP-13, and ADAMTS-4 and -5 were determined using real-time RT-PCR. Knocking down IL-1Ra was achieved by siRNA gene silencing. IL-1Ra protein levels were quantified by ELISA and the Bio-Plex Suspension Array System. COL2A1 protein level was quantified using Western blot analysis. Statistic analysis was done using the two-tailed t-test or one-way ANOVA.

Results

rhMATN3 protein induced gene expression of IL-1Ra in C28/I2 cells, PHCs, and PMCs in a dose- and time-dependent manner. Treatment of C28/I2 cells and PHCs with MATN3 protein stimulated gene expression of COL2A1 and ACAN. Conversely, mRNA levels of COL2A1 and ACAN were decreased in MATN3 KO mice. MATN3 protein treatment inhibited IL-1β-induced MMP-13, ADAMTS-4 and ADAMTS-5 in C28/I2 cells and PHCs. Knocking down IL-1Ra abolished the MATN3-mediated stimulation of COL2A1 and ACAN and inhibition of ADAMTS-5, but had no effect on MATN3 inhibition of MMP-13 mRNA.

Conclusion

Our findings point to a novel regulatory role of MATN3 in cartilage homeostasis due to its capacity to induce IL-1Ra, to upregulate gene expression of the major cartilage matrix components, and to downregulate the expression of OA-associated matrix-degrading proteinases in chondrocytes. The chondroprotective properties of endogenous MATN3 depend partly on its induction of IL-1Ra. Our findings raise a possibility to use rhMATN3 protein for anti-inflammatory and chondroprotective therapy.     

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。     

关节镜下有限清理术治疗膝关节骨性关节炎的体会

目的:探讨关节镜下有限清理术治疗膝关节骨性关节炎的疗效。方法:自2005年6月至2009年10月对62例81膝膝关节骨性关节炎患者进行关节镜下有限清理术,对其临床疗效进行分析。结果:本组病例均获随访,时间12~36个月。优28膝,良39膝,可10膝,差4膝,优良率82.7%。结论:关节镜下有限清理术治疗膝关节骨性关节炎可以有效改善病人的症状,明显改善生活质量。     

Role of cartilage collagen fibrils networks in knee joint biomechanics under compression

Collagen fibrils networks in knee cartilage and menisci change in content and structure from a region to another. While resisting tension, they influence global joint response as well as local strains particularly at short-term periods. To investigate the role of fibrils networks in knee joint mechanics and in particular cartilage response, a novel model of the knee joint is developed that incorporates the cartilage and meniscus fibrils networks as well as depth-dependent properties in cartilage. The joint response under up to 2000 N compression is investigated for conditions simulating the absence in cartilage of deep fibrils normal to subchondral bone or superficial fibrils parallel to surface as well as localized split of cartilage at subchondral junction or localized damage to superficial fibrils at loaded areas. Deep vertical fibrils network in cartilage play a crucial role in stiffening (by 10%) global response and protecting cartilage by reducing large strains (from maximum of 102% to 38%), in particular at subchondral junction. Superficial horizontal fibrils protect the tissue mainly from excessive strains at superficial layers (from 27% to 8%). Local cartilage split at base disrupts the normal function of vertical fibrils at the affected areas resulting in higher strains.Deep fibrils, and to a lesser extent superficial fibrils, play dominant mechanical roles in cartilage response under transient compression. Any treatment modality attempting to repair or regenerate cartilage defects involving partial or full thickness osteochondral grafts should account for the crucial role of collagen fibrils networks and the demanding mechanical environment of the tissue.     

Growth factor effects on costal chondrocytes for tissue engineering fibrocartilage

Tissue-engineered fibrocartilage could become a feasible option for replacing tissues such as the knee meniscus or temporomandibular joint disc. This study employed five growth factors (insulin-like growth factor-I, transforming growth factor-beta1, epidermal growth factor, platelet-derived growth factor-BB, and basic fibroblast growth factor) in a scaffoldless approach with costal chondrocytes, attempting to improve biochemical and mechanical properties of engineered constructs. Samples were quantitatively assessed for total collagen, glycosaminoglycans, collagen type I, collagen type II, cells, compressive properties, and tensile properties at two time points. Most treated constructs had lower biomechanical and biochemical properties than the controls with no growth factors, suggesting a detrimental effect, but the treatment with insulin-like growth factor-I tended to improve the constructs. Additionally, the 6-week time point was consistently better than that at 3 weeks, with total collagen, glycosaminoglycans, and aggregate modulus doubling during this time. Further optimization of the time in culture and exogenous stimuli will be important in making a more functional replacement tissue.