双侧股神经阻滞用于双膝关节置换术患者的麻醉效果和对血清炎性因子水平的影响

目的:研究双侧股神经阻滞术用于双膝关节置换术患者麻醉效果和对患者血清炎性因子水平的影响。方法:选择2015年10月～2018年10月在我院进行双膝关节置换术的110例患者,按照其入院顺序经随机数字表法分为两组,每组55例。对照组采用全身麻醉,研究组采用双侧股神经阻滞联合全身麻醉。比较两组的麻醉情况,治疗前后血清炎性因子白介素6(IL-6)、C反应蛋白(CRP)、舒张压(DBP)、收缩压(SBP)、心率(HR)水平的变化。结果:两组麻醉时间比较差异无统计学意义(P0.05);研究组拔管、恢复室停留和苏醒时间均显著短于对照组(P0.05)。两组术后24 h、48 h血清炎性因子IL-6、CRP水平均高于术前,但研究组以上指标均显著低于对照组(P0.05);两组术中DBP、SBP、HR水平均较术前显著降低(P0.05),但研究组DBP、SBP、HR水平均显著高于对照组(P0.05),两组术后DBP、SBP、HR水平比较差异均无统计学意义(P0.05)。结论:与单纯采用全身麻醉相比,双侧股神经阻滞可有效改善双膝关节置换术患者的麻醉效果,并降低其血清炎症因子和稳定其血流动力学。     

新辅助化疗联合人工膝关节置换治疗膝关节附近骨肉瘤

目的:评价新辅助化疗联合人工膝关节置换治疗膝关节附近骨肉瘤的临床疗效。方法:38例膝关节附近骨肉瘤采用新辅助化疗和人工膝关节置换,所有病例均进行肿瘤细胞坏死率、5年内肿瘤局部复发率、5年生存率和膝关节功能评估。结果:38例患者新辅助化疗后肿瘤细胞坏死率平均95.8%;随访6-9年,38例患者中5年内肿瘤局部复发12例(31.6%),5年后生存31例(81.6%),膝关节功能优良率92.1%。结论:新辅助化疗联合人工膝关节置换治疗膝关节附近骨肉瘤可有效提高骨肉瘤5年生存率,保存患肢功能,是骨肉瘤保肢治疗的一种较好的方法。     

24例人工全膝关节置换术患者手术前后的护理

目的：观察2000年3月至2003年4月人工全膝关节置换术（TKR）患者围手术期进行系统康复训练的护理.方法：选择接受TKR的患者24例30个膝关节,入院后进行术前康复教育和肢体的康复训练（包括肌肉、关节训练及步态训练等）,术后护理包括有针对性的心理护理及系统规范的康复训练.结果：本组术后随访6-12周,效果满意,优良率达95.8%,未发生并发症.结论：TKP患者围手术期间进行系统康复训练,可以减少膝关节并发症,增强膝关节活动范围,满足日常生活所需的关节活动,提高生活质量.     

Neuromuscular activation of quadriceps bellies during tasks performed in the same biomechanical condition in patients undergoing total knee arthroplasty

ObjectiveTo investigate neuromuscular activation of quadriceps bellies during different tasks in patients before and after total knee arthroplasty (TKA).MethodsTwenty-six patients scheduled for TKA and 16 control subjects performed three isometric tasks: knee extension (KE), hip flexion (HF), hip flexion with contralateral hip extension (HFE). Surface electromyography signals of rectus femoris, vastus medialis and vastus lateralis were collected the day before (T0), at one (T1) and three (T2) days after surgery, whereas control subjects underwent a single evaluation. The Root Mean Square peak normalized for its highest value during the three tasks (nRMS-peak) was used as index of maximum neuromuscular activation for each belly. Sixteen patients performed the postoperative assessment, due to the placement of an elastomeric pump aimed at reducing pain in 10 patients.ResultsPatients showed lower rectus femoris nRMS-peak during KE compared to HF and HFE before and after surgery (p < 0.001), as occurred in control subjects. Differently from control subjects, patients showed higher vastus medialis and vastus lateralis nRMS-peak during HF compared to KE at T1 (p = 0.008) and T2 (p = 0.039).ConclusionTKA modified quadriceps neuromuscular activation during different tasks performed the same biomechanical condition. These findings may be considered in planning physiotherapy interventions after TKA.     

The choice of the femoral center of rotation affects material loss in total knee replacement wear testing – A parametric finite element study of ISO 14243-3

A leading cause of long-term failure of total knee replacements (TKRs) is osteolysis caused by polyethylene wear particles. The current gold standard for preclinical wear testing of TKRs is mechanical knee simulators. The definition of the femoral center of flexion-extension rotation (CoR) has been identified as one possible source of variability within TKR wear tests, since the femoral curvature varies from distal to posterior. The magnitude of the influence on wear due to changes in location of femoral CoR has not been investigated in depth. During this study, a computational framework utilizing finite element analysis for modelling wear of TKRs was developed and used to investigate the influence of the location of femoral CoR on TKR polyethylene wear during standardized displacement controlled testing (ISO 14243-3:2014). The study was carried out using a 40-point Latin Hypercube Design of Experiments approach. Volumetric wear was highly correlated to femoral CoR in both the superior/inferior and anterior/posterior directions, with a stronger relationship in the superior/inferior direction. In addition, wear scars showing linear penetration were examined, with large differences in simulations at the extreme ends of the sampling region. In this study, it was found that variations in the location of the femoral center of rotation can represent a large source of variability in the preclinical testing and evaluation of the wear performance of total knee replacements. This study represents the first attempt at quantifying the effect on wear of different femoral center of rotations across a large sampling space.     

Effect of stochastic resonance on proprioception and kinesthesia in anterior cruciate ligament reconstructed patients

Low amplitude mechanical noise vibration has been shown to improve somatosensory acuity in various clinical groups with comparable deficiencies through a phenomenon known as Stochastic Resonance (SR). This technology showed promising outcomes in improving somatosensory acuity in other clinical patients (e.g., Parkinson’s disease and osteoarthritis). Some degree of chronic somatosensory deficiency in the knee has been reported following anterior cruciate ligament (ACL) reconstruction surgery. In this study, the effect of the SR phenomenon on improving knee somatosensory acuity (proprioception and kinesthesia) in female ACL reconstructed (ACLR) participants (n = 19) was tested at three months post-surgery, and the results were compared to healthy controls (n = 28). Proprioception was quantified by the measure of joint position sense (JPS) and kinesthesia with the threshold to detection of passive movement (TDPM).The results based on the statistical analysis demonstrated an overall difference between the somatosensory acuity in the ACLR limb compared to healthy controls (p = 0.007). A larger TDPM was observed in the ACLR limb compared to the healthy controls (p = 0.002). However, the JPS between the ACLR and healthy limbs were not statistically significantly different (p = 0.365). SR significantly improved JPS (p = 0.006) while the effect was more pronounced in the ACLR cohort. The effect on the TDPM did not reach statistical significance (p = 0.681) in either group.In conclusion, deficient kinesthesia in the ACLR limb was observed at three months post-surgery. Also, the positive effects of SR on somatosensory acuity in the ACL reconstructed group warrant further investigation into the use of this phenomenon to improve proprioception in ACLR and healthy groups.     

A Pilot Clinical Study of Hyperacute Serum Treatment in Osteoarthritic Knee Joint: Cytokine Changes and Clinical Effects

The serum fraction of platelet-rich fibrin (hyperacute serum) has been shown to improve cartilage cell proliferation in in vitro osteoarthritic knee joint models. We hypothesize that hyperacute serum may be a potential regenerative therapeutic for osteoarthritic knees. In this study, the cytokine milieu at the synovial fluid of osteoarthritic knee joints exposed to hyperacute serum intraarticular injections was investigated. Patients with knee osteoarthritis received three injections of autologous hyperacute serum; synovial fluid was harvested before each injection and clinical monitoring was followed-up for 6 months. Forty osteoarthritic-related cytokines, growth factors and structural proteins from synovial fluid were quantified and analysed by Multivariate Factor Analysis. Hyperacute serum provided symptomatic relief regarding pain and joint stability for OA patients. Both patients “with” and “without effusion knees” had improved VAS, KOOS and Lysholm-Tegner scores 6 months after of hyperacute serum treatment. Synovial fluid analysis revealed two main clusters of proteins reacting together as a group, showing strong and significant correlations with their fluctuation patterns after hyperacute serum treatment. In conclusion, hyperacute serum has a positive effect in alleviating symptoms of osteoarthritic knees. Moreover, identified protein clusters may allow the prediction of protein expression, reducing the number of investigated proteins in future studies.     

Estrogen receptor-alpha gene haplotype is associated with primary knee osteoarthritis in Korean population

Estrogen and estrogen receptors (ERs) are known to play important roles in the pathophysiology of osteoarthritis (OA). To investigate ER-alpha gene polymorphisms for its associations with primary knee OA, we conducted a case-control association study in patients with primary knee OA (n = 151) and healthy individuals (n = 397) in the Korean population. Haplotyping analysis was used to determine the relationship between three polymorphisms in the ER-alpha gene (intron 1 T/C, intron 1 A/G and exon 8 G/A) and primary knee OA. Genotypes of the ER-alpha gene polymorphism were determined by PCR followed by restriction enzyme digestion (PvuII for intron 1 T/C, XbaI for intron 1 A/G, and BtgI for exon 8 G/A polymorphism). There was no significant difference between primary knee OA patients and healthy control individuals in the distribution of any of the genotypes evaluated. However, we found that the allele frequency for the exon 8 G/A BtgI polymorphism (codon 594) was significantly different between primary knee OA patients and control individuals (odds ratio = 1.38, 95% confidence interval = 1.01-1.88; P = 0.044). In haplotype frequency estimation analysis, there was a significant difference between primary knee OA patients and control individuals (degrees of freedom = 7, chi2 = 21.48; P = 0.003). Although the number OA patients studied is small, the present study shows that ER-alpha gene haplotype may be associated with primary knee OA, and genetic variations in the ER-alpha gene may be involved in OA.     

miR‐370 and miR‐373 regulate the pathogenesis of osteoarthritis by modulating one‐carbon metabolism via SHMT‐2 and MECP‐2, respectively

The aim of this study was to determine the mechanism underlying the association between one‐carbon metabolism and DNA methylation during chronic degenerative joint disorder, osteoarthritis (OA). Articular chondrocytes were isolated from human OA cartilage and normal cartilage biopsied, and the degree of cartilage degradation was determined by safranin O staining. We found that the expression levels of SHMT‐2 and MECP‐2 were increased in OA chondrocytes, and 3′UTR reporter assays showed that SHMT‐2 and MECP‐2 are the direct targets of miR‐370 and miR‐373, respectively, in human articular chondrocytes. Our experiments showed that miR‐370 and miR‐373 levels were significantly lower in OA chondrocytes compared to normal chondrocytes. Overexpression of miR‐370 or miR‐373, or knockdown of SHMT‐2 or MECP‐2 reduced both MMP‐13 expression and apoptotic cell death in cultured OA chondrocytes. In vivo, we found that introduction of miR‐370 or miR‐373 into the cartilage of mice that had undergone destabilization of the medial meniscus (DMM) surgery significantly reduced the cartilage destruction in this model, whereas introduction of SHMT‐2 or MECP‐2 increased the severity of cartilage destruction. Together, these results show that miR‐370 and miR‐373 contribute to the pathogenesis of OA and act as negative regulators of SHMT‐2 and MECP‐2, respectively.     

活动半月板单髁关节置换术治疗膝骨性关节炎早期疗效分析

目的：分析活动半月板单髁关节置换术治疗膝关节骨关节炎的早期临床效果。方法：2009年6月至2010年2月,采用OXFord活动半月板单髁关节治疗膝骨性关节炎患者23例25膝。结果：23例患者（25膝）随访3-8个月,无感染、假体位置不良及松动等并发症。HSS评分由术前56.9分提高至术后93.3分。结论：活动半月板单髁关节置换术治疗膝骨性关节炎短期疗效优良,成功的关键在于适应证的把握和手术技术的掌握,其远期疗效仍需观察。