严重骨质疏松患者全膝关节置换术疗效分析

目的：探讨严重骨质疏松患者在进行人工全膝关节置换术时的特点和围手术期处理方法。方法：2005年至2007年期间,我科进行伴有严重骨质疏松症的人工全膝关节置换术患者共计36例41膝,其中单膝关节置换31例,双膝置换5例。所有病例入院前均采用双光能X线骨密度仪（DEXA）检测骨密度。所有病例均采用后稳定型膝关节假体。患者在术前给予钙尔奇D片及鲑鱼降钙素等抗骨质疏松治疗1月,术后继续给予抗骨质疏松治疗2~3月。结果：术后切口均一期愈合,无并发症。所有病例随访时间36~60个月,平均49个月。膝关节功能评分（HSS评分法）术前平均为37.2±6.4分,术后平均评分94.6±8.8分,随访期间未见假体早期松动影像学改变,骨密度复查较术前有明显改善。结论：对于伴有严重骨质疏松的病例,骨质已受到不同程度的破坏,进行假体选择的个体化,手术操作的精细化以及术后康复治疗具体化等对临床疗效至关重要。     

人工全膝关节置换术50例临床效果观察

目的:探讨人工全膝关节置换术临床效果。方法:选择我院2008年1月至2011年1月收治的行人工全膝关节置换术的患者50例53膝,对其临床资料进行回顾性分析。并作术前、术后HSS评分比较。结果:HSS术后评分,优47膝,占88.7%,良4膝,占7.5%,一般2膝,占3.7%。类风湿性关节炎4例HSS术前评分为35.24±1 1.78,术后评分为89.61±10.37;骨性关节炎44例HSS术前评分为44.37±10.29,术后评分为91.47±15.65;创伤性关节炎5例HSS术前评分为39.23±11.56,术后评分为90.61±13.2。术前、术后比较差异均有统计学意义(P<0.05)。术后整体优良率为96.2%。无严重并发症发生。结论:人工全膝关节置换术实施过程中,制订严密的手术计划,拥有高操作技术和理论基础,做好生命体征的密切观察及术后整体的康复功能训练,可取得较好疗效。     

Sex Difference in Contusion of the Medial Femoral Condyle Rim-Association with MRI Occult Meniscal Tears in the ACL Deficient Knee

BackgroundMeniscal tears, specifically lateral meniscal tears, have a larger than expected un-derdiagnosis rate in the presence of an ACL tear. The purpose of our study was to search for an MRI bone contusion pattern associated with MRI occult meniscal tears in patients with an ACL tear, specifically a contusion of the rim of the medial femoral condyle (RMFC). Our hypothesis was that there would be a significant association between RMFC contusions and MRI occult meniscal tears in patients with an ACL tear. We also searched for a difference between sexes with respect to the presence of the RMFC contusion in the setting of an occult meniscal tear. We also categorized the type, size, and location of these occult meniscal tears in the setting of an ACL tear.Methods This was a retrospective study that examined characteristics of occult meniscal tears and their association with a RMFC bone contusion. IRB approval was obtained. The date range of the study was June 2009 through December 2015. 6392 consecutive knee MRI reports in patients with an ACL deficient knee were reviewed. The study group included 22 patients with MRI occult meniscal tears, the control group included 110 patients. Relevant statistical values were calculated.ResultsThe most common type of occult meniscal tears were small radial and small longitudinal tears of the lateral meniscus. Occult meniscal tears were associated with an RMFC contusion in the study group (p=0.0457), particularly in males (p = 0.0003). In males with a torn ACL, the sensitivity of an RMFC contusion for an occult meniscal tear was 80%.ConclusionIn males with an ACL tear, there was a significant association between a contusion of the RMFC and an occult meniscal tear (commonly small radial or small peripheral partial-thickness longitudinal tears). RMFC contusions were reliably identified by radiologists in this study.Level of Evidence: II     

Knee function through finite element analysis and the role of Miocene hominoids in our understanding of the origin of antipronograde behaviours: the Pierolapithecus catalaunicus patella as a case study

Although extensive research has been carried out in recent years on the origin and evolution of human bipedalism, a full understanding of this question is far from settled. Miocene hominoids are key to a better understanding of the locomotor types observed in living apes and humans. Pierolapithecus catalaunicus, an extinct stem great ape from the middle Miocene (c. 12.0 Ma) of the Vallès-Penedès Basin (north-eastern Iberian Peninsula), is the first undoubted hominoid with an orthograde (erect) body plan. Its locomotor repertoire included above-branch quadrupedalism and other antipronograde behaviours. Elucidating the adaptive features present in the Pierolapithecus skeleton and its associated biomechanics helps us to better understand the origin of hominoid orthogrady. This work represents a new biomechanical perspective on Pierolapithecus locomotion, by studying its patella and comparing it with those drawn from a large sample of extant anthropoids. This is the first time that the biomechanical patellar performance in living non-human anthropoids and a stem hominid has been studied using finite element analysis (FEA). Differences in stress distribution are found depending on body plan and the presence/absence of a distal apex, probably due to dissimilar biomechanical performances. Pierolapithecus’ biomechanical response mainly resembles that of great apes, suggesting a similar knee joint use in mechanical terms. These results underpin previous studies on Pierolapithecus, favouring the idea that a relevant degree of some antipronograde behaviour may have made up part of its locomotor repertoire. Moreover, our results corroborate the presence of modern great ape-like knee biomechanical performances back in the Miocene.     

徒手淋巴引流对全膝关节置换术后肢体肿胀程度及血液炎性指标的影响

目的:探讨徒手淋巴引流对全膝关节置换术(TKA)后肢体肿胀程度及血液炎性指标的影响。方法:选取2018年12月～2019年12月广东省中医院珠海医院收治的拟行初次TKA手术的膝骨关节炎(KOA)患者70例,随机分为观察组和对照组各35例,对照组按TKA术后常规方案治疗,观察组在对照组基础上增加徒手淋巴引流术,比较两组术前,术后1 d、4 d、7 d、2周、4周、8周肤温、肿胀程度及血液炎性指标,评估患者术后康复情况及不良事件发生情况。结果:两组术后2周肤温低于术后7 d,术后4周低于术后2周,术后8周低于术后4周,差异均有统计学意义(P0.05)。观察组术后2周、4周、8周肤温均低于对照组,差异均有统计学意义(P0.05)。两组术后1 d肢体肿胀度低于术后4 d,术后2周低于术后7 d,术后4周低于术后2周,术后8周低于术后4周,差异均有统计学意义(P0.05)。观察组术后7d、2周、4周、8周肢体肿胀度均低于对照组,差异均有统计学意义(P0.05)。两组术后4 d白细胞计数(WBC)水平低于术后1 d,而超敏C反应蛋白(hs-CRP)水平高于术后1 d;两组术后7 d WBC、hs-CRP及血沉(ESR)水平均低于术后4 d,且术后2周低于术后7 d,术后4周低于术后2周,术后8周低于术后4周,差异均有统计学意义(P0.05)。观察组术后7 d hs-CRP水平均低于对照组,术后2周、4周、8周hs-CRP、ESR水平均低于对照组,差异均有统计学意义(P0.05)。结论:TKA术后应用徒手淋巴引流手法能有效减轻患者术后肢体肿胀程度,缩短炎症周期,降低炎症反应,在临床上值得推广应用。     

Assessment of the efficacy and safety of low frequency,low intensity magnetic fields in patients after knee endoprosthesis plasty. Part 1: In vitro safety

The purpose of this in vitro study was to assess the potential influence of low frequency, low intensity magnetic fields (rectangular pulse, 5 mT, 30 Hz) applied in therapy on the temperature, contact electric potential, and magnetization in knee endoprosthesis, which might be dangerous for implantation and stability of knee prosthesis, and later slacking it off, causing postoperative complications. The experimental investigation was carried out on a knee endoprosthesis which had been placed in a container with physiological saline. The prosthesis located inside the container was under the exposure of the magnetic field applied by a solenoid. The results indicated that magnetic fields did not influence thermal and electromagnetic properties of knee endoprosthesis in vitro. The magnetic fields of examined parameters should not be dangerous for implantation and stability of knee endoprosthesis. Bioelectromagnetics 30:159–162, 2009. © 2008 Wiley‐Liss, Inc.     

Computational analysis of knee joint stability following total knee arthroplasty

The overall objective of this study was to introduce knee joint power as a potential measure to investigate knee joint stability following total knee arthroplasty (TKA). Specific aims were to investigate whether weakened knee joint stabilizers cause abnormal kinematics and how it influences the knee joint kinetic (i.e., power) in response to perturbation.Patient-specific musculoskeletal models were simulated with experimental gait data from six TKA patients (baseline models). Muscle strength and ligament force parameter were reduced by up to 30% to simulate weak knee joint stabilizers (weak models). Two different muscle recruitment criteria were tested to examine whether altered muscle recruitment pattern can mask the influence of weakened stabilizers on the knee joint kinematics and kinetics. Level-walking knee joint kinematics and kinetics were calculated though force-dependent kinematic and inverse dynamic analyses. Bode analysis was then recruited to estimate the knee joint power in response to a simulated perturbation.Weak models resulted in larger anterior-posterior (A-P) displacement and internal-external (I-E) rotation compared to baseline (I-E: 18.4 ± 8.5 vs. 11.6 ± 5.7 (deg), A-P: 9.7 ± 5.6 vs. 5.5 ± 4.1 (mm)). Changes in muscle recruitment criterion however altered the results such that A-P and I-E were not notably different from baseline models. In response to the simulated perturbation, weak models versus baseline models generated a delayed power response with unbounded magnitudes. Perturbed power behavior of the knee remained unaltered regardless of the muscle recruitment criteria.In conclusion, impairment at the knee joint stabilizers may or may not lead to excessive joint motions but it notably affects the knee joint power in response to a perturbation. Whether perturbed knee joint power is associated with the patient-reported outcome requires further investigation.     

Genome-wide microRNA screening reveals miR-582-5p as a mesenchymal stem cell-specific microRNA in subchondral bone of the human knee joint

Emerging evidence suggests that microRNAs (miRNAs) may be pathologically involved in osteoarthritis (OA). Subchondral bone (SCB) sclerosis is accounted for the knee osteoarthritis (KOA) development and progression. In this study, we aimed to screen the miRNA biomarkers of KOA and investigated whether these miRNAs regulate the differentiation potential of mesenchymal stem cells (MSCs) and thus contributing to SCB. We identified 48 miRNAs in the blood samples in KOA patients (n = 5) through microarray expression profiling detection. After validation with larger sample number, we confirmed hsa-miR-582-5p and hsa-miR-424-5p were associated with the pathology of SCB sclerosis. Target genes prediction and pathway analysis were implemented with online databases, indicating these two candidate miRNAs were closely related to the pathways of pluripotency of stem cells and pathology of OA. Surprisingly, mmu-miR-582-5p (homology of hsa-miR-582-5p) was downregulated in osteogenic differentiation and upregulated in adipogenic differentiation of mesenchymal progenitor C3H10T1/2 cells, whereas mmu-mir-322-5p (homology of hsa-miR-424-5p) showed no change through the in vitro study. Supplementing mmu-miR-582-5p mimics blocked osteogenic and induced adipogenic differentiation of C3H10T1/2 cells, whereas silencing of the endogenous mmu-miR-582-5p enhanced osteogenic and repressed adipogenic differentiation. Further mechanism studies showed that mmu-miR-582-5p was directly targeted to Runx2. Mutation of putative mmu-miR-582-5p binding sites in Runx2 3′ untranslated region (3′UTR) could abolish the response of the 3′UTR-luciferase construct to mmu-miR-582-5p supplementation. Generally speaking, our data suggest that miR-582-5p is an important biomarker of KOA and is able to regulate osteogenic and adipogenic differentiation of MSCs via targeting Runx2. The study also suggests that miR-582-5p may play a crucial role in SCB sclerosis of human KOA.     

Pre‐Clinical Testing of Microwave Radiometer and a Pilot Study on the Screening Inflammation of Knee Joints

This article presents the pre‐clinical evaluation of our custom‐built, single‐band microwave radiometer centered at 1.3 GHz for deep tissue thermometry, and a pilot study on volunteers for passive detection of inflammation in knee joints. The electromagnetic (EM) compatibility of the battery‐operated radiometer for clinical use was assessed as per International Special Committee on Radio Interference (CISPR) 22 standard. The ability to detect inflammation in knee joints was assessed using a substrate integrated waveguide antenna connected to the radiometer. EM compatibility tests carried out in the laboratory indicated device immunity to intentional radiated interference up to ?20 dBm injected power in the global system for mobile communication frequency band, and pre‐compliance to CISPR 22 standard. Radiometer temperature measurements recorded at the lateral and medial aspects of both knees of 41 volunteers indicated mean temperature greater than 33°C for the diseased sites compared with the mean temperature of 28°C measured for the healthy sites. One‐way analysis of variance statistics indicated significantly (P < 0.005) higher radiometer temperature at the diseased sites unlike the healthy sites. Thus, the EM pre‐compliance of the device and the potential to measure deep tissue inflammation were demonstrated. Bioelectromagnetics. 2019;40:402–411. © 2019 Bioelectromagnetics Society.