膝骨关节炎全膝关节置换前骨质疏松的相关因素分析

BACKGROUND: The greatest risk of osteoporosis in total knee arthroplasty is perioperative and long-term periprosthetic fractures. However, limited by the traditional concept of osteoarthritis patients who usually not associated with osteoporosis, domestic clinical trials have not given enough attention to the osteoporosis before total knee arthroplasty.      

Muscle strength and exercise intensity adaptation to resistance training in older women with knee osteoarthritis and total knee arthroplasty

OBJECTIVES:

To analyze muscle strength and exercise intensity adaptation to resistance training in older women with knee osteoarthritis and total knee arthroplasty.

METHODS:

Twenty-three community-dwelling women were divided into the following groups: older, with knee osteoarthritis and total knee arthroplasty in the contralateral limb (OKG; N = 7); older, without symptomatic osteoarthritis (OG; N = 8); and young and healthy (YG; N = 8). Muscle strength (1-repetition maximum strength test) and exercise intensity progression (workload increases of 5%–10% were made whenever adaptation occurred) were compared before and after 13 weeks of a twice-weekly progressive resistance-training program.

RESULTS:

At baseline, OKG subjects displayed lower muscle strength than those in both the OG and YG. Among OKG subjects, baseline muscle strength was lower in the osteoarthritic leg than in the total arthroplasty leg. Muscle strength improved significantly during follow-up in all groups; however, greater increases were observed in the osteoarthritic leg than in the total knee arthroplasty leg in OKG subjects. Greater increases were also seen in the osteoarthritic leg of OKG than in OG and YG. The greater muscle strength increase in the osteoarthritic leg reduced the interleg difference in muscle strength in OKG subjects, and resulted in similar posttraining muscle strength between OKG and OG in two of the three exercises analyzed. Greater exercise intensity progression was also observed in OKG subjects than in both OG and YG subjects.

CONCLUSIONS:

OKG subjects displayed greater relative muscle strength increases (osteoarthritic leg) than subjects in the YG, and greater relative exercise intensity progression than subjects in both OG and YG. These results suggest that resistance training is an effective method to counteract the lower-extremity strength deficits reported in older women with knee osteoarthritis and total knee arthroplasty.     

Effects of resistance training in older women with knee osteoarthritis and total knee arthroplasty

OBJECTIVES:

This study sought to analyze the effects of resistance training on functional performance, lower-limb loading distribution and balance in older women with total knee arthroplasty (TKA) and osteoarthritis (OA) in the contralateral knee. In addition, this older knee OA and TKA group (OKG) was compared to older (OG) and young women (YG) without musculoskeletal diseases who underwent the same resistance training program.

METHODS:

Twenty-three women divided into OKG (N = 7), OG (N = 8) and YG (N = 8) had their functional performance, lower-limb loading distribution and balance compared before and after 13 weeks of a twice-weekly progressive resistance training program.

RESULTS:

At baseline, the OKG showed lower functional performance and unilateral balance, and impaired lower-limb loading distribution compared to the OG and the YG (p<0.05). After resistance training, the OKG showed improvements in functional performance (∼13% in sit-to-stand and rising from the floor, ∼16% in stair-climbing and ∼23% in 6-minute walking (6 MW)), unilateral balance (∼72% and ∼78% in TKA and OA leg, respectively) and lower-limb loading distribution, which were greater than those observed in the OG and the YG. The OKG showed post-training 6 MW performance similar to that of the OG at baseline. Sit-to-stand performance and unilateral stand balance were further restored to post-training levels of the OG and to baseline levels of the YG.

CONCLUSIONS:

Resistance training partially restored functional, balance and lower-limb loading deficits in older women with TKA and OA in the contralateral knee. These results suggest that resistance training may be an important tool to counteract mobility impairments commonly found in this population.     

膝骨关节炎患者全膝关节置换后影响关节功能恢复的因素

BACKGROUND: Functional recovery after joint arthroplasty is an important indicator to evaluate the effect and prognosis of total knee arthroplasty, and is affected by patients and many kinds of outside factors.     

Immunohistochemical analysis of the neural structures of the posterior cruciate ligament in osteoarthritis patients submitted to total knee arthroplasty: an analysis of thirty-four cases

OBJECTIVES:

Many authors recommend posterior cruciate ligament-retaining arthroplasty with the intention to maintain the proprioception properties of this ligament. Preservation of the neuroreceptors and nervous fibers may be essential for retaining the proprioception function of the posterior cruciate ligament. The present study was thus developed to evaluate the presence of neural structures in the posterior cruciate ligament resected during posterior stabilized arthroplasty in osteoarthritis patients. In particular, clinical, radiographic and histological parameters were correlated with the presence or absence of neural structures in the posterior cruciate ligament.

METHODS:

In total, 34 posterior cruciate ligament specimens were stained with hematoxylin-eosin and Gomori trichrome. An immunohistochemical analysis using antibodies against the S100 protein and neurofilaments was also performed. The presence of neural structures was correlated with parameters such as tibiofemoral angulation, histological degeneration of the posterior cruciate ligament, Ahlbäck radiological classification, age, gender and the histologic pattern of the synovial neurovascular bundle around the posterior cruciate ligament.

RESULTS:

In total, 67.5% of the cases presented neural structures in the posterior cruciate ligament. In 65% of the cases, the neurovascular bundle was degenerated. Nervous structures were more commonly detected in varus knees than in valgus knees (77% versus 50%). Additionally, severe histologic degeneration of the posterior cruciate ligament was related to neurovascular bundle degeneration.

CONCLUSIONS:

Severe posterior cruciate ligament degeneration was related to neurovascular bundle compromise. Neural structures were more commonly detected in varus knees. Intrinsic neural structures were detected in the majority of the posterior cruciate ligaments of patients submitted to knee arthroplasty for osteoarthritis.     

Walking ability following knee arthroplasty: a prospective pilot study of factors affecting the maximal walking distance in 18 patients before and 6 months after total knee arthroplasty

Functional assessment of patients before and after prosthetic knee arthroplasty is based on clinical examination, which is usually summarized in various knee scores. The present study proposes a different and more subject orientated assessment for functional grading of these patients by measuring their maximal distance of walking ability, which is not apparent from the conventional outcome scores.

Eighteen consecutive patients with knee osteoarthritis were evaluated for their knee and knee functional scores (The Knee Society clinical rating system) and for the maximal distance of their walking ability before and 6 months after knee arthroplasty. Specially designed walking ability grading was used for evaluation of walking on walkway. The pre- and post-operative knee scores and maximal walking distance and grading were statistically compared.

A significant improvement in the knee and functional scores following surgery was observed. But the maximal walking ability grades and distances did not change significantly following surgery, showing a high relation between pre- and post-operative values. The limitation in post-operative walking was due to the revealed additional health disabilities, not related to the affected knee.

Therefore we suggest that pre-operative evaluation of walking abilities should be taken into consideration both for patients' selection and timing of surgery and also for matching of patients' expectation from outcome of prosthetic knee arthroplasty.     

全膝关节置换后关节后方复合松解的可行性评价

背景：临床对于膝骨关节炎患者可以实施全膝关节置换治疗,为提高修复效果,促进功能恢复,要采取有效措施改善置换过程中的关节间隙以及置换后的关节活动度。 目的：探讨全膝关节置换后行关节后方复合松解的有效性及可行性。 方法：从两家三甲医院2009年12月至2013年12月收治的行单侧全膝关节置换的膝骨关节炎患者中选择118例进行研究,随机分为对照组和观察组,每组59例。在患者全膝关节置换过程中完成截骨之后,对照组行常规后髁增生骨清理,观察组行关节后方复合松解。观察两组患者置换后伸、屈膝间隙情况和主动屈膝90°和120°所需时间,记录3个月随访时的膝关节功能美国纽约特种外科医院评分以及最大屈膝角度,并进行比较。 结果与结论：经统计和比较,两组患者在屈膝间隙方面差异无显著性意义(P > 0.05);但在伸膝间隙、主动屈膝90°、120°所需时间以及最大屈膝角度方面,两组差异均有显著性意义,观察组优于对照组(P均< 0.05)。比较置换后3个月两组患者的膝关节功能美国纽约特种外科医院评分,可得观察组的各项指标得分以及总分均显著高于对照组,差异均有显著性意义(P均 < 0.05)。表明全膝关节置换后行关节后方复合松解具有一定的有效性和可行性,可以有效改善置换过程中伸膝间隙以及置换后膝关节活动度,但对置换过程中屈膝间隙方面无明显影响。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

人工单髁关节置换治疗膝内侧间室骨性关节炎临床疗效分析

目的 探讨人工单髁关节置换(UKA)在膝内侧间室骨性关节炎治疗中的适应证选择、临床疗效及假体生存率。方法 回顾性分析2007年4月至2017年4月应用UKA治疗膝内侧间室骨性关节炎共500例患者的随访结果。其中,男176例,女324例;年龄43～91岁,平均61.12岁。根据年龄分组:中龄组133例,老龄组295例,高龄组72例。根据Iwano髌股关节影像学分级分组:0-1级组104例,2级组179例,3级组182例,4级组35例。通过膝关节活动度(ROM)、KSS评分与OKS评分评估临床疗效,记录术后并发症的发生率。采用Kaplan-Meier生存分析对单髁关节假体生存率、不同年龄与髌股关节退变程度对假体生存率的影响进行评估。结果500例患者均获得随访,末次随访时间2018年11月,共随访1.59～11.60年,平均5.27年。膝关节ROM:术前111°,术后117°(=-2.334,0.05); KSS评分:术前59分,术后93分(=-2.586,0.05); OKS评分:术前24分,术后45分(=-2.056,0.05)500例患者中共有20例术后并发症发生,人工单髁关节10年假体生存率为96.0%。年龄分组:中龄组10年假体生存率为89.8%,老龄组为99.0%,高龄组为97.2%,三组整体比较,差异有统计学意义(=12.37,=0.02);对于术后KSS及OKS评分而言,不同年龄组在整体比较以及组间比较并无明显差异,但老龄组术后膝关节活动度ROM显著高于高龄组患者,差异有统计学意义(=0.042)。Iwano影像学分级分组:0-1级组假体生存率为98.9%,2级组为92.7%,3级组为97.8%,4级组为96%,差异无统计学意义(=4.162,=0.244); Iwano各期患者术后ROM及KSS评分均未发现显著不同,4级组对术后OKS评分有显著降低,差异有统计学意义(=10.627,=0.00)。结论 UKA治疗膝内侧间室骨关节炎能够取得良好的临床疗效,传统单髁置换手术适应证可能已不再适应现代单髁置换手术,可通过准确的适应证选择以及精确的手术操作,以保证UKA获得良好效果,降低并发症发生率。     

全膝关节置换术与单髁置换术治疗膝关节单间室骨关节炎的疗效比较

目的 比较全膝关节置换术(TKA)与膝关节单髁置换术(UKA)治疗膝关节单间室骨关节炎的临床疗效。方法 对2012年3月—2015年3月徐州医科大学附属医院骨科88例行TKA或UKA治疗单间室骨关节炎并获得随访患者的临床资料进行回顾性分析,依据不同手术方法分为TKA组48例(48膝)和UKA组40例(40膝)。采用美国特种外科医院(HSS)膝关节评分,评价疗效。比较两组患者手术时间、术中出血量、术后引流量,术后第1天、3天、1周血红蛋白水平和术后第3天血红蛋白较术前的下降量,以及末次随访时关节活动度和疗效。结果 两组患者手术顺利,88例患者获随访6~36个月,平均20.25个月。TKA组手术时间(85.77±7.61)min多于UKA组的(80.50±6.82)min,术中出血量(103.54±17.68)mL多于UKA组的(74.75±11.82)mL,术后引流量(420.21±68.80)mL多于UKA组的(241.75±53.05)mL,差异均有统计学意义(t=3.389、t'=8.787、t'=13.411,P值均＜0.01)。两组术前血红蛋白水平差异无统计学意义(P＞0.05);TKA组术后第1天、3天、1周血红蛋白均低于UKA组,术后第3天血红蛋白较术前的下降量高于UKA组,差异均有统计学意义(P值均＜0.05)。UKA组术后膝关节屈曲至90°所需时间为(7.33±3.02)d,短于TKA组的(12.63±3.10)d(t=8.086,P＜0.01);末次随访UKA组患者膝关节屈曲角度为116.98°±13.71°,大于TKA组的125.13°±15.95°(t=2.576,P＜0.01)。TKA组和UKA组HSS评分优、良、可、差者分别为25、19、3、1例和23、15、2、0例,其优良率分别为91.67%(44/48)和95.00%(38/40),差异无统计学意义(Z=0.603,P＞0.05)。两组患者中仅TKA组发生深静脉血栓1例,经介入治疗后痊愈;其余患者无手术并发症发生。结论 UKA与TKA治疗膝关节单间室骨关节炎均能获得满意的临床疗效,但UKA具有出血少、手术时间短、功能恢复快等优点。     

牛津双柱单髁置换术与全膝关节置换术治疗膝内侧骨关节炎的近中期疗效对比

目的:探讨牛津双柱单髁置换术(UKA)与全膝关节置换术(TKA)治疗膝内侧骨关节炎的近中期疗效。方法:回顾性队列研究。纳入2016年10月—2019年11月安徽医科大学第四附属医院50例膝关节内侧间室骨关节炎患者的临床资料。其中,采用牛津双柱UKA治疗的25例(25膝)为UKA组,男7例、女18例,年龄54～81岁;采...     

有限元分析全膝关节置换股骨假体置入定位参数及临床优化验证

文章快速阅读：  文题释义：全膝关节置换三维有限元仿真模型：是指对股骨假体截骨定位参数进行正交实验,选择股骨假体的平移量、外旋度数、外翻度数3个参数作为正交实验的相关因素,创建全膝关节置换膝关节的有限元模型。活动平台型膝关节假体：其聚乙烯衬垫与托盘不固定,之间能够自由滑动和旋转,可以减少聚乙烯磨损和假体松动的风险,现阶段临床应用比较多的是活动性膝关节假体,该假体能够扩大相应界面与聚乙烯衬垫的接触面积,减少接触应力。   背景：三维有限元仿真分析在生物力学中有着广泛应用,但在膝关节置换中的研究不多,对股骨假体的研究也比较少。目的：有限元分析膝关节置换股骨假体置入的优化定位参数,并对Gemini-PS膝关节假体全膝关节置换进行临床验证。方法：①构建全膝关节置换膝关节有限元模型,对股骨假体截骨定位参数进行正交实验,选择股骨假体的平移量A、外旋度数B、外翻度数C 3个参数作为正交实验的相关因素,每个参数取3个值建立正交表,创建9个实验组合的全膝关节置换膝关节的有限元模型,对9个模型进行有限元分析,通过优化处理进行方差和极差分析。②纳入42例(47膝)中老年膝骨关节炎患者,采用Gemini-PS 膝关节假体进行全膝关节置换,采用美国特种外科医院膝关节评分及美国膝关节协会评分评价置换前后膝关节功能,以疼痛目测类比评分评估置换前后膝关节疼痛程度。结果与结论：①聚乙烯衬底表面压应力峰值最小的为平移0 mm,外旋3°,外翻6°组合,压应力峰值为15.9 MPa;聚乙烯衬垫表面压应力的影响因素中,内外平移的影响大于外旋角度的影响大于外翻角度的影响;通过极差分析和方差分析发现股骨假体置入的最佳定位参数组合为平移0 mm,外旋3°,外翻6°;通过仿真计算证明正交实验是有效的;②42例患者均得到随访,随访时间12-36个月,1例发生术口下段皮下脂肪液化;置换后末次随访患膝美国特种外科医院膝关节评分及美国膝关节协会评分均较置换前显著提高(P < 0.05);置换后疼痛目测类比评分较置换前显著降低(P < 0.05)。X射线检查未发现骨溶解、假体脱位及松动等并发症,置换后膝关节功能恢复良好;③结果提示,股骨假体置入位置的微小变化都会引起聚乙烯衬垫表面压应力峰值的异常分布,全膝关节置换术中对股骨假体进行准确定位可以取得良好的置换效果。 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程 ORCID:0000-0002-3861-0467(徐高伟)     

Biomechanical analysis during single-leg squat in individuals with knee osteoarthritis

Backgroud: The single-leg squat (SLS) is a functional task to evaluate the abnormal movement patterns and potential neuromuscular deficits in the lower limbs. Still, it is unknown if SLS could provide information to older adults with knee osteoarthritis (KOA). The study’s objective was to analyze the EMG pattern, kinematics, and postural control in individuals with and without KOA during SLS.Methods: Participated in this study, 60 volunteers of both sexes, 30 had KOA (allocated into the KOA group - KOAG), and 30 were healthy (allocated into the Healthy Group - HG) performing the single-leg squat. Surface electromyography (EMG) was assessed for the gastrocnemius medialis (GM), biceps femoris (BF), gluteus medius (GLM), rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL), and tibialis anterior (TA) in two phases (downward – P1 and upward – P2). The kinematic data was evaluated using an electrogoniometer. The center of pressure (CoP) was obtained using data collected from a force plate.Results: EMG activity was increased for GM and TA muscles during the P1 of the movement and the GM and GLM muscles during P2 of the movement. The angular displacement of the KOAG was lower when compared with the HG. There was no statistical difference for the co-contraction and postural control data.Conclusions: The SLS analysis showed that EMG activity of the muscles TA, GM, and GLM was increased in the KOAG, but this pattern could be affected by fear of movement leading to reduced knee angular displacement.     

股内侧肌入路计算机辅助设计全膝关节置换与传统方案的对比

BACKGROUND: In the treatment of primary knee osteoarthritis, total knee arthroplasty is a common treatment, but there are some shortcomings in the traditional operation, which may lead to early failure of the prosthesis.     

膝骨性关节炎中医手法与功能锻炼后的生物力学分析

背景：应用现代步态分析技术诊断、评估膝骨性关节炎患者足底压力分布的报道较少,尚未建立骨性关节炎患者特征性的足底压力数据库。目的：评估中医手法结合功能锻炼对膝关节骨性关节炎的治疗效果。方法：选取符合条件的左侧膝关节骨性关节炎患者40例,随机分为2组。对照组20例采用常规治疗法,治疗组20例运用中医手法结合功能锻炼治疗。分别对治疗前及治疗后3个月的症状体征进行日本矫形外科学会评分及步态测试,比较各组治疗前后疗效的差异。结果与结论：在减轻步行时疼痛方面,治疗组和对照组均有显著疗效,两组疗效差异无显著性意义。治疗组在上下楼梯、关节屈曲活动度方面的效果治疗前后差异显著,对照组则不明显;其中治疗后关节的屈曲活动治疗组显著优于对照组。在消肿方面两组无明显差异。治疗组日本矫形外科学会评分总评分显著高于治疗前(P < 0.05),对照组在疗前疗后无统计学差异。在步态指标上,两组足底各区受力时间百分比、单足支撑期参数和足底压力峰值都有改善,但治疗前后差异不明显。而治疗组步角的改善在治疗后效果显著,与对照组相比也具有显著意义。治疗组指标虽然具有诸多方面的改善,但并没有达到正常值。中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Two-year fixation and ten-year clinical outcomes of total knee arthroplasty inserted with normal-curing bone cement and slow-curing bone cement: A randomized controlled trial in 54 patients

BackgroundThe normal-curing Refobacin® Bone Cement R (RR) and slow-curing Refobacin® Plus Bone Cement (RP) were introduced after discontinuation of the historically most used bone cement, Refobacin®-Palacos® R, in 2005. The aim of this study was to compare total knee arthroplasty component fixation with the two bone cements.Methods54 patients with primary knee osteoarthritis were randomized to either RR (N = 27) or RP (N = 27) bone cement and followed for two years with radiostereometric analysis of tibial and femoral component migration and dual-energy x-ray absorptiometry measured periprosthetic bone mineral density (BMD). Further, patients were followed up at ten years with clinical outcome scores (OKS and KOOS).ResultsAt two-years follow-up, tibial total translation was 0.31 mm (95% CI: 0.19 – 0.42) for the RP group and 0.56 mm (95% CI: 0.45 – 0.67) (p < 0.01) for the RR group. There was continuous tibial component migration from one to two years follow-up (MTPM > 0.2 mm) in 13/27 patients from the RR and in 12/26 patients from the RP group. There was no difference between groups in BMD baseline values or changes during follow-up, as well as no correlation between change in BMD and tibial component migration. At ten-years follow-up, the improvement in the clinical outcome scores was similar between groups. There were no prosthesis related complications during the 10-year follow-up.ConclusionAt two years, tibial total translation was lower in the RP compared with the RR cement group, but BMD changes were similar. At ten years, no components were revised and clinical outcome scores were similar between groups.     

人工全膝关节置换术结合加速康复外科理念治疗膝关节骨关节炎的临床效果

探讨人工全膝关节置换术(TKA)结合加速康复外科(ERAS)理念治疗膝关节骨关节炎(KOA)的疗效。 方法选取赤峰市医院骨关节科2018年1月至11月收治的KOA患者220例,按随机数字表法分为2组,加速康复组(n＝108),遵循围手术期应用ERAS理念,严格执行加速康复程序;对照组(n＝112),沿袭传统手术管理模式。制定相同的出院标准,比较2组患者术后早期疼痛数字评分法(NRS)评分,术后输血率,恶心、呕吐发生率,口渴、饥饿发生率,达到出院标准的时间,术后2周的满意度评分,术后3个月美国特种外科医院(HSS)膝关节评分,术后并发症发生率等。数据比较采用t检验和χ²检验。 结果术后12、24、48 h,加速康复组术后早期疼痛NRS评分分别为(2.13±1.21)、(2.42±1.11)、(2.83±1.18)分,低于对照组[(3.24±1.45)、(3.35±1.23)、(3.78±1.25)分],差异均有统计学意义(t＝3.9498、3.7689、3.7088,P＝0.0002、0.0003、0.0004);加速康复组术后输血率6.5%(7/108),低于对照组[27.7%(31/112)],差异有统计学意义(χ²＝17.2887,P<0.05);加速康复组术后恶心、呕吐发生率为14.8%(16/108),低于对照组[38.4%(43/112)],差异有统计学意义(χ²＝15.5741,P<0.05);加速康复组术后口渴、饥饿发生率为12.0%(13/108),低于对照组[41.1%(46/112)],差异有统计学意义(χ²＝23.6163,P<0.05);加速康复组达到出院标准的时间平均为(2.9±1.3) d,少于对照组[(5.7±1.6) d],差异有统计学意义(t＝9.1301,P<0.05);加速康复组术后2周的满意度评分为(9.8±1.2)分,高于对照组[(8.9±1.1)分],差异有统计学意义(t＝3.7042,P<0.05);加速康复组、对照组术后3个月HSS膝关节评分分别为(88.2±13.2)、(87.7±16.6)分,2组比较差异无统计学意义(t＝0.1585,P＝0.8744);加速康复组并发症发生率为2.7%(3/108),低于对照组[9.8%(10/112)],差异有统计学意义(t＝4.5779,P＝0.0324)。 结论采用人工TKA结合ERAS理念治疗KOA,可以减轻术后应激反应,加速患者康复进程,减少手术并发症,缩短住院时间,提高患者满意度,是一种安全、可靠的选择,值得临床推广应用。     

Factors affecting the incidence and management of fixed flexion deformity in total knee arthroplasty: A systematic review

Purpose

This study aimed to systematically review the literature and identify factors which would contribute to the intraoperative correction of FFD to frame a potential surgical algorithm or predictive model to guide intraoperative decision-making.

CR假体与PS假体全膝关节置换治疗膝骨性关节炎合并膝外翻畸形的疗效分析

目的 比较后交叉韧带保留型（CR）假体与后方稳定型（PS）假体行人工全膝关节置换术（TKA）治疗膝骨性关节炎合并膝外翻畸形的临床疗效。方法 回顾性分析南昌大学附属赣州医院关节外科2019年5月至2021年5月收治的60例（60膝）膝骨性关节炎合并膝外翻畸形患者资料,均为单侧置换。30例采用CR假体行TKA治疗（CR组）,30例采用PS假体行TKA治疗（PS组）。比较两组患者的手术时间、术中失血量、术后引流量、术后3 d血红蛋白（Hb）下降量及深静脉血栓发生情况;比较两组患者手术前后膝外翻角;比较两组患者术后1周、1个月、3个月、6个月、1年疼痛视觉模拟评分（VAS）、膝关节活动度（ROM）、美国特种外科医院膝关节评分（HSS）。结果 60例患者均顺利完成TKA手术,所有患者随访13 ～ 28个月,平均（18.51±0.90）个月。CR组术中出血量、术后引流量、术后3 d的Hb下降量较PS组减少（P＜0.05）;两组手术时间相当、术后均无深静脉血栓发生,差异无统计学意义（P＞0.05）;两组手术前后膝外翻角的比较差异无统计学意义（P＞0.05）;CR组术后1周、1个月VAS评分较PS组更低（P＜0.05）,两组术后3个月、6月、1年VAS评分比较差异无统计学意义（P＞0.05）;CR组术后1周、1个月、3个月膝关节ROM和HSS评分优于PS组（P＜0.05）,两组术后6个月、1年膝关节ROM和HSS评分比较差异无统计学意义（P＞0.05）。结论 采用CR或PS假体行TKA手术治疗膝骨性关节炎合并膝外翻畸形均可有效纠正膝关节畸形、减轻膝关节疼痛、改善膝关节活动度及功能,取得满意临床疗效;但相对PS假体,CR假体保留了后交叉韧带,减少了股骨髁部截骨量,从而减少手术出血,更好减轻早期术后疼痛,有助于TKA术后早期功能康复。     

膝骨关节炎时关节滑液中炎症相关物质的表达

背景：膝骨关节炎的主要改变是关节软骨面的退行性病变和继发性的骨质增生,病变的机制还不明确,但现已有实验证实膝骨关节炎的发病与炎症相关物质有密切的关系。 目的：分析炎症相关物质在膝骨关节炎发病机制中的作用。 方法：按美国风湿病学分会制定的诊断标准选择膝骨关节炎患者60例,来自因外伤截肢或半月板损伤性手术治疗的患者(排除膝关节内损伤)60例作为对照组,抽取两组患者膝关节液,采用酶联免疫吸附试验方法检测白细胞介素1β、白细胞介素6、白细胞介素8、白细胞介素10、肿瘤坏死因子α、碱性成纤维细胞生长因子、骨桥蛋白水平,采用一氧化氮检测试剂盒检测一氧化氮水平,按TBA荧光法测定过氧化脂质浓度。 结果与结论：膝骨关节炎患者表达高水平白细胞介素1β、白细胞介素6、白细胞介素8、白细胞介素10、肿瘤坏死因子α、碱性成纤维细胞生长因子、骨桥蛋白、一氧化氮和过氧化脂质水平均明显高于对照组;这些细胞因子及一氧化氮、过氧化脂质与膝骨关节炎的病变呈正相关。结果提示这些炎症相关物质确实参与了人膝骨关节炎的发病进程。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

Instrumented gait analysis in patients with medial osteoarthritis of the knee after mobile-bearing unicompartmental knee arthroplasty

Background

Unicompartmental knee arthroplasty (UKA) is an effective treatment for patients with medial osteoarthritis of the knee joint. Instrumented gait analysis provides an objective measure to quantify and qualify postoperative changes of gait. The purpose of this study was to evaluate standardized instrumented gait analysis for functional recovery and gait as an outcome of mobile-bearing UKA in patients with medial osteoarthritis of the knee.