ObjectiveTo compare the early clinical outcomes of posterior cruciate ligament-retaining (CR) and posterior stabilized (PS) knee prostheses in total knee arthroplasty for patients with rheumatoid arthritis.MethodsA retrospective analysis was conducted on 74 patients with rheumatoid arthritis (RA) who underwent unilateral total knee arthroplasty (TKA) from January 2021 to December 2022. Among these, 39 patients received CR prostheses (CR group), while 35 received PS prostheses (PS group). Data on operation time, intraoperative blood loss, hospital stay, preoperative and postoperative Visual Analogue Scale (VAS) scores, American Knee Society Score (AKSS), Functional Joint Score-12 (FJS-12) scores, Health Assessment Questionnaire scores (HAQ) and postoperative complications were recorded and compared between the two groups.ResultsAll 74 patients successfully completed the surgery without complications. The average operation time for the CR group was shorter than that of the PS group, with no statistically significant differences in intraoperative blood loss or hospital stay. Both groups showed improved postoperative AKSS scores, VAS scores, and HAQ Scores compared to preoperative levels. Between-group comparisons showed no statistical differences in postoperative AKSS, VAS, HAQ scores. However, the CR group had significantly higher FJS-12 scores at 6 and 12 months postoperatively compared to the PS group.ConclusionBoth CR and PS prostheses can achieve good clinical outcomes in TKA for RA patients. Compared to PS prostheses, CR prostheses may provide better knee proprioception postoperatively, as indicated by higher FJS-12 scores at 6 and 12 months postoperatively.

Triptolide (TP) has various pharmacological activities, but its hepatotoxicity limits its therapeutic potential. Licorice has been evaluated to harmonize various medicines, and its active ingredient glycyrrhizic acid (GA) has been identified for its detoxification effect. In this study, we demonstrated that the combination of GA and TP (G&T) could mitigate TP-induced hepatotoxicity. To explore TP toxicity and G&T detoxification mechanisms, transcriptomics and proteomics have been utilized. TP was found to promote the expression of PKCα and FIS1, accompanied by an increase in mitochondrial fission. After pretreatment with GA, improvements were observed in TP-induced mitochondrial fission, as well as the expression of active-caspase3, and cytochrome c release. Silencing PKCα and FIS1 has a similar effect to GA on the regulation of mitochondria-dependent apoptosis and mitochondrial fission. In conclusion, PKCα and FIS1-involved mitochondrial dynamic regulation is associated with TP-induced hepatotoxicity. The G&T combination may be an effective strategy for ameliorating TP-induced toxicity.

In recent years, difficult-to-treat rheumatoid arthritis (D2T RA) has attracted significant attention from rheumatologists due to its poor treatment response and the persistent symptoms or signs experienced by patients. The therapeutic demands of patients with D2T RA are not properly met due to unclear pathogenic causes and a lack of high-quality data for current treatment options, creating considerable management difficulties with this patient population. This review describes the clinical challenges associated with disease-modifying antirheumatic drugs (DMARDs) and explores contributing factors associated with inappropriate response to DMARDs that may lead to D2T RA and related immunological dysregulation. It is now understood that D2T RA is a highly heterogeneous pathological status that involves multiple factors. These factors include but are not limited to genetics, environment, immunogenicity, comorbidities, adverse drug reactions, inappropriate drug application, poor adherence, and socioeconomic status. Besides, these factors may manifest in the selection and utilization of specific DMARDs, either individually or in combination, thereby contributing to inadequate treatment response. Finding these variables may offer hints for enhancing DMARD therapy plans and bettering the condition of D2T RA patients.

Objective To compare the early knee joint functional scores and forgotten joint score between unicompartmental knee arthroplasty(UKA)and total knee arthroplasty(TKA)for the treatment of early-stage medial compartment osteoarthritis of the knee,and to evaluate and analyze the differences in early forgotten joint score between the two procedures.Methods A retrospective analysis was conducted on 296 patients who underwent TKA or UKA in the department of joint surgery of Shanghai Guanghua Hospital of Integrative Traditional Chinese and Western Medicine from October 2016 to October 2020.The patients were divided into two groups based on the different surgical procedures:TKA group(144 cases)and UKA group(152 cases).Outpatient follow-up examinations were performed at 1,3,6,12 and 24 months after discharge,and the forgotten joint score,knee joint function scores(HSS scores),and visual analog scale(VAS)scores were evaluated.Results ① All 296 patients were followed up for 24-37 months,with an average follow-up period of(30.41±6.93)months.② The HSS scores and VAS scores of both TKA and UKA groups significantly improved at 2 years postoperatively compared to preoperative scores,and the differences within each group were statistically significant(P<0.05).③ There was no statistically significant difference in the degree of improvement in knee joint VAS scores at 2 years postoperatively between the two groups(P>0.05),but the improvement in HSS scores in the UKA group was better than that in the TKA group,and the difference was statistically significant(P<0.05).④ The forgotten joint score at 1,3,6,12 and 24 months postoperatively were all higher in the UKA group compared to the TKA group,and the differences were statistically significant(P<0.05).Conclusion ① Both procedures can effectively improve the function and pain scores of late-stage knee osteoarthritis.② UKA,as an effective treatment for medial compartment destruction of the knee,not only improves the knee joint function score but also significantly enhances the patients'perception of their knee joint,making it a preferable option for treating late-stage knee osteoarthritis.

目的 比较后交叉韧带保留型和后稳定型全膝关节假体治疗晚期膝骨关节炎的早期膝关节功能评分与关节遗忘度评分,评价并分析两类假体在早期关节遗忘度评分方面的差异.方法 采用回顾性队列研究上海中医药大学附属光华医院关节外科2016年10月至2020年10月期间行全膝人工关节置换术患者共172例.按不同假体类型进行分组,其中CR组共84例、PS组共88例,出院后对患者术后1、3、6、12、24个月进行门诊复查,进行关节遗忘评分、膝关节功能HSS评分、目测类比评分与膝关节活动度评价.结果 ①172例患者均随访24～40个月,平均(32.03±5.01)个月,期间均未出现假体周围感染、松动、脱位及僵硬等并发症;②HSS评分:术后2年CR组与PS组HSS评分均明显好于术前,差异具有统计学意义(P＜0.001),两组患者术后2年膝关节HSS评分改善程度差异无统计学意义(P＞0.05).③VAS评分:术后2年CR组与PS组VAS评分均明显好于术前,且差异具有统计学意义(P＜0.001),两组患者术后2年VAS评分的改善程度差异无统计学意义(P＞0.05).④FJS-12评分:术后3个月的关节遗忘度评分两组间比较差异无统计学意义,但术后6、12、24个月的CR组关节遗忘度评分均高于PS组,差异有统计学意义(P＜0.001).结论 ①两类假体均可有效改善晚期膝骨关节炎的功能、疼痛评分;②CR假体除了可保持与PS假体相同的改善膝关节功能、疼痛评分外,尚可有效提高患者术后遗忘人工假体存在等主观感受,提升患者的"本体感觉".

目的:观察加味桃红四物汤联合那曲肝素钙预防膝关节置换术后深静脉血栓的临床疗效.方法:将2019年1月至2020年6月收治的96例行单侧全膝关节置换手术的膝骨关节炎患者,随机分为中西联合组、方药组和西药组,每组32例.方药组术后第1天开始口服加味桃红四物汤,西药组术后第1天开始注射那曲肝素钙,中西联合组术后口服加味桃红四物汤联合注射那曲肝素钙.3组均观察治疗2周,比较3组术后深静脉血栓(DVT)形成情况,术后D-二聚体、血红蛋白、视觉模拟疼痛评分(VAS)、运动范围(ROM)、膝关节功能评分(HSS)、血瘀证候积分等.结果:术后2周中西联合组D-二聚体值低于西药组和方药组(P＜0.05),术后1周中西联合组血瘀症状明显轻于西药组和方药组(P＜0.05),术后1周中西联合组、方药组贫血改善优于西药组(P＜0.05),术后2周中西联合组VAS疼痛评分明显轻于西药组和方药组(P＜0.05).3组术后ROM活动度较术前明显改善,3组术后HSS功能评分明显优于术前(P＜0.05).结论:加味桃红四物汤与那曲肝素钙联合治疗能改善膝关节置换术后临床症状,预防DVT效果好,利于术后康复.

Abstract Background Rheumatoid arthritis (RA) is a chronic and refractory autoimmune disease. Deficiency pattern (DP) and excess pattern (EP), as crucial types of Chinese medicine pattern diagnoses published by International Classification of Diseases 11th Revision (ICD-11), could provide new strategies for RA diagnosis. However, the biological basis of DP and EP of RA is not explicit. Methods 19 female RA DP patients, 41 female RA EP patients and 30 female healthy participants were included in the study. The serums of participants were collected and analyzed by metabolomics based on ultra-performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry to profile metabolic characteristics of RA DP and EP. Furthermore, bioinformatics analysis results were obtained by using Ingenuity Pathway Analysis (IPA) and statistical analysis was performed by SAS version 9.4 for further identification of potential biomarkers. Results Serum metabolic profiling revealed 25 and 24 differential metabolites in RA DP and EP respectively, and 19 metabolites were common to RA DP and EP. Compared with DP group, L-Homocysteic acid, LysoPE(P-16:0/0:0), N(omega)-Hydroxyarginine and LysoPC(16:0/0:0) decreased (P < 0.05), and Pyruvic acid, D-Ribose, Gamma-Glutamylserine, PE(22:0/24:1(15Z)), Inosinic acid increased (P < 0.05) in EP group. Menawhile, S-Nitrosoglutathione, 5-Thymidylic acid, SN38 glucuronide, PE(22:0/24:0), PC(24:0/24:1(15Z)) and Bisdiphosphoinositol tetrakisphosphate increased significantly in DP group compared to EP group (P < 0.05). For the unique metabolites, bioinformatics analysis results showed that 5-Methoxytryptamine involved in Melatonin Degradation II and Superpathway of Melatonin Degradation is the key metabolite to RA DP. Meanwhile, GABA is the key metabolite in EP group, which involved in Glutamate Dependent Acid Resistance, GABA Receptor Signaling, Glutamate Degradation III (via 4-aminobutyrate) and 4-aminobutyrate Degradation I. Bioinformatics analysis between unique metabolites of RA DP and EP groups with human target genes for RA showed that 5-methoxytryptamine and LysoPC(18:1(9Z)/0:0), the unique metabolites of RA DP, might participate in colorectal cancer metastasis signaling, tumor microenvironment pathway, apoptosis signaling, MYC mediated apoptosis signaling, erythropoietin signaling pathway and LXR/RXR activation. Simultaneously, GABA, LysoPA(18:1(9Z)/0:0) and L-Targinine, the unique metabolites of RA EP, might participate in neuroinflammation signaling pathway, osteoarthritis pathway, glucocorticoid receptor signaling, ILK signaling, IL-17 signaling and HIF1α signaling. Conclusions The study indicates that serum metabolomics preliminarily revealed the biological basis of RA DP and EP. 5-methoxytryptamine, LysoPC(18:1(9Z)/0:0) and GABA, LysoPA(18:1(9Z)/0:0), L-Targinine might be the predictors to distinguish the DP and EP of RA respectively. These interesting results provide thoughts for further study of traditional medicine patterns of ICD-11. It also contributes to provide strategy for personalized precision treatment of RA and further validation is needed.

Objective This study aimed to systematically review the efficacy and clinical safety of different courses and doses of tripterygium glycoside (TG) adjuvant methotrexate (MTX) therapy in the treatment of rheumatoid arthritis (RA). Methods Randomized controlled trials (RCTs) of TG adjuvant MTX therapy in patients with RA were retrieved from SinoMed, China Network Knowledge Infrastructure, WanFang Data, PubMed, Cochrane Library, and Embase from inception to September 30, 2021. The effects and clinical safety evaluations were conducted using RevMan 5.3 software. Results A total of 9 RCTs and 892 patients with RA were included in this study. In the meta-analysis, a total of 463 and 429 patients were enrolled into the TG adjuvant MTX therapy group and MTX monotherapy group, respectively. In comparison with MTX monotherapy, the results of the analyzed effects showed that the TG adjuvant MTX therapy can achieve 20%, 50%, and 70% improvements in American College of Rheumatology (ACR) criteria ACR20, ACR50, and ACR70 at P = 0.005, P = 0.0001, and P = 0.004, respectively. Simultaneously, the efficacy of the TG adjuvant MTX therapy was improved at either 30 or 60 mg/day over a six-month course compared to MTX monotherapy (P < 0.0001). There was no statistical difference in the effects between the doses of 30 and 60 mg/day after three months (P = 0.82). TG adjuvant MTX also reduced the expression rate of the swollen joint count, tender joint count, erythrocyte sedimentation rate, rheumatoid factor, and C-reactive protein in subgroup analyses with different courses and doses. In terms of hepatic adverse effects (P = 0.28), leukopenia (P = 0.78), gastrointestinal adverse effects (P = 0.17), cutaneous adverse effects (P = 0.94), and irregular menstruation adverse effects (P = 0.29), there was no statistically significant difference with TG adjuvant MTX therapy and MTX monotherapy with different courses and doses. Conclusions TG adjuvant MTX therapy is more effective than MTX monotherapy and is a safe strategy for RA treatment in doses of 30 or 60 mg/day over a treatment course of six months. However, high-quality multicenter RCT studies with large sample sizes are still needed to confirm the effects and clinical safety of different courses and doses of TG adjuvant MTX therapy.

AbstractIntroductionOsteoporosis is related to lncRNA‐neighboring enhancer of FOXA2 (NEF) and inversely correlated to ankylosing spondylitis (AS), implying that lncRNA‐NEF might also relate to AS. Thus, the study was carried out to investigate the involvement of lncRNA‐NEF in AS.MethodsThe study included 60 AS patients and 60 healthy controls. LncRNA‐NEF expression in synovial fluid samples was analyzed by reverse transcription quantitative real‐time polymerase chain reaction. Disease activity of the 60 AS patients was determined using the Ankylosing Spondylitis Disease Activity Score (ASDAS) 1–4 and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Western blot was carried out to investigate the effects of lncRNA‐NEF on inflammatory factors in human fibroblast‐like synovial (HFLS) cells. A 3‐year follow‐up was performed to analyze the role of lncRNA‐NEF in the prediction of the recurrence of AS.ResultsOur study observed that lncRNA‐NEF expression was upregulated in synovial fluid of AS patients and significantly correlated with the ASDAS 1–4, BASDAI, erythrocyte sedimentation rate (ESR), and C‐reactive protein level (p < .05). Treatment with nonsteroidal anti‐inflammatory drugs significantly downregulated lncRNA‐NEF expression (p < .01). A 3‐year follow‐up showed that patients with high lncRNA‐NEF levels had a high recurrence rate (hazard ratio = 2.266). In addition, lncRNA‐NEF was found to regulate the expression of inflammatory factors in HFLS cells.ConclusionsTherefore, lncRNA‐NEF upregulation can predict recurrence and poor treatment outcomes of AS and has a great potential to serve as a predictive biomarker factor for the recurrent AS.

目的 研究四物加味汤联合屈膝法对膝关节置换术后失血性贫血的疗效.方法 将2018年1月—2019年8月上海中医药大学附属光华医院收治的93例初次行全膝关节置换手术的膝骨关节炎患者随机分为联合组、中药组和屈膝组,每组31例.中药组术后第1天开始口服四物加味汤,连服14 d;屈膝组术后患肢屈膝法放置;联合组术后口服四物加味汤14 d联合患肢屈膝法放置.检测3组术后第1天、第8天、第14天血红蛋白水平和红细胞计数,比较3组术后第8天中医血虚症状积分及凝血酶原时间、部分凝血活酶时间、D-二聚体水平,比较3组术中出血量、术后输血情况、术后3个月美国特种外科医院膝关节(HSS)评分.结果 术后第1天、术后第14天,3组血红蛋白水平和红细胞计数比较差异均无统计学意义(P均>0.05);术后第8天,联合组血红蛋白水平和红细胞计数均明显高于中药组和屈膝组(P均<0.05),中药组和屈膝组比较差异均无统计学意义(P均>0.05).术后第8天,联合组血虚症状积分明显低于中药组和屈膝组(P均<0.05),且中药组明显低于屈膝组(P<0.05);3组凝血酶原时间、部分凝血活酶时间、D-二聚体水平比较差异均无统计学意义(P均>0.05).3组术中出血量、术后输血人数比较差异均无统计学意义(P均>0.05).3组术后3个月HSS评分均明显高于术前(P均<0.05),但3组间比较差异均无统计学意义(P均>0.05).结论 四物加味汤联合屈膝法能明显改善膝关节置换术后贫血,有利于术后早期康复.

目的 探讨加味八珍汤治疗类风湿关节炎膝关节置换术后贫血的疗效.方法 选取2018年3月～2019年9月我院收治的64例膝关节置换术后贫血的类风湿性关节炎患者作为研究对象,按随机数字表法分为研究组和对照组,每组32例.两组均行单侧全膝关节置换术,对照组给予琥珀酸亚铁片治疗,研究组在对照组基础上给予加味八珍汤治疗,比较两组术前、术后第1天、第10天、第6周的血红蛋白、红细胞计数水平及髌骨中点下10 cm肿胀程度.结果 两组术后第1天、术后第6周血红蛋白、红细胞计数、髌骨中点下10 cm肿胀程度比较,差异无统计学意义(P>0.05);研究组术后第10天血红蛋白、红细胞计数水平及髌骨中点下10 cm肿胀改善程度优于对照组,差异有统计学意义(P<0.05).结论 加味八珍汤有助于改善类风湿关节炎膝关节置换术后贫血、缓解肢体肿胀,促进患者术后早期康复.

类风湿关节炎(RA)是一种慢性、以关节滑膜为主要靶组织的炎症性自身免疫疾病,其滑膜炎症和滑膜组织的异常生长,对软骨、骨等组织造成破坏,出现关节痛和肿胀反复发作,并逐渐导致关节畸形.RA的病因病机尚未明确,但在生理病理方面,滑膜细胞是关节滑膜组织的主要细胞,且滑膜细胞在RA中显示出异常的行为,其在疾病发展和病理过程中扮演重要角色.而细胞因子通过介导细胞之间的通讯来参与免疫反应,缺氧诱导因子可响应细胞环境中氧变化,微RNA调节细胞代谢和发育、调控细胞增殖与凋亡,这三者均对滑膜细胞的增殖和炎症有影响,今后将成为治疗RA的研究热点.

目的 探讨中药熏蒸联合推拿手法治疗膝关节类风湿关节炎(RA)的临床疗效.方法 选取2017年3月至2018年3月上海市光华中西医结合医院收治的84例膝关节RA患者为研究对象,依据随机数字法分为观察组和对照组,各42例.对照组患者入院后予以基础治疗联合温水熏蒸治疗;观察组患者予以基础治疗联合中药熏蒸及推拿手法治疗,两组患者均治疗20 d.观察两组患者的临床疗效,比较治疗前后红细胞沉降率、C反应蛋白、视觉模拟评分、Lysholm膝关节功能评分,以及磁共振成像(MRI)及B超下滑膜厚度.结果 观察组治疗总有效率明显高于对照组[90.5％(38/42)比71.4％(30/42)](P<0.05).治疗后3周、3个月、6个月,两组患者的红细胞沉降率、C反应蛋白、视觉模拟评分呈下降趋势,观察组低于对照组(P<0.05);两组Lysholm膝关节功能评分呈升高趋势,观察组高于对照组(P<0.05).通过MRI及B超检查,治疗后3周、3个月、6个月观察组患者髌上囊滑膜厚度均小于对照组(P<0.01).两组患者治疗期间均未见明显不良反应发生.结论 中药熏蒸联合推拿手法治疗膝关节RA具有较好的临床疗效,能最大限度地减轻患者膝关节疼痛肿胀,促进关节功能恢复,安全性高.

Objective To study the short-term and medium-term effects of mini- strip anchor and capsulotomy in the treatment of first metacarpophalangeal joint dislocation in rheumatoid arthritis (RA). Methods From January 2015 to December 2016,fifty-eight RA patients with first metacarpophalangeal joint dislocation were randomly divided into study group (20 cases),joint replacement group (19 cases) and non-operation group (19 cases). Postoperative evaluation indexes: the wound healing was observed in accordance with ＂trial standard of functional evaluation of upper limbs of Chinese Medical Association Hand Surgery Society＂. The surgical outcomes of the three groups were compared. The hand function and quality of life were assessed by Michiga Hand Outcomes Questionnaire ( MHQ ) and arthritis impact measurement scale 2 (AIMS2) before treatment, 6 months after treatment and 12 months after treatment. Results All the patients in the study group and the joint replacement group healed by first intention without any early complications. According to the criteria of upper extremity functional evaluation of Chinese Medical Association,the curative effect of the operation was evaluated. In the study group,15 cases were excellent,3 cases were good,2 cases were poor,the excellent and good rate was 90. 0%. In the joint replacement group, 15 cases were excellent,3 cases were good,1 case was poor,and the excellent and good rate was 94. 7%. After treatment for 6months, the MHQ scores were improved significantly in the three groups (( 48. 36 ±8. 24) vs. (73. 06±10. 55); (47. 56±7. 75) vs. (81. 42±8. 54); (48. 75±8. 85) vs. (65. 91±8. 26)) (F＝33. 19,35. 12,28. 42, P＜0. 05). The MHQ scores of study group ( (73. 06±10. 55)points) and joint replacement group ( ( 81. 42 ± 8. 54) points) were significantly higher than those of non-operation group ((65. 91± 8. 26) points) ( P＜0. 05), and the MHQ scores of joint replacement group were significantly higher than those of study group (P＜0. 05). At 12 months after treatment,there was no significant difference in MHQ score between the study group ((82. 45±7. 18)points) and the arthroplasty group ((84. 36±6. 33) points) (P＞0. 05) . At 6 and 12 months after treatment, AIMS2 scores of each group were significantly improved,but AIMS2 scores of study group (( 216. 51 ± 35. 28) points, ( 230. 28 ± 23. 51) points) and arthroplasty group ((221. 45±31. 63) points,(234. 15±21. 42) points) were significantly higher than those of non-operation group ((192.69±41.31) points,(200.43 ±28.42) points) (P＜0.05).At 6 and 12 months after treatment,there was no significant difference in AIMS2 scores between the study group and the arthroplasty group ( P ＞ 0. 05 ) . Conclusion Micro-strip line anchors combined with posterior capsulorrhaphy in the treatment of first metacarpophalangeal joint dislocation in rheumatoid arthritis can achieve good stability of articular reduction,significantly improve the joint function and quality of life and have ideal short-term and mid-term effect.

Background Secondary osteoporosis may occur in patients with rheumatoid arthritis (RA), causing irreversible joint damage and disability. Bisphosphonates, the recently developed bone resorption inhibitors, have demonstrated significant therapeutic effects on senile and postmenopausal osteoporosis. This study evaluated the efficacy and safety of zoledronic acid (ZOL), with or without methotrexate (MTX), for the prevention and treatment of bone destruction in RA patients. Methods We recruited 66 RA patients with symptoms of secondary osteoporosis. They were randomized into three treatment groups—combined treatment with MTX and ZOL, ZOL monotherapy, or MTX monotherapy—in two consecutive 6-month periods. The participants were followed for 12 months. At the end of each treatment period, improvement in disease activity, bone destruction, and fracture risk were evaluated. Results Combined treatment with ZOL and MTX had significantly better clinical efficacy compared with either ZOL or MTX monotherapy ( P < 0.05). The combination significantly improved the lumbar spine and hip BMD and reduced FRAX scores, suggesting that ZOL combined with MTX reduces bone loss and risk of hip fracture in RA patients with secondary osteoporosis. Conclusion ZOL has a synergistic effect when combined with MTX, inhibiting RA disease activity, reducing fracture risk, and improving quality of life in RA patients with secondary osteoporosis. Trial registration Chinese Clinical Trial Registry, ChiCTR1800019290. Registered 3 November 2018–Retrospective registered, http://www.chictr.org.cn/showproj.aspx?proj = 31758

很多自身免疫性疾病的靶器官中均有异位生发中心(ELS)出现,ELS在类风湿关节炎(RA)中主要存在于关节的滑膜中,ELS的特点是在滤泡树突状细胞的网状结构支撑下形成有规律的T/B细胞的聚合体,从而支撑ELS反应.ELS的功能通过产生特异性自身抗体来维持免疫应答,并且与患者疾病的严重程度及药物治疗敏感性相关.ELS发挥功能的机制尚不完全清楚,ELS是否为RA的一种表型或疾病炎症的进一步进化仍不清楚,但可能成为RA的一个新的治疗靶点.

BACKGROUND:Data on indication of Unicompartmental Knee Arthroplasty (UKA) in the Asian population are currently not available. The current paper evaluates patients undergoing knee replacement at a Chinese Orthopaedic Specialty Hospital to report the percentage of patients who meet radiographic and clinical indication criteria for UKA.METHODS:Over a one-year period 463 consecutive patients (515 knees) underwent primary knee replacement surgery. Clinical data were recorded and preoperative radiographs were assessed. Patients were classified as suitable candidates for UKA based on the degree of deformity, preoperative ROM and radiographic appearance of osteoarthritis. The different indication criteria for body weight and extend of patellofemoral osteoarthritis as reported by Kozinn and Scott as well as the Oxford Group were applied.RESULTS:160 knees (31%) were excluded because of inflammatory and posttraumatic arthritis. 55 knees had to be excluded because of incomplete radiographs. Of the remaining 300 knees with osteoarthritis, 241 knees were excluded because of extend of deformity (n=156), decreased range of motion (n=119), advanced patellofemoral arthritis with bone loss (n=11) and AP instability (n=1). Of the remaining 63 knees, 54 knees (18%) met the modified Oxford criteria for mobile UKA and only 25 knees (8%) met the Scott and Kozinn criteria for fixed UKA.CONCLUSION:The current paper suggests that in comparison to Caucasian population, only a smaller percentage of patients at a Chinese Orthopaedic Specialty Hospital meet the indication criteria for UKA. Therefore, it might make sense to concentrate UKA surgeries in high volume centers.

Objective To discuss the influence of Zhuyu Shenggu Decoction on early osteolysis of periprosthetic femoral after total hip replacement (THA) in elderly patients.Methods 60 elderly patients who received THA were randomly divided into the combination group and control group,30 cases in each group.The control group was orally treated with alendronate after surgery,the combination group was treated with alendronate and Zhuyu Shenggu Decoction,with a course of 6 months.The changes of bone mineral density (BMD) of periprosthetic femoral,bone metabolism state and inflammatory cytokines were observed and compared.Results ①After treatment,the BMD was significantly decreased at the region of interest(ROI) 1-7 in the control group(P ＜ 0.05) and at ROI 7 in the combination group(P ＜0.05).Except ROI 4,the BMD of the combination group at other regions were all significantly higher than those of the control group (P ＜ 0.05).②After treatment,the levels of total pro-collagen type Ⅰ N-terminal peptide (TP I NP) and C-telopeptide β cross link of type Ⅰ collagen (CTX-β) in both groups were significantly decreased compared with treatment before (P ＜ 0.05),and the levels in the combination group were significantly lower than those in the control group (P ＜ 0.05).③After treatment,the levels of interleukin-6 (IL-6),C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) in both groups were significantly decreased compared with treatment before(P ＜ 0.05),and the levels in the combination group were significantly lower than those in the control group(P ＜ 0.05).Conclusion Zhuyu Shenggu Decoction can effectively inhibit the inflammatory reaction in elderly patients after THA,prevent bone loss in periprosthetic femoral and delay the osteolysis.

Patella osteomalacia is one kind diseqse of patella cartilage degeneration. Western medical treatment in the early and middle stage mostly advocates conservative treatment, includes intra-articular injection of sodium hyaluronate, oral sulfate amino glucose, non steroidal anti-inflammatory drugs, etc. in the late stage always recommend surgical treatment, all the treatments have certain effect and toxic side effect. Traditional Chinese medicine thinks that the disease is due to lack of blood after injury, blood stasis, the wind cold dampness evil invasion, or because of old and weak, deficiency of liver and kidney, deficiency of qi and blood, weakened defensive of qi, cannot moisten joint, wind cold and dampness take advantage of a weak point to lead to disease. The main TCM treatment contains traditional Chinese medicine, topical, fumigation, acupuncture, massage and other methods. We advocate if the disease' s condition is more severe we should treat its most serious symptoms at first, if the condition is light we should treat it from the root. Chose measures to different persons, take care of both tip and root. Treatment can complement each other with combination of TCM and Western medicine.

BACKGROUND:The incidence of patel ar complications is decreasing, however, the necessity of patel ar replacement remains unclear. OBJECTIVE:To investigate the incidence rate of anterior knee pain and postoperative pain score in total knee arthroplasty without the patel ar replacement and to provide a reference for the formulation of clinical operation scheme. METHODS:151 patients with 193 knees receiving total knee arthroplasty were involved in this study. Al the patients were treated with patel ar forming but not resurfacing of the patel a. The Western Ontario and McMaster University (WOMAC) Osteoarthritis Index and America Hospital for Special Surgery (HSS) score were used to evaluate patients before surgery and at 6 and 12 months after surgery. The function of knee joint, the incidence rate of anterior knee pain and visual analogous scale score before and after operation were compared. RESULTS AND CONCLUSION:After 6 and 12 months of total knee arthroplasty, WOMAC osteoarthritis index was significantly lower and HSS score was significantly higher than those before surgery (P<0.05). At 12 months post-operation, the incidence rate of anterior knee pain was 11.3%, which was significantly lower than the preoperative rate (94.5%) (P<0.05). At 12 months post-surgery, visual analogous scale scores were also significantly lower than the preoperative score (P<0.05). Total knee replacement without resurfacing of the patel a can effectively improve knee joint function in knee osteoarthritis or rheumatoid arthritis patients, ameliorate the symptoms of anterior knee pain, has a good clinical effect within short term post-operation. The middle-and long-term effects need further exploration.