To date, we have reviewed the synthesis literature critically through four databases: PubMed, Embase, Cochrane Library and Web of Science. Eight relevant studies were examined after compliance with the criteria for inclusion and exclusion, as well as documentation quality evaluation. This report covered all randomised, controlled studies of total hip arthroplasty (THA) comparing the direct anterior approach (DAA) with the postero-lateral approach (PLA). The main result was surgical site infection rate. The secondary results were duration of the operation, length of the incision and VAS score after surgery. The results of the meta-analyses of wound infections in the present trial did not show any statistically significant difference in DAA versus PLA (between DAA and PLA) (OR = 1.42, 95%CI: 0.5 to 4.04, p = 0.51). Compared with PLA, DAA had shorter surgical incision (WMD = -3.2, 95%CI: -4.00 to -2.41; p < 0.001) and longer operative times(WMD = 14. 67, 95%CI: 9.24 to 20.09; p < 0.001). Postoperative VAS scores were markedly lower in DAA compared with PLA within 6 weeks of surgery (p < 0.05), with low heterogeneities(I2  = 0). We found that DAA did not differ significantly from PLA in terms of the risk of wound infection for THA and that the surgical incisions was shorter and less postoperative pain after surgery, even though DAA surgery takes longer.

目的:探究关节镜下双滑轮和双排缝线桥联合技术治疗肩袖损伤(rotator cuff tears,RCT)的效果及对肩关节功能恢复的影响.方法:回顾性分析 2018 年 7 月至 2022 年 6 月于我院接受传统缝线桥技术治疗的52 例RCT患者临床资料,纳入对照组,回顾性分析同期于我院接受关节镜下双滑轮结合双排缝线桥技术治疗的53 例RCT患者临床资料,纳入观察组.比较两组患者手术指标,随访 6 个月后,比较两组患者治疗效果[愈合率、再撕裂率、视觉模拟评分(visual Analogue Scale,VAS)],术前和术后6 个月关节活动度(前屈上举、体侧外旋、体侧内旋)、肩关节功能[美国肩肘外科协会评分(american Shoulder and Elbow Surgeons,ASES)、Constant-Murley评分(constant-Murley Score,CMS)、加州大学洛杉矶分校评分(university of California at Los Angeles,UCLA)],统计术后并发症发生情况.结果:两组患者手术时间、手术出血量、住院时间及疼痛缓解时间均差异无统计学意义(P 均>0.05);术后 6 个月,两组患者VAS评分较术前降低,观察组低于对照组(P<0.05);前屈上举、体侧外旋、体侧内旋度数、ASES 评分、UCLA评分及CMS 评分均较术前升高,观察组高于对照组(P 均<0.05).结论:关节镜下双滑轮结合双排缝线桥技术在RCT治疗中效果显著,可加强RCT患者关节灵活度,有利于RCT患者肩关节功能恢复.

[目的]对比运动性肩袖损伤关节镜修复与保守治疗的疗效.[方法]2016年5月-2020年11月治疗100例运动性肩袖损伤患者.依据治疗前医患沟通结果,50例采用手术治疗,50例采用保守治疗.比较两组疗效.[结果]两组患者均顺利完成治疗,无严重并发症.随时间推移,两组QOL、UCLA和Constant-Murley评分,以及外展上举ROM和外旋ROM均显著增加(P＜0.05).治疗前两组间QOL、UCLA和Constant-Murley评分,以及外展上举ROM和外旋ROM的差异均无统计学意义(P＞0.05),但术后8周,3、6个月,手术组QOL、UCLA和Constant-Murley评分,以及外展上举ROM和外旋ROM均显著优于保守组(P＜0.05).[结论]与保守治疗相比,关节镜手术治疗运动性肩袖损伤效果确切,可有效减轻疼痛,改善肩关节功能和生活质量.

目的 探索黄芪多糖对去卵巢大鼠骨量和骨代谢以及BMP-2/Smads信号通路的影响.方法 30只雌性SD大鼠进行去卵巢手术或假手术.正常饲养12周后被分为黄芪多糖组(ASNT组)、对照组(CON组)和去卵巢组(OVX组),其中黄芪多糖组每天给予400 mg/kg黄芪多糖治疗.通过骨密度、骨代谢指标、Micro-CT以及WB检测评估ASNT对骨质疏松症大鼠骨量、骨代谢以及BMP-2/Smads信号通路的影响.结果 经过12周治疗,ASNT组大鼠骨密度较OVX组显著增加(P<0.05);ASNT治疗12周可以降低血清ALP和OC水平,增加血钙含量,增加股骨骨密度.经过12周治疗,ASNT组大鼠骨体积分数(BV/TV)、表面积体积分数(BS/TV)、骨小梁厚度(Tb.Th)、骨小梁数目(Tb.N)较OVX组显著增加;而骨小梁间隙(Tb.Sp)较OVX组显著降低,差异比较有统计学意义(P<0.05).WB结果表明OVX大鼠骨组织的BMP-2/Smsds信号通路受到抑制;ASNT可以通过上调BMP-2、p-Smad1和p-Smad5的表达显著激活BMP-2/Smsds信号通路传导.结论 研究表明ASNT对去卵巢大鼠骨密度和骨量具有保护作用,可能和激活BMP-2/Smads信号通路有关.

The cholinergic pathway neurotransmitter acetylcholine (ACh) regulates the inflammatory cascade through a specific alpha 7 nicotinic acetylcholine receptor (alpha 7nAChR). However, the role and related mechanisms of alpha 7nAChR in osteoporosis (OP) remain unclear. Therefore, this study aims to analyze the effects of alpha 7nAChR on osteoblasts and related mechanisms. Mouse osteoblast MC3T3-E1 was cultured in vitro and divided into a control group and an alpha 7nAChR agonist group (2.4 and 4.8 mg/kg.d). An MTT assay was used to detect the osteoblast activity, an ARS staining assay was used to analyze the formation of calcified nodules of osteoblasts, and an alkaline phosphatase (ALP) activity colorimetric assay was used to determine the ALP activity. Real-time PCR was performed to analyze the expression of RUNX2 and OPN mRNA. The inflammatory factor tumor necrosis factor-a (TNF-alpha) and interleukin-6 (IL-6) secretions were analyzed by ELISA. The alpha 7nAChR agonists dose-dependently promoted osteoblast proliferation, increased calcified nodules, ALP activity, RUNX2 and OPN mRNA expression, decreased inflammatory factors TNF-alpha and IL-6 secretion, and increased Wnt1, beta-catenin mRNA and protein expression. Compared with the control group, the differences were statistically significant (P<0.05). alpha 7nAChR agonists can inhibit the proliferation and differentiation of osteoblasts by regulating the Wnt/beta-catenin signaling pathway, and then participate in the regulation of osteoporosis.

The cholinergic pathway neurotransmitter acetylcholine (ACh) regulates the inflammatory cascade through a specific α7 nicotinic acetylcholine receptor (α7nAChR). However, the role and related mechanisms of α7nAChR in osteoporosis (OP) remain unclear. Therefore, this study aims to analyze the effects of α7nAChR on osteoblasts and related mechanisms. Mouse osteoblast MC3T3-E1 was cultured in vitro and divided into a control group and an α7nAChR agonist group (2.4 and 4.8 mg/kg.d). An MTT assay was used to detect the osteoblast activity, an ARS staining assay was used to analyze the formation of calcified nodules of osteoblasts, and an alkaline phosphatase (ALP) activity colorimetric assay was used to determine the ALP activity. Real-time PCR was performed to analyze the expression of RUNX2 and OPN mRNA. The inflammatory factor tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) secretions were analyzed by ELISA. The α7nAChR agonists dose-dependently promoted osteoblast proliferation, increased calcified nodules, ALP activity, RUNX2 and OPN mRNA expression, decreased inflammatory factors TNF-α and IL-6 secretion, and increased Wnt1, β-catenin mRNA and protein expression. Compared with the control group, the differences were statistically significant (P<0.05). α7nAChR agonists can inhibit the proliferation and differentiation of osteoblasts by regulating the Wnt/β-catenin signaling pathway, and then participate in the regulation of osteoporosis.

Objective To study the clinical effect of arthroscopy in the treatment of knee discoid meniscus injury,and to analyze the influencing factors of postoperative pain. Methods The clinical data of 200 patients with knee discoid meniscus injury who underwent orthopedic treatment from Jan. 2013 to Aug. 2016 in Ningxia People's Hospital were retrospectively analyzed. There were 86 males and 114 females aged 12 to 76 (mean,45. 24) years, with left knee meniscus injury in 103 cases and right knee meniscus injury in 97 cases,and all meniscus injury types were discoid. Injury degree was based on MRI signal,withⅠdegree injury in 32 cases,Ⅱdegree injury in 67 cases and Ⅲ degree injury in 101 cases. All patients underwent arthroscopic treatment. The treatment effect was observed and they were divided into pain group and painless group according to whether there was pain after surgery. The Ly-sholm knee function score and the clinical data were compared between the two groups,and the factors influencing the postoperative pain were analyzed by single factor and multivariate logistic regression analysis. Results After arthroscopic treatment,the efficacy of the 200 patients were excellent in 119 cases,good in 75 cases,fair in 4 cases and poor in 2 cases,and the excellent rate was 97. 0％. A total of 56 patients after surgery developed knee pain,and the incidence was 28. 0％. The Lysholm score (67. 62 ± 12. 21) in the pain group was significantly lower than that in the painless group (83. 45 ± 13. 57,P<0. 05). The factors influencing postoperative pain were mainly age,artic-ular cartilage injury, premature postoperative weight bearing and no cold compress after operation. Conclusion Clinical efficacy of arthroscopic treatment for knee joint discoid meniscus injury is significant,but postoperative pa-tients are prone to knee pain. Corresponding treatment should be based on related factors.

Obective To establish animal mnodel of osteoarthritis (OA) plus osteoporosis (OP) and observe the effects of Zhuangguguanjie on bone mineral density and estrogen receptor (ER) in SD rats with OA and OP.Methods Thirty female unpregnant SD rats were selected,and the rats were randonly divided into control group,model group and treatment group (n =10 each).The model of OA plus OP was established by ovariectomy and modified Hulth method in model group and treatment group,and Zhuangguguanjie capsule was given for 8 weeks continuously 12 weeks after modeling in treatment group.In control group,a little fat tissues around the ovary and a small amount of right knee synovium were removed only,and equivalent distilled water was given after operation.Right femoral condyle specimen was prepared to observe morphologic changes of articular cartilage tissues of femoral medial condyle under light microscope.Dual-energy X ray was used to observe the changes of right femur bone mineral density.Immunohistochemieal methods was used to detect estrogen receptor (ER) expression in bone tissues.Results Findings under light microscope showed that in model group,cartilage layer thinned;chondrocytes decreased;structure was irregular and had many cracks;a large number of homologous chondrocytes can be seen.Aforementioned changes obviously improved in treatment group.X ray examination showed that compared with control group,bone mineral density decreased significantly in model group (P ＜ 0.01),while it increased in treatment group after drug intervention (P ＜ 0.05).Immunohistochemical results showed that according to the comparison of positive cells grey value,the expression quantities of ERα and ERβ in model group decreased significantly compared with control group(all P ＜ 0.01),and the expression quantities of ERoα and ERβ in treatment group increased significantly compared with model group(all P ＜ 0.01).Conclusion Zhuangguguanjie capsule can improve cartilage morphology,increase bone mineral density and expressions of ERα and ERβ3 in osteoblasts in SD rats with OA and OP,but its effective mechanism needs to be studied further.

BACKGROUND:Lycium barbarum polysaccharide, the main active component of leaves of lycium barbarum, has a remarkable therapeutic effect on osteoporosis in adult ovariectomized female rats. <br> OBJECTIVE:To explore effects of leaves ofLycium barbarum on serum estradiol and bone estrogen receptor expressions in adult oxariectomized female rats. <br> METHODS: Thirty-two 6-month-od female rats were randomized into sham-surgery, model, and treatment groups, respectively. Rat models of postmenopausal osteoporosis were induced by ovariotomy folowed by oraly administration of water solution of leaves ofLycium barbarum (500 or 1 000 mg/kg) or distiled water once daily for consecutive 12 weeks in treatment and model groups, respectively. Serum estradiol level was detected by radiation immunoassaymethod. Estrogen receptor α, β immunoreactivities in bone tissue were determined by immunohistochemical staining. <br> RESULTS AND CONCLUSION:Serum estradiol level in the model group was significantly decreased compared with the sham-surgery group (P < 0.01), but that was significantly increased in the treatment groups, particularly at high dose, compared with the model group (P< 0.01). Estrogen receptor α, βimmunoreactivities were weaker in the model group than the sham-surgery group (P < 0.01), and those were stronger in the treatment groups than the model group (P < 0.01). Our results suggest that leaves of Lycium barbarum treat osteoporosis through enhancing serum estradiol and estrogen receptor expressions in adult ovariectomized rats.

目的 探讨用髓内钉治疗儿童成骨不全致股骨骨折的疗效.方法 治疗10例11处骨折,术中暴露骨折端,将弯曲股骨多段截骨,从骨折端处理髓腔后后髓内钉固定,术后髋人字石膏固定6周.结果 术后10例畸形改善明显,随访8个月～4年,平均22.1个月.随访中治疗肢体未再发骨折,未见髓内针断裂,无感染;1例发生骨不连,但能下地行走.结论 髓内钉辅助多段截骨治疗儿童成骨不全致股骨骨折,对骨折愈合,肢体畸形矫正、再次骨折机会减少,效果可靠.

Osteoporosis is one common disease in postmenopausal women due to depressed estrogen level. It has been known that inflammatory factors are involved in osteoporosis pathogenesis. One regulator of inflammatory cascade reaction, a7-nicotinic acetylcholine receptor (a7nAChR), therefore, may exert certain role in osteoporosis. This study thus investigated this question on an osteoporosis rat model after castration. Rats were firstly castrated to induce osteoporosis, and then received a7nAChR agonist (PNU-282987), diethylstilbestrol or saline via intraperitoneal injection. After 6 or 12 weeks, bone samples were collected for counting osteoblast number, bone density and estrogen receptor (ERα and ERβ) expression, in addition to the serum laboratory of inflammatory factors. Bone density, osteoclast number, ERα and ERβ expression level were significantly depressed in model group, and were remarkable potentiated in the drug treatment group (P<0.05). The levels of BGP and PTH in drug treatment group were decreased compared to diethylstilbestrol group, while E2 and IGF-1 showed up-regulation. Agonist of a7nAChR can up-regulate estrogen receptor expression and may prevent the occurrence and development of osteoporosis.

BACKGROUND:Previous experiments have shown that Lycium barbarum polysaccharide has a remarkable therapeutic effect on osteoporosis in adult castrated female rats.OBJECTIVE:To explore the effects of rat serum containing Lycium barbarum polysaccharides on the intracellular Ca2+ concentration and the expression of collagen type Ⅰ in osteoblastic MC3T3-E1 cells in vitro.METHODS:The rat serum containing 5%,10% and 20% Lycium barbarum polysaccharide was added into the media of osteoblastic MC3T3-E1 cells,respectively.Blank serum with 20% volume concentration was added into the control group.3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide viability analysis was utilized to investigate the cell proliferation.The intracellular Ca2+ concentration was determined by laser scanning confocal microscope.The expression of collagen type Ⅰ was examined by immunocytochemical technique.RESULTS AND CONCLUSION:Compared with control group,the rat serum containing 5% and 10% Lycium barbarum polysaccharides significantly promoted the proliferation of osteoblastic MC3T3-E1 cells (P < 0.05,P < 0.01).Rat serum containing 10% and 20% Lycium barbarum polysaccharides increased the intracellular Ca2+ concentration and the expression of collagen typeⅠin osteoblastic MC3T3-E1 cells (P < 0.05,P < 0.01).These findings indicate that rat serum containing Lycium barbarum polysaccharides may prevent and heal osteoporosis by affecting the intracellular Ca2+ concentration and the expression of collagen typeⅠ.

Objective:To assess the anti-inflammation and analgesia of β-cyclodextrin inclusion compound of aconitum pendulum.Methods: The inclusion compound of menthol was prepared by β-CD.Two experimental techniques,including xylene-induced eartumefaction,twisting method to evaluate the pharmacodynamic effects of Aconiti.Results:The inclusion compoud of Aconiti(1∶2)group can significantly reduce the number of mice writhing,the inclusion compoud(1∶1)group can significantly reduce the extent of xylene-induced ear tumefaction swelling,and the mice do not appear toxic during the experiment.Conclusion:Aconiti has anti-inflammatory analgesic action and lower toxicity.

OBJECTIVE:To investigate CD molecular recognition technology applied in active constituents extracted and isolated from traditional Chinese medicine--Aconitum pendulum.METHODS:The inclusion constant and form probability of the inclusion complex of Aconitum pendulum with p-CD was calculated by UV spectra method. The active constituents of Aconitum pendulum were extracted and isolated by molecular recognition technology. The inclusion complex was identified by UV. The chemical constituents of Aconitum pendulum and inclusion complex was determined by HPLC. The analgesic effects of inclusion complex was investigated by experiment of intraperitoneal injection of acetic acid in rats.RESULTS:The inclusion complex was identified and confirmed by UV spectra method, the chemical components of inclusion complex were simple, and the content of active constituents increased significantly, the analgesic effects of inclusion complex was well.CONCLUSION:The molecular recognition technology can be used for extracting and isolating active constituents of Aconitum pendulum, and the effects are obvious.