Glucocorticoid (GC)-induced osteonecrosis of the femoral head (ONFH) is a serious complication of glucocorticoid treatment and is characterized by dysfunctional bone reconstruction at necrotic sites. Our previous study confirmed the protective potential of necrostatin-1, a selective blocker of necroptosis, in glucocorticoid-induced osteoporosis. In this study, rat models of GC-induced ONFH were established to evaluate the effects of necrostatin-1 on osteonecrotic changes and repair processes. Osteonecrosis was verified by histopathological staining. An analysis of trabecular bone architecture was performed to evaluate osteogenesis in the osteonecrotic zone. Then, necroptotic signaling molecules such as RIP1 and RIP3 were examined by immunohistochemistry. Histopathological observations indicated that necrostatin-1 administration reduced the incidence of osteonecrosis and the osteogenic response in subchondral areas. Additionally, bone histomorphometry demonstrated that necrostatin-1 intervention could restore bone reconstruction in the necrotic zone. The protective mechanism of necrostatin-1 was related to the inhibition of RIP1 and RIP3. Necrostatin-1 administration alleviated GC-induced ONFH in rats by attenuating the formation of necrotic lesions, recovering the function of osteogenesis, and suppressing glucocorticoid-induced osteocytic necroptosis by inhibiting the expression of RIP1 and RIP3.

目的:探讨局部联合静脉应用氨甲环酸(TXA)对股骨近端防旋髓内钉(PFN A)治疗老年股骨粗隆间骨折患者围手术期失血量及并发症的影响.方法:选取使用PFN A治疗股骨粗隆间骨折的患者 100 例为研究对象.所有患者被分成TXA组和对照组(NS组),每组50例.TXA组分别于术前30 min静脉注射 TXA 1 g/100 ml,同时于创面闭合前用2 g/100 ml TXA溶液浸泡创面5 min.NS组术前静脉滴注 0.9%氯化钠注射液 100 ml.分别于手术当天和术后第5天进行血常规检查,计算两组总出血量和隐性出血量.比较两组术中出血量、隐性出血量、引流量、输血量、总出血量及并发症.所有患者均于术前及术后 1 周进行下肢深静脉超声检查,记录下肢深静脉血栓形成的发生情况.结果:与NS组比较,TXA组显性出血量、隐性出血量、输血量、输血率及总出血量低于NS组(均P＜0.05).无论是NS组还是TXA组,与接受长钉固定的患者比较,接受短钉固定的患者术中出血量比较无统计学差异(P＞0.05),但是隐性出血量和总出血量明显减少(均 P＜0.05).两组下肢深静脉血栓形成、伤口血肿、伤口感染、脑血管意外及出院后 1个月再入院等方面比较无统计学差异(均 P＞0.05).结论:局部联合静脉应用氨甲环酸可以显著减少老年股骨粗隆间骨折患者使用PFNA治疗时的出血量,使用短钉固定的隐性出血量较使用长钉固定明显减少,同时这种用药方式并没有增加下肢深静脉血栓形成等并发症的发生风险.

目的 探索基于模拟体验系统的VAD教学法在关节镜手术模拟教学中的应用效果.方法 选取2021年4—5月在陕西省人民医院参加住院医师规范化培训的120名学员,按照随机对照原则分为试验组(n=60)与对照组(n=60).试验组接受基于模拟体验系统的VAD教学法,对照组接受单纯VAD教学法;培训周期均为4周.培训结束后对所有学员完成关节镜下各项操作的效率进行评估.结果 两组学员在年龄、性别、优势手、专业及既往有无关节镜操作史方面的差异无统计学意义(P>0.05);试验组完成膝关节镜下标准化诊断操作的评分为(63.0±4.4),显著高于对照组的(38.0±5.2)分,差异具有统计学意义(P<0.05);试验组完成膝关节镜下游离体取出和套环操作的评分为(23.0±3.8),也显著高于对照组的(14.0±4.5),差异具有统计学意义(P<0.05);在最终的DASS评分方面,试验组的得分为(86.0±5.2),高于对照组的(48.0±5.8)分,差异具有统计学意义(P<0.05).结论 模拟体验系统与VAD相结合的教学方法可有效提高住培学员的关节镜操作技能,提升住培学员对关节镜下实践操作的学习效率.

目的:探讨超声引导下穿刺减压联合体外冲击波疗法(ESWT)治疗肩袖钙化性肌腱炎(RCCT)的短期疗效.方法:选择RCCT患者57例(60个患肩),随机分为试验组(30个患肩)和对照组(30个患肩).试验组采用超声引导下穿刺减压联合ESWT治疗.对照组行超声引导下穿刺减压治疗.比较两组患者短期临床疗效,治疗前后肩关节视觉模拟量表(VAS)评分、Constant-Murley及美国加州大学(UCLA)肩关节功能评分,以及不良反应发生情况.结果:试验组治疗总有效率高于对照组(P<0.05).治疗前,两组患者肩关节VAS评分、活动度(外展、外旋、前屈、内旋)评分以及UCLA肩关节功能评分比较差异无统计学意义(均P>0.05).治疗后,两组患者肩关节VAS评分低于治疗前,且试验组低于对照组(均P<0.05);肩关节活动度(外展、外旋、前屈、内旋)评分及UCLA肩关节功能评分高于治疗前,且试验组高于对照组(均P<0.05).两组患者均未发生严重不良反应,术后均无肩关节粘连、肩袖或神经损伤、穿刺部位感染等并发症.结论:超声引导下穿刺减压联合ESWT治疗肩袖钙化性肌腱炎具有良好的临床疗效,与单一超声引导下钙化灶穿刺减压相比能更好地减轻疼痛,恢复肩功能.

Inflammatory bone destruction has gradually attracted attention worldwide and has been observed in several kinds of pathological bone diseases, such as osteoarthritis, osteomyelitis, rheumatic arthritis, and other infectious clinical trials in the skeletal system. In this regard, excessive osteoclasts and bone resorption activity participate in osteolytic processes. Thus, negatively modulating osteoclast differentiation and bone erosion has been considered an effective therapeutic strategy to limit the poor progression of inflammatory osteolysis. Astragalin (AST) is a bioactive component of traditional Chinese drugs, such as Rosa agrestis, which presents anti-inflammatory and antioxidant effects. However, it is unclear how AST may play an essential role in regulating the dynamic balance of the bone matrix by affecting osteoclastogenesis. This study found that AST could inhibit osteoclastic formation and bone resorption activity in a dose-dependent manner without cytotoxicity. Administration of AST also inhibited the expression of cathepsin K, c-Fos, NFATc1, and TRAP at different stages of mRNA and protein levels during osteoclastogenesis. Reactive oxygen species (ROS) signalling could also be modulated by treatment with AST during RANKL-induced osteoclast differentiation through the Nrf2-HO1 signalling pathway. Additionally, AST could negatively regulate mitogen-activated protein kinase (MAPK) signalling in this process. In vivo, AST significantly reduced lipopolysaccharide (LPS)-induced bone loss in an osteolytic mouse model. AST might be a promising therapeutic candidate for treating osteolytic bone diseases in the future.

Background: Pulmonary embolism (PE) is extremely rare after shoulder arthroscopy. However, early identification of the situation deserves attention due to its potential risk of causing death. By now, it is still difficult to detect the PE without symptoms and clear sources during the perioperative period. Case presentation: We report here two cases of asymptomatic PE, both happening within 24 h after shoulder arthroscopy, without any detected deep venous thrombosis of extremities. It is suspected the cases were due to the abnormal decrease in partial pressures of oxygen and arterial oxygen saturation, and were confirmed by computed tomography pulmonary angiography. We also discuss the reason why the patients showed no related symptoms when PE occurred and perform a review of PE following shoulder arthroscopy. Conclusions: This report highlights that PE could occur in the early phase after shoulder arthroscopy. An unexplained decrease in partial pressure of oxygen or arterial oxygen saturation should be considered seriously. The symptoms of PE might be masked due to patients' tolerance to hypoxia.

目的:评价CBL结合TBL教学法在骨科临床实习中的教学效果.方法:120名骨科实习学生随机分为两组,实验组接受CBL与TBL结合的教学方法,对照组接受传统教学方法,教学结束后进行考核及问卷调查.结果:实验组和对照组的理论成绩无显著性差异(P>0.05),但两组临床技能得分有显著差异(P<0.05).问卷评价中,实验组和对照组的学习积极性和临床思维能力具有显著性差异(P<0.05),但两组的信息获取及分析能力和教学满意度的差异无统计学意义(P>0.05).结论:CBL联合TBL教学法更能提高学生临床实践技能,提高学习积极性和临床思维能力.

目的 探讨经皮超声引导肩峰下滑囊造影对肩袖损伤的诊断价值,分析肩袖损伤几种不同分型的造影图像特征.资料与方法回顾性分析35例二维超声诊断疑似肩袖损伤,并接受超声引导下肩峰下滑囊造影检查患者的影像学资料.以肩关节镜为“金标准”,采用受试者工作特征(ROC)曲线分析肩峰下滑囊造影对肩袖损伤的诊断效能.结果 二维超声诊断肩袖全层撕裂12例,肩关节滑囊造影诊断阳性18例,经关节镜证实20例;二维超声诊断肩袖部分撕裂5例,肩峰下滑囊造影诊断阳性8例,经关节镜证实10例,两种方法对肩袖损伤的诊断结果差异有统计学意义(x2=8.67,P=0.034).对于全层撕裂,二维超声诊断的ROC曲线下面积为0.71,敏感度、特异度及准确度分别为60％、83％、65％;肩峰下滑囊造影诊断的ROC曲线下面积为0.78,敏感度、特异度及准确度分别为90％、83％、88％.对于部分撕裂,二维超声诊断的ROC曲线下面积为0.65,敏感度、特异度及准确度分别为50％、80％、60％;肩峰下滑囊造影的ROC曲线下面积为0.80,敏感度、特异度及准确度分别为80％、80％、80％.结论 肩峰下滑囊造影诊断肩袖损伤的效果优于二维超声,可作为评估肩袖损伤的重要影像学方法.

Objective To investigate the relationship between acromion index and degenerative full-thickness rotator cuff tears. Methods We enrolled 48 patients ( mean age: 66 years) diagnosed with full-thickness rotator cuff tears by magnetic resonance imaging and intraoperative arthroscopic findings between March 2014 and October 2017.Another 52 patients ( mean age: 63 years) with shoulder pain identified on magnetic resonance imaging induced by other shoulder diseases, such as frozen shoulder and instability, were enrolled as controls. Standardized, true anteroposterior radiographs were assessed by one radiologist. Two independent orthopedic surgeons, who were both blinded to the patients' diagnosis, measured the AI on all radiographs. Then we compared the AI between the 2 groups.Results The mean AI of the control and RCT groups were 0.65 and 0.71, respectively ( P ＜ 0.05, 95％ confidence interval). No differences were found between the AI of male ( 0.70) and female ( 0.69) in the RCT group ( P＞0.05). Conclusions AI is an effective predictive factor for degenerative full-thickness rotator cuff tears in an older population.

目的:通过CT测量适合行全膝关节置换术(total knee arthroplasty,TKA)的大骨节病膝关节股骨远端解剖参数,为行TKA的大骨节病股骨假体的设计提供参考依据.方法:选取适合TKA的大骨节病和骨性关节炎患者进行膝关节CT扫描,用Mimics软件进行三维重建并测量股骨内外径(femoral mediolateral,ML)、股骨外侧髁前后径(lateral anteroposterior,LAP)、股骨内侧髁前后径(medial anteroposterior,MAP)、股骨内侧髁宽(medial condylar width,MCW)、股骨外侧髁宽(lateral condylar width,LCW),并计算ML/LAP比值,比较股骨远端各解剖形态参数差异.结果:大骨节病组股骨远端各解剖数据测量值(ML、MAP、LAP、MCW、MCW)均小于骨性关节炎组,差异有统计学意义(P<0.01).大骨节病股骨远端ML/LAP比值明显大于骨性关节炎组,显示一个给定LAP的股骨假体,大骨节病股骨远端ML有可能会覆盖不全,骨性关节炎有可能会悬空.结论:大骨节病膝关节股骨远端解剖形态与骨性关节炎存在一定差异,为设计适合大骨节病的TKA人工股骨假体提供理论依据.

Objective To define the benefit of arthroscopic release of the anterior glenohumeral joint in frozen shoulder. Methods Sixty idiopathic adhesive capsulitis (IAC) patients were diagnosed by magnetic resonance imaging or intraoperative arthroscopic findings in Shaanxi Provincial People’s Hospital from March 2015 to March 2017. The exclusion criteria included fractures, subacromial impingement, rotator cuff tear and calcifying tendinitis. All the patients underwent arthroscopic capsular release. The extent of release focused on the rotator interval, subscapularis tendon and inferior glenohumeral ligaments (IGHL). Visual analogue scale (VAS), Constant functional scores, the Fudan University shoulder score (FUSS) and the range of motion (ROM) in various directions were recorded preoperatively and postoperatively. Statistical analysis was performed with one-way repeated measures ANOVA and paired t-test. Results None of the patients had postoperative complication such as axillary nerve injury or shoulder instability. At 12 weeks postoperatively, both of VAS [(0.7±0.6)vs(8.1±0.7), F =38.01], Constant score [(93.9±3.0)vs (34.2±3.4), F=121.42]and FUSS [(93.8±1.3)vs (40.1±2.2), F=220.09] increased significantly compared with the preoperative ones(all P<0.01). ROM showed satisfactory results at the final follow-up: abduction [(152±13)° vs (74±9)°, t=37.678], flexion[(156±12)° vs (60±10)°, t=46.469], external rotation at 90° of abduction[(66±11)° vs (8±3)°, t=37.762], internal rotation at 0°of abduction, and internal rotation at 90° of abduction recovered 12 weeks after the surgery(all P<0.01). Conclusion The arthroscopic release of the anterior glenohumeral joint may significantly improveboth of the function and ROM in IAC patients. Key words: Bursitis; Shoulder joint; Arthroscope; Joint capsule release

OBJECTIVE:To investigate the relationship between necroptosis and apoptosis in MCET3-E1 cell death induced by glucocorticoids. METHODS:MC3T3-E1 cells were incubated with 10-6 mol/L dexamethasone followed by treatment with the apoptosis inhibitor z-VAD-fmk (40 μmol/L) or the necroptosis inhibitor necrostatin-1 (40 μmol/L) for 2 h. At 72 h after incubation with dexamethasone, the cells were harvested to determine the cell viability using WST-1 assay and the rate of necrotic cells using annexin V/PI double staining; the percentage of apoptotic cells was determined using Hoechst staining. The mitochondrial membrane potential and the level of ATP in the cells were also evaluated. Transmission electron microscopy was used to observe the microstructural changes of the cells. The expressions of RIP-1 and RIP-3 in the cells were detected by Western blotting. RESULTS:At a concentration of 10-6 mol/L, dexamethasone induced both apoptosis and necroptosis in MC3T3- E1 cells. Annexin V/PI double staining showed that inhibition of cell apoptosis caused an increase in cell necrosis manifested by such changes as mitochondrial swelling and plasma membrane disruption, as shown by electron microscopy; Hoechst staining showed that the percentage of apoptotic cells was significantly reduced. When necroptosis was inhibited by necrostatin-1, MC3T3-E1 cells showed significantly increased apoptosis as shown by both AV/PI and Hoechst staining, and such changes were accompanied by changes in mitochondrial membrane potential and ATP level in the cells. CONCLUSIONS:In the process of dexamethasone-induced cell death, necroptosis and apoptosis can transform reciprocally accompanied by functional changes of the mitochondria.

Glucocorticoids have been shown to induce apoptosis in different cell types. Recent studies have indicated that apoptosis may not be the only form of death that is activated in osteoblasts in response to glucocorticoids. The aim of this study was to investigate whether necrostatin-1 could protect osteoblasts from glucocorticoid-induced cell death. Dexamethasone could induce both apoptotic and necrotic cell death in MC3T3-E1 cells, in a dose- and time-dependent manner. Necrotic cell death was induced by dexamethasone in MC3T3-E1 cells and was characterized by caspase independence, delayed externalization of phosphatidylserine, cellular swelling and plasma membrane disruption. Blockages of necroptotic induction by a special inhibitor (Necrostatin-1) succeed to protect cells against dexamethasone induced cell death. The levels of RIP-1 production and loss of mitochondrial membrane potential were also determined to assess the effects of dexamethasone. This study showed, for the first time, that high-doses of dexamethasone can induce necrotic-like cell death in osteoblastic MC3T3-E1 cells, and this induction could be inhibited by necrostatin-1.

目的 观察全膝关节置换术(TKA)对晚期膝骨性关节炎临床疗效和下肢力线的影响.方法 对45例膝骨性关节炎患者(57膝)行TKA治疗,采用疼痛VAS评分、膝关节活动度(ROM)、KSS关节及功能评分对膝关节功能进行评价,采用SF-36评分对患者生活质量进行评价,摄双下肢全长片评估下肢力线.结果 患者均获得随访,时间48～60(54±4)个月.1例术后5个月发生膝前痛,行股四头肌肌力锻炼后缓解.随访期间所有膝关节假体位置良好,未见骨溶解、假体松动或下沉.末次随访时,VAS评分、ROM、KSS关节及功能评分、SF-36评分、下肢力线与术前比较差异均有统计学意义(P<0.01).结论 TKA是治疗晚期膝骨性关节炎的有效方法,可以缓解疼痛,纠正畸形,恢复下肢力线,改善关节功能,提高患者的生活质量.

Objective To investigate the effects of panax notoginseng saponins (PNS) on early-stage apoptosis in steonecrosis of rabbit femoral head .Methods The 24 rabbits were randomly divided into three groups :normal control group ,model group ,and PNS group .In model group ,equine serum (10 mL/kg) and methylprednisolone (40 mg/kg) were injected alternatively to induce osteonecrosis of the femoral head .In PNS group ,PNS (50 mg/kg , i .v .) was administered continuously before methylprednisolone management .In control group ,the rabbits were fed routinely .TUNEL method was used to detect apoptotic cells .Caspase-3 activity in the femoral head was measured by caspase-3 assay kit . Immunohistochemistry method and Western blot analysis were applied to detect the expressions of Bcl-2 and Bax .Results In model group ,typical appearance of apoptotic cells was observed in the femoral head by TUNEL staining (P< 0 .05) .PNS treatment significantly inhibited cell apoptosis of the femoral head in model group .Furthermore ,pretreatment with PNS significantly reversed the inhibition of Bcl-2 expression , augmentation of Bax expression and caspase-3 activity ( P< 0 .05 ) . Conclusion PNS could up-regulate the expression of Bcl-2 ,down-regulate that of Bax ,reduce the activity of caspase-3 ,and inhibit cell apoptosis of the femoral head .

目的:探讨肩关节镜下探查清理联合肩峰成形术治疗肩峰下撞击综合征临床疗效.方法:收集肩峰下撞击综合征患者52例,均行肩关节镜下探查清理及肩峰成形术,该术式在关节镜下利用刨刀、磨钻彻底去除肩峰下滑囊,将增生的肩峰磨平.对患者术前及术后采用UCLA、ASES和FUSS评分系统评价其疗效.结果:所有患者均获随访,时间1~6个月.术前UCLA、ASES、FUSS评分依次为(21.19±2.14)、(42.29±9.60)、(41.15±6.99)分,终末随访时评分依次为(31.25±1.18)、(90.65±5.17)、(88.15±4.30)分,手术前后各项评分分别比较,差异均有统计学意义(P<0.01).结论:肩关节镜下探查清理联合肩峰成形术是治疗肩峰下撞击综合征有效方法.

Objective:The objective of this study was to measure and analyze morphologic feature of proximal tibial in Kaschin-Beck disease knees which fit for total knee arthroplasty(TKA) and its clinical significance.Methods:46 KBD and 46 normal knees) were measured by three dimensional CT for the proximal tibial mediolateral (ML),middle anteroposterior (AP),medial anteroposterior (MAP),lateral anteroposterior (LAP) dimensions and ML/AP aspect ratio to compared the differences of proximal tibia between KBD and normal knees.Results:There were significant differences between KBD and normal knees in relation to ML,AP,MAP and LAP dimensions (P＜0.01).We also found that KBD have larger ML/AP aspect ratio than that of normal knees under a given AP dimension (P＜0.01).This means that under a given AP dimension component,the tibial ML dimension tended to undersized in KBD and to overhang in normal knees.Conclusion:Proximal tibia showed significant differences in the size and shape between KBD and normal knees.The results of this study can provide inportant theoretical basis in designing proper tibia prosthesis,improving the accuracy and clinical efficacy of TKA for KBD population.

目的:评估肘关节镜下前后联合松解术对创伤性肘关节僵直患者肘关节活动度及功能性的疗效.方法:选取创伤性肘关节僵直患者18例,均行肘关节镜下松解术.术后早期给予所有手术患者有效疼痛控制后进行早期主动及被动锻炼.分别于术后2周、1月、3月及6月对所有患者的肘关节活动度,VAS评分及梅奥肘关节功能评分进行观察分析.结果:术后6个月,肘关节平均活动度由(45.2 ± 17.6)°增加至(113.5 ± 22.4)°(P<0.01);M EPI评分由术前(65.6 ± 17.3)分提升至(91.1±24.3)分(P<0.01);VAS评分由术前的(4.2±1.5)分降低至(0.8±0.4)分(P<0. 01).结论:肘关节镜手术可以极大程度改善创伤性肘关节僵直患者的肘关节活动度及功能.同时,术后早期开始肘关节主动及被动活动尤为重要.