The skeletal system is essential for preserving body structure and facilitating mobility; however, bone diseases frequently result in significant disabilities, necessitating the investigation into biomaterials for bone restoration. Nevertheless, these biomaterials may elicit immune reactions that obstruct the healing process. Macrophages assume a pivotal role in modulating inflammation and sustaining immune homeostasis essential for bone regeneration. A comprehensive understanding of the molecular interactions between biomaterials and macrophages is imperative for the development of sophisticated biomaterials designed to regulate the bone immune environment and promote bone remodeling. This review delves into the generation, polarization, and interaction of macrophages with principal cell types implicated in osteogenesis, detailing the molecular mechanisms by which macrophages influence bone repair and their response to biomaterials. Additionally, it discusses strategies for the precise modulation of macrophage functionality via intelligent mechanisms, and outlines the challenges and constraints in designing biomaterials that integrate bone immune functions. By elucidating these mechanisms and challenges, the review lays the groundwork for the creation of advanced biomaterials endowed with smart bone immunomodulatory capabilities, heralding novel approaches for the treatment of bone defects and the advancement of bone regeneration therapies.

Background: Total knee arthroplasty (TKA) is a common surgical procedure for patients with knee osteoarthritis. The patellar component plays a crucial role in knee biomechanics and can influence postoperative outcomes. This study aimed to investigate the relationship between radiological indices of patellar height and patient outcomes following TKA. Methods: A retrospective analysis was conducted on patients who underwent TKA for osteoarthritis. Radiographic measurements of patellar height, including the Insall-Salvati (IS) ratio, modified Blackburne-Peel (mBP) ratio, Caton-Deschamps ratio, and plateaupatellar angle (PPA), were obtained. Clinical outcomes were assessed using the Knee Society Score (KSS) and the Forgotten Joint Score-12 (FJS-12). Patient satisfaction and postoperative complications were also evaluated. Statistical analyses, including correlation analysis and multiple regression models, were performed to determine the association between radiological indices and Results: The study included 330 cases that met the inclusion criteria. The analysis revealed significant correlations between different radiological indices of patellar height and patient outcomes. Lower postoperative PPA was correlated with worse KSS and range of motion scores. A decreased mBP ratio was associated with poorer FJS-12 responses and higher risks of dissatisfaction and patellar clunk or crepitus. Increased IS ratio was linked to a lower likelihood of incidental giving way of the knee. Advanced age was associated with reduced dissatisfaction and incidental giving way probabilities. Conclusions: The findings of this study demonstrate that radiological indices of patellar height can predict patient outcomes following TKA. Assessing patellar height using various radiographic measurements provides valuable information for surgical planning and prognostic evaluation. Understanding the impact of patellar height on clinical outcomes can aid in optimizing TKA procedures and improving patient satisfaction. These findings emphasize the importance of considering patellar height as a predictive factor in TKA and highlight its potential role in guiding postoperative management and rehabilitation strategies.

Osteosarcoma (OS) is one of the most common primary solid malignant tumors in orthopedics, and its main clinical treatments are surgery and chemotherapy. However, a wide surgical resection range, functional reconstruction of postoperative limbs, and chemotherapy resistance remain as challenges for patients and orthopedists. To address these problems, the discovery of new effective conservative treatments is important. Long non-coding RNAs (lncRNAs) are RNAs longer than 200 nucleotides in length that do not encode proteins. Researchers have recently found that long non-coding RNAs are closely associated with the development of OS, indicating their potentially vital role in new treatment methods for OS. This review presents new findings regarding the association of lncRNAs with OS and summarizes potential clinical applications of OS with lncRNAs, including the downregulation of oncogenic lncRNAs, upregulation of tumor suppressive lncRNAs, and lncRNAs-based treatment to improve chemotherapy resistance. We hope these potential methods will be translated into clinical applications and greatly reduce patient suffering.

Periprosthetic bone mineral density (BMD) loss after total hip arthroplasty (THA) may threaten the survival of implants. Zoledronic acid (ZA) and denosumab were effective in reducing bone loss in conditions associated with accelerated bone turnover by inhibiting osteoclast activity. This meta-analysis aimed to assess the efficiency and safety of ZA and denosumab for periprosthetic BMD loss after THA. A systematic search of randomized controlled trials (RCTs) associated with ZA or denosumab and THA was performed in MEDLINE, PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Web of Science from 1980 to 2022. Meta-analysis was performed by the Cochrane Review Manager 5 (RevMan) version 5.41. Cochrane risk of bias tool and GRADEpro were applied for methodological quality and overall evidence quality, respectively. Nine RCTs involving a total of 480 patients were finally included and analyzed. The pooled data that demonstrated significantly less periprosthetic BMD loss in Gruen zone 7 occurred in the intervention group patients than in the control group patients at 3 months (MD = 4.30, 95% CI: 1.78–6.82, P = 0.0008), 6 months (MD = 7.71, 95% CI: 5.41–10.02, P < 0.00001), and 12 months (MD = 8.19, 95% CI: 5.97–10.42, P < 0.00001) after THA. No serious adverse events (AEs) were observed. In the current analysis with evidence on the efficacy and safety of ZA and denosumab, the authors recommend the use of ZA or denosumab treatment for periprosthetic bone mineral density loss. Systematic review registration: PROSPERO registration number: CRD42022369273

Total knee arthroplasty(TKA) is currently the main surgical method for the treatment of knee osteoarthritis, rheumatoid arthritis and other knee diseases. It has a good effect in reducing the pain of diseased joints and improving joint function. The goal of TKA is to restore normal knee function and stability. However, among patients receiving TKA, up to 20% of patients are dissatisfied with the postoperative effect, and joint instability is one of the main causes of postoperative dissatisfaction. Discussing joint instability is helpful to improve product design and manufacturing concepts and improve product performance. At the same time, it can help surgeons optimize surgical techniques and reduce joint instability caused by human factors. There are many factors that affect joint instability. The impact of prosthesis (such as prosthesis design, prosthesis selection), surgical technique (such as osteotomy error, joint line level) and patient factors (such as age, gender, weight), etc. The stability after joint replacement has an important impact. Joint instability is a common indication for knee revision, and most conservative treatments are ineffective. Therefore, it should be prevented by optimizing the design of the prosthesis, improving the surgical technique, and guiding the rehabilitation of the patient.

布鲁氏菌病由布鲁氏菌引起,其可通过皮肤、黏膜、消化道和呼吸道侵入人体[1].布鲁氏菌病的症状多种多样,最常见的临床特征是发热、多汗、乏力、肌肉关节疼痛.骨关节受累是其最常见的并发症,如多关节痛、脊柱炎、骶髂关节炎、髋关节炎、骨髓炎等[2].布鲁氏菌引起的假体关节感染(periprosthetic infection, PJI)极其罕见[3].Walsh等[4] 2019年统计全世界已记录的病例仅有30例,因此临床上容易造成误诊.吉林大学第一医院(以下简称"我院")近期收治1例布鲁氏菌致全髋关节置换术后PJI的患者,通过进行关节清创及一期翻修术,术后给予抗布鲁氏菌病治疗成功,现报道如下,同时进行相关文献回顾.

At present,total hip arthroplasty (THA) is the primary treatment for hip diseases such as femoral head necrosis and developmental dysplasia of the hip.It has good effects in reducing pain and improving joint function.The appearance of modular hip prosthesis facilitates adjustment of limb length and femoral offset.However,the wear between the interface of hip prosthesis can lead to inflammatory pseudotumor,osteolysis and other adverse reactions.To explore the risk factors of wear between hip prosthesis interface is helpful to improve the design and manufacturing concept of the product,improve the product performance,help surgeons optimize the operation technology and reduce the impact of human factors on the wear of the prosthesis.Many literatures have reported the mechanism of wear between the head-acetabula interface of prosthesis.The mechanism of wear between the interfaces has been described relatively clearly.In addition to the head-acetabula interface,the wear between the head-neck interface is another major cause of unexplained pain around the joint and prosthesis loosening after hip replacement.Many factors affect head-neck wear.The design of prosthesis (such as prosthesis material and prosthesis taper),surgical technology (such as impact strength and prosthesis mismatch) and patient factors (such as age,gender and activity) have important impact on head-neck wear.Adverse reactions caused by head-neck wear have also been widely concerned.However,there is no considerable solution for wear prevention.Thus,we should optimize the design of prosthesis,improve the surgical technology,and guide the rehabilitation of patients to prevent wear.In order to improve the attention of joint surgeons,the present paper reviews the literatures and analyzes the risk factors of head-neck interface wear and the clinical manifestations caused by head-neck wear.

患者,女,40 岁,右大腿远端肿物伴逐渐增大2年,于2017年12月3日为主诉入院.该患2年前发现右大腿远端肿物,当地医院怀疑为囊肿,多次给予穿刺抽液,穿刺液呈暗红色血性液体.治疗效果不佳,肿物逐渐增大.为求明确诊断被收入我科.查体:右大腿远端可见一肿物,大小约15 cm×10 cm.肿物表面皮温皮色正常,元压痛,触之质软,活动度较差.

Osteonecrosis is a condition that frequently affects patients with systemic lupus erythematosus (SLE). However, reports on severe multifocal osteonecrosis involving more than three anatomical sites in patients with SLE are scarce. The present study describes a case of SLE with multifocal osteonecrosis involving all four limbs. A 22-year-old woman was diagnosed with SLE in 2010 and the disease was controlled by treatment with methylprednisolone and hydroxychloroquine. Approximately 1 year following the diagnosis of SLE, the patient developed pain in the elbows and hips. Magnetic resonance imaging revealed evidence of multifocal osteonecrosis in the bilateral distal segments of the humerus and femoral head, the distal segment of the right femur and the proximal segment of the right tibia. The patient was treated with right total hip arthroplasty and core decompression of the right femur and tibia, followed by continuation of the earlier medical treatment for SLE. The present case highlights the importance of conducting a careful investigation of patients with SLE who present with multiple joint involvement, and the choice of the appropriate treatment according to the presentation.

患者,女,43岁.因左侧胸锁关节疼痛1年余,加重20 d于2018年4月20日入院.患者1年多前无明显诱因出现左侧胸锁关节疼痛,自服止痛药物可缓解,未在意.20 d前疼痛症状加重,呈持续性伴局部热胀感.同时左侧胸锁关节处可触及一大小呈3 cm×2 cm的隆起包块.于当地医院行超声示:左侧胸锁关节可见低回声,大小3.4 cm×2.2 cm,形态不规则,内可见少许点状血液信号,待排除滑膜来源肿瘤.为求明确诊断,被收入我院肿瘤科.查体:左侧胸锁关节处可见一隆起包块.局部皮温高,皮色红.压痛阳性,触之质较韧,活动度差.完善各项检查,以排除肿瘤的可能性.胸锁关节CT示:左侧锁骨端前缘皮质局部骨质破坏,前方软组织密度减低、密度欠均匀(图1a,1b).PET/CT示:左侧胸锁关节反射性增高伴骨质改变.超敏C反应蛋白33.60 mg/L,血沉35 mm/1 h.为明确诊断,行肿物穿刺活检术,病理回报:肉芽肿性炎,未见恶性肿瘤细胞.考虑到肉芽肿性炎可能为结核杆菌感染,完善结核相关检查:结核T斑点试验和结核IgG试验均阴性.由于患者有局部骨质破坏,软组织穿刺无法明确骨组织情况,为行切开取病理术转入我科.

先天性凝血因子Ⅹ(factor Ⅹ,FⅩ)缺乏是1种极为罕见的凝血障碍,可使患者自发性出血或在创伤性或侵入性手术中有过度出血的风险.鉴于这种疾病的罕见性,关于如何最好地预防或治疗出血的指南很少发表.吉林大学第一医院骨关节外科收治1例患有先天性FⅩ缺乏症合并股骨干骨质破坏患者,需手术干预,治疗选用4因子凝血酶原复合物浓缩物(4-factor prothrombin complex concentrate,4F-PCC),含有治疗因子Ⅱ、Ⅶ、Ⅸ和Ⅹ,成功完成了取病理术和截肢术而无不良反应,没有观察到血栓栓塞并发症.

1 资料与方法 45 岁男性患者,因右髋关节间歇性疼痛 1 年,摔倒后疼痛加重伴行走困难 2 周入院.既往史:2 年前曾因"潜伏梅毒"行规范抗生素治疗.否认糖尿病、结核病病史,否认冶游史.查体:跛行步态,全身无皮疹,右下肢短缩外旋畸形,右髋部轻度肿胀,局部无瘢痕、窦道,右腹股沟中点、大转子轻度压痛,右侧髋关节被动活动范围基本正常,右下肢肌力Ⅳ级,深感觉减弱,右下肢生理反射减弱、病理反射未引出.骨盆正位 X 线片及髋关节 CT 示右侧髋臼、股骨颈骨折,股骨头及髋臼内陷,关节内可见游离骨块(见图 1 ～ 2);髋关节MRI 示右髋关节及相邻盆底软组织渗出肿胀(见图 3);骨扫描未见异常;颈椎、胸腰椎核磁示轻度退行性变.实验室检查:梅毒螺旋体抗体阳性,梅毒螺旋体颗粒凝集试验阳性,快速血浆反应素阴性.超敏 C 反应蛋白 45.60 mg/L,血沉 120 mm/h.髋关节穿刺液细菌、真菌、抗酸杆菌培养阴性.明确临床诊断:脊髓痨性夏科氏髋关节病.

骨纤维结构不良,是一种病因不明的,非遗传性的良性纤维性骨病,多发于长骨的骨干及干骺部,多累及股骨近端、胫骨及面部骨,而无论是骨纤维结构不良还是其他骨肿瘤均极少发生于锁骨.本文针对1例锁骨骨纤维结构不良患者的诊断、手术治疗及预后进行汇报.

Precise measurement of lateral femoral bowing is important to achieve postoperative lower limb alignment. We aimed to investigate factors that affect the precision of the radiographic lateral femoral bowing (RLFB) angle using three-dimensional (3D) models and whether the angle affects surgery design.

Hereditary onycho-osteodysplasia, also known as nail-patella syndrome (NPS), is a rare genetic disorder that is primarily characterized by poorly developed nails and patella. Patients with NPS frequently suffer from patellar instability that requires surgical management. The present case report describes a 25-year-old man with NPS. The patient presented with left knee pain and was found to have recurrent left patellar dislocation. The knee pain was first reported 1-year after a minor knee trauma incident. Following complete evaluation, a diagnosis of NPS was reached. The patient underwent surgical intervention using medial patellofemoral ligament (MPFL) reconstruction with a gracilis tendon autograft looped through two transverse 3.2-mm drill holes in the patella and fixed at the natural MPFL insertion site on the medial femoral condyle with an interference screw. The surgery resulted in stabilization of the patella in the femoral trochlea and the patient did not have any subsequent dislocations or subluxations. The patient had an excellent range of knee movement in the follow-up period. This case indicates that MPFL reconstruction in patients with patellar dislocation secondary to NPS can successfully restore normal patellar tracking and result in good range of movement and functional activity.

Nuchal-type fibroma, initially described in 1988 by Enzinger and Weiss, is a rare clinical entity associated with distinct subcutaneous and dermal fibrous tissue proliferation. The etiology of nuchal-type fibroma largely remains to be elucidated. Typical characteristics of this entity include hypocellular, haphazardly arranged collagen with entrapped adipose tissue, paucity of elastin and entrapped small nerves, on which the pathological diagnosis is based. Magnetic resonance imaging (MRI) is the preferred imaging modality for the detection of nuchal-type fibroma, due to its superior soft tissue resolution and multi-planar capabilities. The present study presents the unique findings of a nuchal-type fibroma arising in the shoulder of a 48-year-old man. Distinct features of the nuchal-type fibroma in the present case included hyperintensity on T1- and T2-weighted MRI. Microscopic examination revealed marked mucoid tissue degeneration. To the best of our knowledge, this is the first case report of nuchal-type fibroma presenting with these distinct features. The present findings may therefore assist with the general and differential diagnosis of nuchal-type fibroma.

钙化性肌坏死是一种少见的创伤后并发症。1960年Gallie和Thomson［1］首先报告了2例Volkmann缺血挛缩后发生钙化性肌坏死的患者。钙化性肌坏死的具体病理生理学机制尚不清楚，但多发生在创伤和骨筋膜室综合征之后，尤其是伴有周围神经损伤的病例［2］。临床表现多为逐渐增大的无痛性肿物，偶尔存在压痛。由于距初始创伤时间间隔长、临床症状不典型，钙化性肌坏死的诊断比较困难。我们报告1例诊断为左小腿胫前肌钙化性肌坏死的男性患者，并复习相关文献，探讨钙化性肌坏死的临床特征、诊断要点与治疗方法。

心脏瓣膜置换手术已经成为心脏外科的常规手术，心脏机械瓣膜置换术后需终生抗凝，以防血栓形成和体循环栓塞。与抗凝治疗有关的出血，是换瓣术常见的并发症，常见的如牙龈出血、皮下淤斑、消化道出血、脑出血等，但膝关节腔内出血较少见。2013年7月吉林大学白求恩第一医院骨关节外科收治1例膝关节骨关节炎合并瓣膜置换术后长期服用华法令，致膝关节腔内出血病例。现报道如下。