Osteoarthritis (OA) is a chronic disease characterized by the progressive loss of cartilage and failure of the diarrheal joint. Quercetin has been reported to attenuate the development of OA. Bone marrow derived mesenchymal stem cell (BMSC)-derived exosomes are involved in OA progression. However, the role of BMSC-derived exosomes in quercetin-mediated progression of OA remains unclear. Western blotting and RT-qPCR were used to assess protein and mRNA levels, respectively. CCK8 assay was performed to assess cell viability, and cell apoptosis was assessed using flow cytometry. A dual-luciferase assay was performed to assess the relationship between miR-124-3p and TRAF6 expression. Furthermore, in vivo experiments were performed to test the function of exosomes derived from Quercetin-treated BMSCs in OA patients. IL-1β significantly inhibited the viability of chondrocytes, whereas the conditioned medium of Quercetin-treated BMSCs (BMSCsQUE-CM) reversed this phenomenon through exosomes. IL-1β notably upregulated MMP13 and ADAMT5 and reduced the expression of COL2A1 in chondrocytes, which were rescued by BMSCsQUE-CM. The effects of BMSCsQUE-CM on these three proteins were reversed in the absence of exosomes. Exosomes can be transferred from BMSCs to chondrocytes, and exosomes derived from Quercetin-treated BMSCs (BMSCsQue-Exo) can reverse the apoptotic effects of IL-1β on chondrocytes. The level of miR-124-3p in BMSCs was significantly upregulated by quercetin, and miR-124-3p was enriched in BMSCsQue-Exo. TRAF6 was identified as a direct target of miR-124-3p, and BMSCsQue-Exo abolished the IL-1β-induced activation of MAPK/p38 and NF-κB signaling. Furthermore, BMSCsQue-Exo significantly attenuated OA progression in vivo. Exosomes derived from Quercetin-treated BMSCs inhibited OA progression through the upregulation of miR-124-3p.

BackgroundTotal dislocation of the talus from all its surrounding joints (talonavicular, tibiotalar, subtalar) is one kind of serious injury of the lower extremity with rare occurrence. It is usually accompanied by fractures of the talus and its periphery, as well as severe soft tissue injury, which is difficult to reset. Complications such as skin necrosis and infection are prone to occur in the early stage, and talus necrosis are prone to occur in the late stage, all of which aggravate disease severity and increase difficulties for its treatment.Case PresentationHerein, we reported a case of right talus total dislocation accompanied by medial malleolus fracture and posterior tubercle fracture caused by traffic accident. One hour after injury, the doctor tried to perform manual reduction but failed. Then, we successfully performed manual reduction and plaster external fixation on this patient under anesthesia 6 h after injury, followed by the oral administration of Chinese medicine for 3 months. Twenty months of follow‐up investigations revealed that no skin necrosis, talus dislocation, talus necrosis, or other complications occurred; no obvious joint degeneration was observed and the fractures of medial malleolus and talus healed well. MRI of ankle joint indicated the disappearance of ankle effusion caused by injury, and the bone marrow edema had also subsided at talus, medial malleolus, and lateral malleolus and calcaneus. Patient presented with no ligament relaxation, ankle instability, pain, swelling, or functional limitation of the injured limb. AOFAS score reached 100. Daily functions and recreation activities were recovered back to the normal level.ConclusionFor patients with closed total dislocation of the talus, fine therapeutic effects can be achieved by early closed manual reduction and plaster external fixation under anesthesia, in combination with oral Chinese herbal medicine afterwards. It is worthy of reference for clinicians.

目的 探讨股骨近端防旋髓内钉(PFNA)治疗老年股骨粗隆间骨折术后功能康复的影响因素.方法 回顾性分析2016年1月至2021年10月于北京中医药大学第三附属医院接受PFNA手术治疗的220例老年股骨粗隆间骨折患者的临床资料.根据术后半年髋关节Harris评分将患者进行分组,其中评分≥80分为疗效优良组,评分＜80分为疗效一般组.对两组性别、年龄、骨折分型、手术时间、手术时机、体重指数、美国麻醉医师协会(ASA)分级进行单因素分析,并对有统计学意义的指标进行多因素回归分析,以明确PFNA治疗老年股骨粗隆间骨折术后功能康复的影响因素.结果 单因素分析结果显示,两组性别、手术时间、体重指数比较,差异无统计学意义(P＞0.05),两组年龄、骨折分型、手术时机、ASA分级比较,差异有统计学意义(P＜0.05).logistic多元线性回归分析结果显示,年龄、手术时机是PFNA治疗老年股骨粗隆间骨折术后功能康复的独立影响因素(P＜0.05).结论 高龄及各种原因延迟手术都将影响PFNA治疗老年股骨粗隆间骨折术后功能康复效果,因此对于上述患者应早期创造条件行手术治疗以提高临床效果.

OBJECTIVE:To evaluate the needle puncture safety and clinical efficacy of manual reduction combined with external fixation of ankle frame in the treatment of trimalleolar fracture under the guidance of Chinese Osteosynthesis (CO) theory.METHODS:The clinical data of 118 patients with trimalleolar fractures admitted from December 2010 to December 2021 were retrospectively analyzed. Fifty-three patients were treated with manual reduction combined with external fixation of ankle frame(observation group). Sixty-five patients were treated with open reduction and internal fixation with plate and screws(control group). The operation time, hospitalization days, non-weight-bearing time of the affected limb, clinical healing time of fracture, incidence of complications, visual analogue scale (VAS) before and 1 month after operation, and American Orthopedic Foot and Ankle Society(AOFAS) score of ankle joint before and 1 year after operation were compared between the two groups.RESULTS:Patients in both groups were followed up for more than 1 year. All patients were followed up, and the duration ranged from 14 to 70 months, with an average of(35.28±14.66) months. There were statistically significant in operation time, hospitalization days, non-load-bearing time of affected limbs, clinical healing time of fractures and VAS score one month after operation between the two groups. One month after operation, the VAS score of the observation group was lower than that of the control group(t=3.343, P=0.001). The operation time of the observation group was significantly shorter than that of the control group(t=9.091, P=0.000). The hospitalization days in the observation group were significantly less than those in the control group(t=5.034, P=0.000). The non-load-bearing time of the affected limb in the observation group was significantly shorter than that in the control group(t=11.960, P=0.000). The clinical healing time of fracture in the observation group was significantly shorter than that in the control group(t=4.007, P=0.000). There was no significant difference in AOFAS score between the two groups one year after operation(t=0.417, P=0.678). In the observation group, there were 2 cases of pinhole infection and 3 cases of loss of reduction less than 2 mm. There were 3 cases of surgical incision infection in the control group. There was no significant difference in the incidence of complications between the two groups(χ2=0.446, P=0.504).CONCLUSION:Manual reduction combined with external fixation is safe and effective in the treatment of trimalleolar fracture under the guidance of CO theory, and the function of ankle joint recovers well after operation. This therapy has good clinical value.

目的:分析膝骨关节炎患者中医证候类型,探寻不同证候膝骨关节炎患者的临床特征.方法:从我院门诊系统中以"膝骨关节病""膝骨关节炎"和"膝痹"为关键词进行检索,并提取28 763例患者的基本信息、就诊日期以及诊断信息,对上述信息进行整理后,按照节气进行统计.结果:患者平均年龄是(64.24±12.60)岁,男女患者比例为1 ∶ 2.4,气滞血瘀证发病率为64.98％,肝肾亏虚证发病率为37.30％,寒湿痹阻证发病率为21.33％,气血虚弱证发病率为1.22％,湿热痹阻证发病率为0.24％;男性在立春和雨水时寒湿痹阻证发病率高,在清明至芒种时段湿热痹阻证发病率与女性相当,其余时段男性发病率略高于女性,在秋分时气血虚弱证发病率高;女性在惊蛰和春分时寒湿痹阻证和气滞血瘀证发病率高,在立春至春分时肝肾亏虚证发病率高.结论:膝骨关节炎是中老年人常见疾病,女性发病率高于男性,不同证型与节气有相关性,男性在立春和雨水时节应注意预防风寒湿邪,在夏季应预防湿热,临近秋分时节应提前补益气血;女性在平时更应注重补益肝肾,在惊蛰和春分时应预防风寒湿邪、调理气血.

目的:基于六经辨证理论探讨葛根汤化裁治疗神经根型颈椎病的临床疗效.方法:回顾性分析2020年3月至2021年9月就诊神经根型颈椎病患者116例.所有患者均采用葛根汤化裁口服治疗,治疗时间最短2周,最长4周,平均(2.91±0.94)周,比较治疗前后疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)及中医疗效指标.结果:治疗后VAS评分、颈椎功能障碍指数与治疗前相比,差异有统计学意义(P＜0.01).根据中医疗效指标评估结果:痊愈40例,显效54例,有效14例,无效8例,总有效率为93.10％.结论:基于六经辨证运用葛根汤化裁能缓解神经根型颈椎病的临床症状,具有较好的临床疗效.

目的:观察桃红四物汤十五苓散口服治疗踝关节骨折术后肿胀的临床疗效.方法:回顾性分析2018年1月至2019年1月采用桃红四物汤十五苓散口服治疗25例踝关节骨折术后患者病例资料,男13例,女12例;年龄28?65岁,平均(46.0士3.5)岁.全部行切开复位内固定术,术后第1?7天口服桃红四物汤十五苓散,观察术后第1,3,5,7天患肢的肿胀程度及疼痛减轻程度,并评定临床疗效.结果:肿胀值术后第1,3,5,7天分别为(4.89士1.09)cm,(3.82士0.64)cm,(2.93士0.42)cm,(1.65士0.46)cm,治疗前后差异有统计学意义(P＜0.05),说明患肢的肿胀程度明显减轻.疼痛视觉模拟评分(VAS):术后第1,3,5,7天分别为7.80士0.84,5.41士0.83,3.68士0.54,1.45±0.73,治疗前后差异有统计学意义(P＜0.05),说明患肢的疼痛程度明显减轻.临床疗效:显效18例,有效3例,无效4例,总有效率为84.00％.结论:桃红四物汤十五苓散口服能够减轻踝关节骨折术后肿胀及疼痛,有利于早期康复,值得推广应用.

目的 观察生肌玉红膏治疗跟骨骨折术后切口愈合不良的临床疗效.方法 选取2018年12月-2020年5月北京中医药大学第三附属医院及中国人民解放军陆军第八十集团军医院收治的72例跟骨骨折术后切口愈合不良患者,采用随机数字法分为试验组36例和对照组36例,试验组采用生肌玉红膏换药,对照组采用凡士林换药,2组均治疗4周.观察2组治疗不同时间点创面视觉模拟疼痛(VAS)评分、创面面积、创面愈合时间及治疗4周后创面愈合率、临床疗效、不良反应发生情况.结果 对照组脱落1例;对照组治疗后VAS评分均随治疗时间延长逐渐提高(P均＜0.05),试验组随治疗时间延长,VAS评分先增高,而后降低,试验组换药第7次VAS评分明显高于对照组(P＜0.05),治疗第14次时VAS评分明显低于对照组(P＜0.05).2组创面面积均随治疗时间延长逐渐缩小(P均＜0.05),且试验组各时间点创面面积均小于同期对照组(P均＜0.05);治疗4周后试验组的创面愈合率和总有效率均显著高于对照组(P均＜0.05).2组均未发现不良反应.结论 生肌玉红膏能够增加跟骨骨折术后切口愈合不良患者对疼痛的敏感度,促进创面早期愈合,愈合率高,且愈合时间明显缩短.

由于受到医疗条件限制,过去许多髌骨不稳(Patellofemoral Instability,PI)的患者未能被及时确诊.随着X线的普及使用,现代解剖学及生物力学的发展,该病逐渐被临床医师认识而被诊断[1].髌骨不稳主要发生于20～30岁年轻人,发病率为13％～27％,而女性的发病率是男性的2～4倍,运动员的发病率可高达40％[15].虽然多种原因都可以导致髌骨不稳,但是目前认为髌股关节运动轨迹、对应关系失常,是发生髌骨不稳的最主要原因[6-7].髌骨不稳的患者在屈膝运动过程中,由于髌股韧带内、外侧肌力不平衡,导致膝关节周围疼痛,甚至可以出现膝关节不稳、打软腿[3],患者通常伴有髂胫束紧张而影响蹲起活动[6].由于髌骨倾斜度增加,髌股关节内侧接触面积减小,应力主要集中于外侧髌股关节面,导致髌股关节软骨退变,最终发生膝骨关节病[8-10].

目的:观察耳穴压豆法对缓解跟骨骨折术后疼痛的临床疗效.方法:选取跟骨骨折行外侧L形入路切开复位术后的患者72例,采用随机数字表法分为对照组与治疗组,对照组和治疗组各36例.对照组采用静脉镇痛泵、冰敷,治疗组采用静脉镇痛泵、冰敷联合耳穴压豆.治疗7 d后采用疼痛视觉模拟评分(VAS)评定跟骨骨折术后疼痛改善情况,记录术后止痛药物服用与不良事件发生情况,调查患者满意率.结果:71例患者获得随访.VAS评分:时间因素与分组因素存在交互效应,且术后1～7 d治疗组止痛效果优于对照组,差异有统计学意义(P＜0.0 5).止痛药物服用率:治疗组5.5 6％,对照组97.14％,差异有统计学意义(P＜0.05).不良反应发生率:治疗组13.89％,对照组74.29％,差异有统计学意义(P＜0.05).患者满意率:治疗组91.67％,对照组85.71％,差异有统计学意义(P＜0.05).结论:耳穴压豆法治疗跟骨骨折术后止痛效果良好,止痛药物服用率低,不良反应发生率低,患者满意度高,值得临床推广应用.

目的 观察电针深刺"腰突五穴"治疗腰椎间盘突出症的疗效和安全性.方法 采用前瞻性队列研究的方法,将187例腰椎间盘突出症患者根据其接受的治疗方式分为2组.对照组87例(后脱落8例)采用西医保守治疗,治疗组100例(后脱落4例)采用电针深刺"腰突五穴"治疗.2组均隔日治疗1次,6次为1个疗程,连续治疗2个疗程.比较2组治疗前及治疗6、12次疼痛视觉模拟评分(VAS),治疗6、12次镇痛率,治疗6、12次日本骨科协会(JOA)下腰痛评分改善率及分级情况,并统计患者满意度及不良事件发生率.结果 治疗6、12次2组疼痛VAS均较本组治疗前降低(P<0.05),且治疗6、12次治疗组均低于对照组同期(P<0.05).治疗6、12次治疗组镇痛率60％ ～89％、30％ ～59％、<30％均优于对照组同期(P<0.05).治疗6、12次治疗组JOA下腰痛评分改善率均高于对照组(P<0.05).治疗6、12次治疗组JOA下腰痛评分改善率60％ ～89％、25％ ～59％、<25％均优于对照组同期(P<0.05).2组不良事件发生率比较差异无统计学意义(P>0.05),治疗组患者满意度高于对照组(P<0.05).结论 电针深刺"腰突五穴"可缓解腰椎间盘突出症患者的腰痛程度,改善腰椎功能,疗效和患者满意度均优于西医常规治疗.

目的:探讨在仰卧定点复位法中术者沿水平横向发力与斜向发力对神经根型颈椎病患者的临床疗效差异.方法:将63例神经根型颈椎病患者随机分为两组,旋转复位组手法采用水平横向发力,旋推复位组手法采用斜向发力,采集首次就诊及治疗2周后的模拟视觉评分(VAS评分)、颈椎功能障碍指数(NDI指数).结果:两组神经根型颈椎病患者在治疗2周后均能使VAS评分及NDI指数评分得到显著改善(P＜0.01),且旋推复位组改善显著优于旋转复位组(P＜0.01).结论:仰卧定点复位法中采用旋推复位法治疗神经根型颈椎病能够在2周的治疗时间内,缓解疼痛、改善颈椎功能,该方法能够较传统旋转复位法取得更显著的临床疗效.

目的 观察复元活血汤加减联合常规抗血栓治疗对股骨颈骨折人工全髋关节置换术后患者血液高凝状态及深静脉血栓形成(DVT)的影响.方法 将116例股骨颈骨折人工全髋关节置换术患者按照随机数字表法分为2组,对照组56例术后予常规抗血栓治疗,治疗组60例在对照组治疗基础上加用复元活血汤加减治疗,连续治疗14 d.比较2组术前及术后3、7、14 d凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和血浆D-二聚体(D-D)水平及术后2周DVT发生率,比较2组术后输血量、48 h引流量及术后3d大腿、小腿周径,术后3、7、14 d血栓溶解疗效,术后6个月关节功能疗效.结果 治疗组术前和术后3、7、14 d凝血指标及血浆D-D水平两两比较差异均有统计学意义(P＜0.05),随着术后时间的延长,PT、APTT明显延长,FIB、TT、D-D水平明显下降;对照组术后7、14 d凝血指标及术后3、7、14 d血浆D-D水平与本组术前比较差异均有统计学意义(P＜0.05),且术后7、14 d凝血指标和D-D水平与本组术后3d比较差异有统计学意义(P＜0.05);治疗组术后第3、14dPT、APTT长于对照组(P＜0.05),FIB、TT、D-D水平低于对照组(P＜0.05);术后7d,治疗组PT、FIB、TT与对照组同期比较差异有统计学意义(P＜0.05).2组术后输血量及术前大腿、小腿周径比较差异无统计学意义(P＞0.05),治疗组术后48 h引流量低于对照组(P＜0.05);2组术后3d大腿、小腿周径均较本组术前明显增加(P＜0.05),但治疗组小于对照组(P＜0.05).治疗组术后第3、7、14 d血栓溶解总有效率分别为77.77％、88.89％、94.44％,对照组分别为55.17％、65.52％、68.96％,治疗组术后第7、14 d血栓溶解总有效率明显高于对照组(P＜0.05).术后6个月,治疗组关节功能总优良率(95.00％)高于对照组(80.36％,P＜0.05).结论 复元活血汤加减联合常规抗血栓治疗能显著降低股骨颈骨折人工全髋关节置换术术后患者血液高凝状态,降低血液黏稠度,促进血栓溶解和血管再通,降低DVT发生率.

OBJECTIVE:To study soft tissue changes observed through musculoskeletal ultrasound (MSUS) in the treatment of knee osteoarthritis with needle-knife, so as to provide MSUS basis for needle-knife in the treatment of knee osteoarthritis.METHODS:Forty patients with knee osteoarthritis treated in the Third Affiliated Hospital of Beijing University of Chinese Medicine from December 2011 to December 2012 were selected according to inclusion and exclusion criteria. All the patients were treated with needle-knife release method. The VAS scores and knee joint circumference were recorded before treatment and 2 weeks after treatment. The changes of knee joint hydrops articuli and joint synovial thickness were measured through MSUS.RESULTS:The knee pain index was 6.850 +/- 1.417 before treatment and 2.790 +/- 1.299 after treatment;the index after treatment was lower than that of before treatment. The knee joint circumference was 407.320 +/- 45.151 mm before treatment and 391.240 +/- 41.129 mm after treatment; the knee joint circumference decreased after treatment. The amount of hydrops articuli observed by musculoskeletal ultrasound showed that 47 knees were cured, 19 knees improved and 2 knees failed. The synovial membrane thickness: 43 knees cured, 17 knees improved and 8 knees failed.CONCLUSION:The hydrops articuli and synovial thickness of knee joint of patients with knee osteoarthritis observed under the MSUS is consistent with the main symptoms and signs, which suggests that MSUS observation on soft tissue changes before and after needle knife in the treatment of knee osteoarthritis with high reliability.

经皮给药系统近年来发展迅速,随着促渗剂的改进、以及离子导入、激光、电致孔、超声导人等新技术的发展,低频超声经皮促透药物广泛应用于临床实践,并引起了研究者的研究兴趣.本文就低频超声的作用机制、影响作用效益的因素、动物实验研究以及安全性评估展开综述.

转化医学(Translation Medicine)的概念自从1992年提出以来,已成为医学研究领域的一个热点问题.转化医学的核心是打破基础医学、药物研究、临床医学之间的屏障,在它们之间建立起联系,从实验室到病床,把基础研究获得的知识和成果,快速转化到临床,成为对疾病新的诊断和治疗方法,提高疾病的诊治水平[1].中医药领域的学者利用其发展模式、研究方法已开展对中医药的研究. 中医骨伤科学历史悠久,疗效显著,对骨折、脱位、颈肩腰腿痛等运动系统疾病有着丰富的诊疗经验,取得了较好的疗效.回顾其近半个世纪的发展历程,成绩巨大,尤其是骨折外固定器的研制代表了同时期的中国骨科的最高水平.近十几年来,中医骨伤科发展步伐减缓,与人民群众的现实需要,与整个医学的快速发展,仍然存在着较大的差距.

Objective To observe the clinical curative effects of self-made Jianbu Decoction for external washing in the treatment of knee osteoarthritis with syndrome of cold-damp obstructing the collaterals(KOA).Methods 60 patients with knee osteoarthritis of syndrome of cold-damp obstructing the collaterals were randomly divided into the Jianbu Decoction for external washing group(Chinese medicine external washing group) and the Voltaren Ointment for external coating group(control group).The Chinese medicine external washing group used self-made Jianbu Decoction for the external washing of knee joint twice per day and 30 minutes per time while the control group used Voltaren Ointment for external coating twice per day,with 14 days as one treatment course.With the WOMAC score as the evaluation standards,the curative effects of both groups were observed.Results After treatment,the pain,physical function,stiffness scores and other scores significantly reduced compared with those before treatment(P 0.05).One week later,the pain,physical function,stiffness scores and other scores between the two groups showed no statistically significant differences(P 0.05).Two weeks later,the pain,physical function,stiffness scores and other scores between the two groups showed no statistically significant differences(P 0.05).Conclusion The self-made Jianbu Decoction for external washing has similar curative effects with the control group in the treatment of KOA of syndrome of cold-damp obstructing the collaterals after one week,but has superior curative effects to the control group after two weeks.The self-made Jianbu Decoction for external washing has positive curative effects in the treatment of KOA,thereby worthy of promotion and further research into its mechanism.

Objective To observation the effect on the Zhongtong'an Capsule and Duyiwei Capsule in the treatment of knee osteoarthritis with the syndrome of phlegm and blood stasis.Methods 120 patients with knee osteoarthritis with the syndrome of phlegm and blood stasis were divided into treatment group and control group,treatment group and control group were given Zhongtong'an Capsule and Duyiwei Capsule respectively,2 grains,3 times a day.Symptoms and signs score,WOMAV score,general efficacy of two groups were observed before and after treatment.Results There were no significant differences in Symptoms and signs score and WOMAV score between the two groups before treatment and after treatment of 2 weeks(P 0.05).There were significant differences in Symptoms and signs score and WOMAV score after treatment(P = 0.047,0.035).there was significant difference in the general efficacy between the two groups after treatment(P = 0.041).Conclusion Zhongtong'an Capsule has a better effect in the treatment of knee osteoarthritis with the syndrome of phlegm and blood stasis,which compared with Duyiwei Capsule,so it is worthy to be popularized and studied its mechanism of action.