Bone marrow mesenchymal stem cells (BMSCs) have chondrogenic differentiation potential to treat cartilage injury. N6 methyladenosine (m6A), one of the most prevalent mRNA modifications, has been reported to be crucial in cartilage disease. Herein, we further investigated the effects and underlying mechanisms in the modification of m6A on the chondrogenic differentiation of MSCs. This study showed that the m6A level was decreased in the chondrogenic differentiation of MSCs and m6A mRNA demethylation fat mass and obesity-associated protein (FTO) played an important role in these processes. The overexpression of FTO has been demonstrated to improve the levels of chondrogenic markers. We confirmed that FTO directly bound to SMAD3 mRNA and increased its demethylation, which promoted the chondrogenic differentiation of MSCs. We further indicated that the m6A "reader" YTHDF2 was probably related to the chondrogenic differentiation of MSCs. SiFTO attenuated the SiYTHDF2-increased mRNA stability of SMAD3, leading to the declining levels of chondrogenic markers. Collectively, these results reveal FTO could act as an important mediator of SMAD3 mRNA demethylation and improve the chondrogenic differentiation of MSCs.

Varus mechanical alignment of the knee is a recognized contributor to medial compartment osteoarthritis (OA). Medial meniscus tears (MMT) frequently occur with knee OA. The present study aimed to analyze the association between mechanical alignment and MMT. We retrospectively analyzed 201 knee joints from patients with knee pain who underwent whole-leg weight-bearing radiographs and magnetic resonance imaging (MRI). Mechanical alignment was quantified using the hip–knee–ankle angle (HKAA), measured independently by two radiologists with excellent interrater reliability (intraclass correlation coefficient = 0.93). MMTs were assessed on MRI with high diagnostic agreement (κ = 0.87). Based on MRI findings, participants were classified into two groups: those with MMT (n = 104) and those without MMT (n = 97). Group comparisons were performed using t-tests and chi-square tests. Patients with MMT had greater varus alignment (HKAA: −6.2 ± 3.4 vs. −2.4 ± 1.4 degrees, p < 0.001), were older (53.7 ± 8.3 vs. 49.3 ± 9.0 years, p < 0.001), and had higher body mass index (26.6 ± 3.0 vs. 25.2 ± 2.4 kg/m2, p = 0.001). Sex distribution did not differ between groups (p = 0.479). Logistic regression identified HKAA as the only independent predictor of MMT. When entered as a continuous variable, each additional degree of varus increased the odds of MMT nearly 2-fold (adjusted OR = 2.01, 95% confidence interval [CI]: 1.64–2.47, p < 0.001). The complementary binary analysis showed that patients with varus alignment had over a 3-fold higher risk of MMT compared with those with neutral or valgus alignment (OR = 3.25, 95% CI: 1.85–5.72, p < 0.001). Posterior horn tears were the most common subtype (47.1%), followed by multisite tears (33.7%). MMTs are strongly associated with varus mechanical alignment. Each incremental degree of varus increased the likelihood of MMT, and posterior horn tears were the most prevalent subtype. These findings highlight the pivotal role of mechanical alignment in the prevention, early detection, and management of MMT.

Bone marrow mesenchymal stem cells (BMSCs) possess the potential to differentiate into cartilage cells. Long noncoding RNA (lncRNAs) urothelial carcinoma associated 1 (UCA1) has been confirmed to improve the chondrogenic differentiation of marrow mesenchymal stem cells (MSCs). Herein, we further investigated the effects and underlying mechanisms of these processes. The expression of UCA1 was positively associated with chondrogenic differentiation and the knockdown of UCA1 has been shown to attenuate the expression of chondrogenic markers. RNA pull-down assay and RNA immunoprecipitation showed that UCA1 could directly bind to PARP1 protein. UCA1 could improve PARP1 protein via facilitating USP9X-mediated PARP1 deubiquitination. Then these processes stimulated the NF-κB signaling pathway. In addition, PARP1 was declined in UCA1 knockdown cells, and silencing of PARP1 could diminish the increasing effects of UCA1 on the chondrogenic differentiation from MSCs and signaling pathway activation. Collectively, these outcomes suggest that UCA1 could act as a mediator of PARP1 protein ubiquitination and develop the chondrogenic differentiation of MSCs.

Background: High tibial osteotomy (HTO) can cause postoperative hemorrhage. The use of tranexamic acid to reduce the hemorrhage is still controversial. Purpose: To investigate the efficacy and safety of tranexamic acid in HTO. Study Design: Systematic review; Level of evidence, 4. Methods: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors conducted a comprehensive search of the Embase, Cochrane Library, PubMed, Web of Science, MEDLINE, and Foreign Medical Literature Retrieval Service databases between their inception and January 1, 2023. All clinical studies comparing the use of tranexamic acid versus no tranexamic acid during HTO were collected. The primary outcome measures were hemoglobin decrease, drainage volume, and blood loss, and the secondary outcome measures were wound complications, blood transfusion, and postoperative thrombosis. All indicators were analyzed using meta-analysis software. Results were reported as mean differences or risk ratios with 95% confidence intervals. Results: Of 152 initial results, 9 studies involving 908 patients were included. The tranexamic acid group had lower indicators for total blood loss, hemoglobin decrease, and total drainage volume ( P < .00001 for all). There were no differences between patients with versus without tranexamic acid in wound complications, including hematoma ( P = .21) or infection ( P = .18), nor were there any group differences in the prevalence of blood transfusion ( P = .21) or postoperative thrombosis ( P = .36). Conclusion: Tranexamic acid was able to effectively reduce postoperative hemorrhage in patients undergoing HTO without affecting the rates of wound complications, blood transfusion, or postoperative thrombosis.

ObjectiveThis study was conducted to explore the main indicators of ultrasonic shear wave elastography (SWE) for the diagnosis of osteoarthritis (OA) and its influencing factors.MethodsWe collected 910 patients between January 2018 and November 2023 from the department of ultrasound, Third Hospital of Hebei Medical University. Logistic regression was used to analyze the effects of age, gender, body mass index (BMI), smoking, alcohol, hypertension and diabetes on the diagnosis of OA by SWE.ResultsThe results showed that medial meniscal projection distance (MMPD) and OA had a positively correlated dose–response relationship (OR = 2.12, 95%CI (1.53, 3.95), trend p < 0.05). Also, medial meniscus elastometry (MME) had a positive dose–response correlation with OA (OR = 8.98, 95%CI (3.89, 11.52), trend p < 0.05). In addition, regarding the analysis of factors influencing the diagnosis of OA, the risk of OA was significantly higher in the older age group [OR = 1.11, 95%CI (1.01, 1.25)], and the risk of diagnosis in OA was high in the high BMI group [OR = 1.8, 95%CI (1.23, 3.01)].ConclusionIn diagnosing OA, MMPD and MME can be used as reliable indicators, while people of advanced age and high BMI have a high possibility diagnosed with OA.

Objective:To compare the efficacy of intraarticular injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) in the treatment of K-L stage Ⅰ-Ⅲ knee osteoarthritis (KOA).Methods:A total of 100 patients with stage Ⅰ-Ⅲ KOA admitted to the joint department of the Third Hospital of Hebei Medical University were prospectively collected and divided into 2 groups by random number table method between January 2020 and August 2021. Finally, 96 patients in PRP group (n=46 cases) and HA group (n=50 cases) met the atretic criteria. The patients of two groups received intra-articular injection of PRP (5 ml) or HA (2 ml) once a week for 4 consecutive times. All patients received the same rehabilitation training and life guidance after treatment, and received regular follow-up for at least 12 months. The demographic data of the enrolled patients were recorded, and were divided into 2 subgroups: <30 kg/m2 and ≥30 kg/m2 according to the BMI. The VAS, WOMAC, HSS scores and 2-minute walking test (2MWT) were used to evaluate the clinical efficacy of the two groups before treatment and 1, 3, 6 and 12 months after treatment, respectively.Results:The degree of knee pain and function were improved in both groups after intraluminal injection of PRP or HA. In the subgroup of BMI<30 kg/m2, there were statistically significant differences in VAS score at 6 and 12 months after PRP injection compared with HA injection (1.4±0.8 vs. 1.9±0.7, P=0.014; 1.0±0.6 vs. 1.4±0.8, P=0.028); The WOMAC (45.4±7.7 vs. 28.3, P<0.001; 19.6±5.1 vs. 25.5±3.5, P<0.001; 19.6±5.1 vs. 18.5±4.5, P=0.002), HSS scores (80.9±6.3 vs. 76.2±6.7, P=0.001; 86.3±5.4 vs. 80.4±5.9, P<0.001; 91.4±3.5 vs. 88.6±4.2, P=0.001) and 2MWT results (134.6±15.5 vs. 122.5±20.4, P=0.002; 134.6±15.5 vs. 129.0±23.2, P=0.041; 139.8±12.6 vs. 130.8±20.3, P=0.012) at 3, 6 and 12 months after treatment were better than those in HA group, with significant differences. In the subgroup of BMI≥30 kg/m2, there were no significant differences in VAS, WOMAC, HSS scores and 2MWT results between patients receiving PRP injection and patients in HA group at all treatment stages (P>0.05).Conclusions:Intraarticular injection of PRP in knee joint has a good therapeutic effect on non-obese KOA patients of stage Ⅰ to Ⅲ, and can improve pain and knee joint function in effective patients. Compared with patients treated with HA, PRP treatment can improve knee joint function more significantly after 3 months and relieve pain more significantly after 6 months, which is worthy of clinical application.

ABSTRACT:Metastases of prostate carcinoma in the skeleton are usually multiple. Solitary metastasis in appendicular skeleton is extremely rare. We present bone scan findings of solitary scapular metastasis from prostate adenocarcinoma as the initial presentation of his malignancy in a 62-year-old man. The 99mTc-MDP SPECT/CT demonstrated intense activity in the coracoid process of left scapula, whereas the tracer uptakes in other bones were not typical of metastases. The subsequent pathological results of the punctured left scapula confirmed as metastasis from prostate adenocarcinoma.

The aim of this was to investigate the efficacy of physical exercise (leg swing and quadriceps strengthening exercises) versus platelet-rich plasma (PRP) and hyaluronic acid (HA) combination therapy. From January 2020 to August 2021, 106 patients with Kellgren-Lawrence Grade I-III knee osteoarthritis were divided into leg swing and quadriceps strengthening exercises (Group A) and intra-articular combination injections of PRP and HA (Group B) according to the treatment strategies. Patients in Group A received regular leg swing and quadriceps strengthening exercises for 3 months. Patients in Group B received 2 intra-articular combination injections of PRP (2 mL) and HA (2 mL) every 2 weeks. The primary outcome measures were the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities (WOMAC) score. Secondary outcomes included single leg stance test and functional activity by 2-minute walk test and time up and go test. All outcomes were evaluated at baseline and again 1, 3, 6, and 12 months. The VAS and WOMAC scores were similar in both groups at 1 and 3 months after treatment (P > .05); however, Group A patients had significantly superior VAS and WOMAC scores than Group B patients at 6 and 12 months after treatment. For the single leg stance test, 2-minute walk test, and time up and go test, Group A patients were significantly superior to Group B throughout follow-up (P < .001). The leg swing and quadriceps strengthening exercises resulted in a significantly better clinical outcomes than the combined PRP and HA therapy, with a sustained lower pain score and improved quality of life, balance ability, and functional activity within 12 months.

Objective: The aim of our study was to evaluate the effect of tear and repair of the lateral meniscal posterior root (LMPR) on the patellofemoral contact pressure of the knee after anterior cruciate ligament (ACL) reconstructed. Methods: This was a descriptive study. Six fresh-frozen cadaveric knees collected by The Third Hospital of Hebei Medical University from January 2019 and January 2022 were placed on a customized testing rig. Patellofemoral contact pressures were measured at 30°, 60°, and 90° of flexion using pressure-sensitive film inserted between the patella and trochlea. The following knee states were tested: ACL reconstruction and intact lateral meniscus, ACL reconstruction, and LMPR tear, and ACL reconstruction and LMPR repair. Pressure measurements were recorded for each state. Result: In the ACL-reconstructed knee, a tear of the LMPR increased patellofemoral contact pressure at 30° of knee flexion. The repair of the posterior root by transosseous pull-out suture reduced the patellofemoral contact pressure as the status of intact lateral meniscal posterior root at 30° of knee flexion. There was no statistical difference between ACL reconstruction with the intact meniscal root and with the meniscal root tear and with the meniscal root repair at 60° and 90° of knee flexion. Conclusion: The posterior root tear and repair of the lateral meniscus could have an influence on patellofemoral contact stress of the knee after ACL reconstruction at 30° of knee flexion.

Abstract Background The surgical technique for treatment of tibial avulsion fractures of the posterior cruciate ligament (PCL) remains challenging due to the deep-located lesion and the complexity of the anatomy. The purpose of this study was to report preliminary results of an arthroscopic technique in patients with the “hinged” type PCL tibial avulsion fractures. Methods Twenty-eight patients with the displaced “hinged” fractures with elevation of the posterior aspect of the bony fragment were arthroscopically treated. The bony fragment was reducted and fixed with the sutures passing through only one single tibial tunnel. The clinical outcomes were assessed by Lysholm score, Tegner activity score, and the side-to-side differences of KT-1000 measurement. The reduction and union of the fracture were assessed by radiography of the knee. Results Patients were followed up for a mean of 19 (12 to 24) months. There were no surgery-related complications, and all patients regained normal range of motion of the knees at the last follow-up. The Lysholm score significantly increased from preoperative 14.78 ± 8.23 to postoperative 96.96 ± 3.62 (P = 0.000). The Tegner score was 6.78 ± 1.35 pre-injury and 6.48 ± 1.20 at the last follow-up with no statistical difference (P = 0.688). The KT-1000 side-to-side differences significantly decreased from 8.26(SD 1.86; 6 to 12) pre-operatively to 0.91 (SD 0.85; 0 to 3) (P = 0.000). X-rays showed that satisfactory reduction and solid union was achieved in all patients. Conclusion The arthroscopic suture fixation through single-tibial tunnel technique yielded good clinical and radiographic outcome for treatment of displaced “hinged” type of PCL avulsion fractures.

Objective To confirm whether a novel sagittal patellar angle linear equation used for evaluating patellar height by calculating expected sagittal patellar angle (SPA) at any degree of knee flexion angle is suitable for patients older than 17 years and its reliability compared with other commonly used methods. Methods From September 2016 to September 2019, a total number of 202 consecutive outpatients' knee lateral X‐ray radiographs were retrospectively measured and evaluated using a recently proposed linear equation Y = 1.94 + 0.74 × knee flexion(KF) angle. Patients were divided by ages into ayounger group, whose ages were between 17–49 years, and an older group, whose ages were older than 49 years, which has not been validated in the original study. Parameters such as KF, SPA, patella and patella tendon length and so on were measured on computer with picture archiving and communication system by two independent observers at an interval of 1 month. Insall‐Salvati (IS) index, Caton‐Deschamps (CD) index and Y value, correlation coefficients were calculated and compared using SPSS 22.0 software. Results In the younger group, 143 patients (165 knees) were included, ages were 17–49 (31.62 ± 11.38) years, males/females were 70 (48.95%)/73 (51.05%), left knees/right knees were 83 (50.30%)/82 (49.70%), mean value of Y was 31.50° ± 10.07°, and SPA was 34.38° ± 12.38°, mean value of IS was 1.06 ± 0.17, mean value of CD was 1.04 ± 0.18. While in older group, 59 patients (78 knees) were included, ages were 50–60 (mean 54.61 ± 2.99) years, there were 32 males (54.24%) and 27 females (45.76%), 42 knees were left (53.85%) and 36 knees were right (46.15%), mean values of Y and SPA were 25.90° ± 11.55° and 29.36° ± 14.22°, mean IS index in older group was 1.06 ± 0.18, mean CD index was 1.00 ± 0.16. Intra‐ and inter‐observer reliabilities of Y in younger and older groups were 0.999, 0.999, 1.000 and 0.999, meaning high reliability and reproducibility, but low Pearson's correlation coefficients with IS and CD index were showed as −0.213 and − 0.216 in younger group and − 0.113 and − 0.316 in older group. Conclusions In patients older than 17 years, the linear equation Y = 1.94 + 0.74 × KF is a reliable and practical method to evaluate SPA regardless of age and knee flexion angle, but has weak correlation coefficients with the IS and CD index.

Background Depression has been shown in some studies to be associated with knee pain. Females were widely recognized as more vulnerable to depression and knee pain than males. However, the role of sex in this correlation was under-researched. This study aimed to investigate the association between depressive symptoms and subsequent knee pain, as well as whether and how sex would moderate this association based on a four-wave (Wave 1 in 2010–2011, Wave 2 in 2013, Wave 3 in 2015, and Wave 4 in 2018) longitudinal study among middle-aged and elderly Chinese adults. Methods Seventeen thousand seven hundred eight participants were recruited and followed in the China Health and Retirement Longitudinal Study (CHARLS). Ten thousand four hundred fifty-one entered the final analysis based on the inclusion and exclusion criteria. Knee pain was assessed by self-report. Depressive symptoms were evaluated using the validated 10-item Center for Epidemiological Studies-Depression Scale (CESD-10). Cox proportional hazards models were used to calculate hazard ratios with 95% confidence intervals (CIs) after controlling potential confounders to examine the association between depressive symptoms and subsequent incident and persistent knee pain. Non-linear association of depressive symptoms score (CESD-10) and risk of knee pain was also investigated via applying 3-knotted restricted cubic spline regression. An interaction term of depressive symptoms status and sex was added to investigate the moderating effect of sex on the relationship between depressive symptoms status and the risk of knee pain. Results The median follow-up time was seven years for all the outcomes. Participants with depressive symptoms were 1.45 times (95% CI: 1.34–1.56) and 2.16 times (95% CI: 1.85–2.52) more likely to develop the incident and persistent knee pain after multivariable were adjusted, compared with those without depressive symptoms. There was a non-linear association between CESD-10 score and risk of knee pain. Compared with females, males had an enhanced correlation between depressive symptoms status and knee pain (multivariable-adjusted HR: 1.22, 95% CI: 1.05–1.42 and HR: 1.57, 95% CI: 1.14–2.17 for the incident and persistent knee pain, respectively). Conclusion Depressive symptoms are independently associated with an excess risk of knee pain, with a stronger correlation for males than females among middle-aged and elderly Chinese adults.

Evidence from high-income countries suggests that depressive symptoms may mediate the relationship between smoking and pain. However, the relationship remains poorly understood for the population in low- and middle-income countries (LMICs), who account for 80% of the current tobacco consumers. Using cross-sectional data from a nationally representative longitudinal survey in China, this study conducted the mediation analysis within the structural equation model (SEM) framework. It tested the indirect effect using the Monte Carlo method. Among the 16,575 participants, 29.2% (n = 4,839) reported being current smokers, 8.5% (n = 1,412) being former smokers, and 62.3% (n = 10,324) being never smokers. Phenotypic characteristics of smokers revealed some distinct characteristics concerning smoking rates, gender, and education attainment compared with results from high-income countries. Besides, current smokers reported significantly higher pain severity than never and former smokers and more depressive symptoms compared with never smokers. The mediation analysis indicated that the self-reported pain was mediated by depressive symptoms 62.7% of the association with smoking and 82.1% of the connection to the number of years quit. However, no mediation effect of depressive symptoms was found for the relationship between the amount smoked and pain severity. This study may fill the literature gap in examining depressive symptoms' mediating role in the relationship between smoking and pain severity for LMICs.

Melatonin is crucial for protecting neural stem cells (NSCs) from reactive oxygen species (ROS). However, the mechanism underlying these processes is unclear. In this study, we first investigated the significantly upregulated lncRNA MEG3 biomarker in the H2O2-induced NSCs and control groups. Melatonin inhibited the expression of MEG3 by methylation. MEG3 overexpression reversed the positive effects of melatonin on NSCs against H2O2. Furthermore, MEG3 reduced the expression levels of its targeted miRNA-27a-3p, which could be considered a neuroprotective effect. In addition, the elevated miRNA-27a-3p decreased JNK phosphorylation by targeting MAP2K4. Overexpression of MAP2K4 suppressed the neuroprotective effects of miRNA-27a-3p. Therefore, melatonin appeared to protect NSCs from H2O2-induced ROS by modification of the MEG3/miRNA-27a-3p/MAP2K4 axis.

Bone marrow mesenchymal stem cells (BMSCs)-derived exosomes (Exos) have anti-inflammatory and anti-apoptotic functions. miRNA-210 has also been confirmed to play a role in inhibiting proinflammatory cytokines. Herein, we aimed to explore the effects of Exos derived from miRNA-210-overexpressing BMSCs (BMSCs-210-Exos) and the mechanisms by which they provide protection to chondrocytes from lipopolysaccharide (LPS)-induced injury. BMSCs were transfected with or without miRNA-210. Exos substantially improved the proliferation of chondrocytes and inhibited LPS-induced cell apoptosis. Furthermore, BMSCs-210-Exos promoted the proliferation of chondrocytes and prevented LPS-induced cell apoptosis better than BMSCs-Exos not overexpressing miRNA-210. In addition, tumor necrosis factor receptor superfamily member 21 (Tnfrsf21) expression was inhibited and the NF-κB pathway was attenuated by both BMSCs-Exos and BMSCs-210-Exos during LPS-induced chondrocyte injury. Collectively, these results suggest that BMSCs-210-Exos enhance the protection of chondrocytes from LPS-induced injury via the NF-κB pathway.

病例 女,59岁,主因右侧骶尾部疼痛2月加重7天就诊.现病史:患者于2月前无明显诱因出现右侧骶尾部疼痛,劳累后加重,伴右下肢放射痛,休息后可缓解,无明显夜间痛,患者未引起重视,近7天无明显诱因出现疼痛加重,遂就诊于当地医院,CT检查示骶骨占位,现为求进一步诊治而来我院.患者自发病以来,饮食、睡眠及二便均正常.既往史:患者患甲状腺功能亢进症多年,药物治疗,控制尚可.

病例女,12岁,“发现皮肤片状色素沉着12年,间断阴道出血10年,骨痛9年余”为主诉就诊.患者于出生时无明显诱因发现其左颞部、右侧臀部及右下肢皮肤片段不规则状牛奶咖啡斑,未引起重视,出生后40d出现白色阴道分泌物,未予治疗.2岁时家长发现患儿出现少量阴道出血,持续3～4d,伴左侧乳房发育,并可触及硬结,无泌乳及阴毛生长,就诊于我院妇产科,行“左侧卵巢剥离术”,术后病理为“卵巢单纯性囊肿”,术后阴道出血停止.3岁时再次出现阴道分泌物伴左侧乳房发育,双膝关节及左肘关节间断性隐痛,活动后加剧,给予药物治疗,应用1月后阴道分泌物减少,左侧乳房缩小,骨痛无明显缓解.4岁时出现双侧乳房发育,阴道分泌物增多且伴间断性阴道出血,身高增长速度快于同龄儿童,行头部MR检查显示垂体无异常,从此一直给予内分泌及对症治疗后,症状间有好转,此次为复查而入住我院内分泌科.患者一般情况良好,否认家族遗传病史,入院后体格检查示:发育正常,营养中等,左颞部、右侧臀部及右下肢皮肤可见不规则牛奶咖啡斑,脊柱、四肢活动自如,外生殖器无异常.患者为足月顺产,出生时体质量、身高正常.

Abstract Background There is no consensus as to the choice of grafts for primary anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the clinical and second-look arthroscopic outcomes after ACL reconstruction by use of autograft, hybrid graft, and γ-irradiated allograft. Methods Ninety-seven patients who underwent second-look arthroscopy after ACL reconstruction with autografts (28 patients, hamstring autograft), hybrid grafts (32 patients, hamstring autograft augmented with γ-irradiated tibialis anterior tendon allograft), or γ-irradiated allografts (37 patients, tibialis anterior tendons) were included in this study. The clinical outcomes were compared by using Lysholm score, International Knee Documentation Committee (IKDC) score, and Tegner activity score, and the side-to-side differences of KT-1000 measurement. Second-look arthroscopic findings were compared in terms of synovial coverage and graft tension. Results There were no statistical significances among the three groups in Lysholm score, IKDC score, or Tegner activity score (P > 0.05). The KT-1000 examination showed more anterior laxity in the γ-irradiated allograft group than in the autograft or hybrid graft groups (P = 0.006, and P = 0.013, respectively). Two patients in the autograft group, 2 patients in the hybrid graft group and 4 patients in the allograft group were evaluated as graft failure on second-look arthroscopy. The synovial coverage was superior in the autograft group than that in the hybrid graft group or the allograft group (P = 0.013 and P = 0.010, respectively), and was comparable between the hybrid graft group and allograft group (P = 0.876). With regard to graft tension, the autograft group and hybrid group were comparable (P = 0.883) but showed better results than the allograft group (P = 0.011 and P = 0.007, respectively). Conclusion The hamstring autografts and hybrid grafts used for ACL reconstruction produced equal efficacy but provided better knee stability than allografts. In addition, the hamstring autografts showed better synovial coverage than the other two graft types.

病例 女,13岁,主因“外伤后出现左上肢疼痛2d”为主诉就诊.患者于2d前外伤后出现左上肢疼痛、肿胀及活动受限,未行任何治疗而就诊于我院骨科.患者一般情况良好,否认家族遗传病史,入院后体格检查示:腹部膨隆,肝脾肋下可及,质地硬.左上臂轻度肿胀,上臂中段压痛,左肩及左肘关节活动良好.

Objective: To evaluate the effect of promoting knee joint rehabilitation after total knee arthroplasty (TKA) with a rehabilitation training instrument NEO-GAIT. Methods: Sixty patients who received TKA from January 2017 to July 2017 in the Third Hospital of Hebei Medical University were randomly assigned to receive rehabilitation training with continuous passive motion (CPM) or NEO-GAIT with random number (30 cases in CPM group, included 8 males and 22 females; 30 cases in NEO-GAIT group, included 6 males and 24 females). The visual analogue scale (VAS) evaluation of pain, the postoperative range of motion (ROM) of the knee at the 5th and 10th day, and the Hospital for Special Surgery Knee-rating Score (HSS) at 1-month and 3-month follow-up were recorded. The data were compared between the two groups with paired t test. Results: All the patients were followed-up for more than 3 months. The mean VAS in CPM group and NEO-GAIT group on the 5th day was 2.4±1.1, 2.8±1.3, respectively; and it was 2.1±1.1, 2.5±1.2 respectively on the 10th day after the operation (t=-1.618, -1.505, both P>0.05). There was no significant difference in ROM on the 5th day after operation between the 2 groups (84°±12° vs 85°±12°, t=-0.377, P>0.05); however, it was remarkably higher in the NEO-GAIT group (95°±11°) than that in CPM group (88°±8°) on the 10th day after the operation (t=-3.002, P<0.05). The HSS score at 1-month follow-up in CPM group was 72±9, and it was 84±10 in NEO-GAIT group (t=-5.358, P<0.05); but it was comparative between the two groups at the 3-month follow-up (87±5 vs 89±5, t=-1.575, P>0.05). Conclusion: NEO-GAIT plays a more active and effective role in promoting postoperative rehabilitation after TKA than CPM.