目的:分析腰椎管狭窄症(LSS)患者分别采用改良经椎间孔腰椎体间融合术(TLIF)技术、单侧双通道内镜手术的临床疗效.方法:选取2020年2月—2022年2月166例在我院骨科行手术治疗的LSS患者,以双盲交叉法分为TLIF组(86例)、内镜治疗组(80例),前者采用改良TLIF技术治疗,后者采用单侧双通道内镜手术治疗,观察两组临床指标变化.结果:与TLIF组比较,内镜治疗组手术指标较优(P<0.05),腰腿疼痛、ODI评分、并发症总发生率较低(P<0.05),腰肌相对截面积较大(P<0.05),多裂肌脂肪沉积等级、治疗总有效率较高(P<0.05);多裂肌功能横截面积较小(P<0.05).结论:与改良TLIF技术相比,单侧双通道内镜手术治疗LSS的临床疗效更为理想,此种术式视野更清晰、操作更灵活,可缩短手术时间,缓解疼痛,值得应用.

目的 比较关节镜下不同固定方式(肩峰下间隙固定、结节间沟下固定)治疗肱二头肌长头肌腱炎的临床效果.方法 回顾性选取郑州大学第一附属医院运动医学科2016年7月至2020年7月收治的73例因肱二头肌长头肌腱炎行关节镜下肱二头肌长头腱切断固定术的患者,均获得随访.38例接受关节镜下肩峰下间隙固定(A组),35例接受关节镜下结节间沟下固定(B组).比较两组患者术前、术后1个月和术后末次随访时视觉模拟评分(VAS)、美国肩肘关节医师协会(ASES)评分、Constant肩关节评分、手术时间、术后大力水手征发生情况和肘关节屈曲力量等.结果 术前及术后末次随访时,两组VAS评分、Constant评分和ASES评分比较,差异无统计学意义(P＞0.05);与术前比较,两组患者术后1个月、术后末次随访时VAS评分降低,Constant评分和ASES评分升高(P＜0.05);术后1个月,B组VAS评分低于A组,Constant评分和ASES评分高于A组(P＜0.05).A组手术时间长于B组(P＜0.05).A组术后大力水手征发生情况与B组比较,差异无统计学意义(P＞0.05).与术前比较,两组术后末次随访时屈肘力量差异无统计学意义(P＞0.05),且两组患者术前、术后屈肘力量比较,差异无统计学意义(P＞0.05).结论 与关节镜下肩峰下间隙固定术相比,关节镜下结节间沟下固定术具有手术时间短、术后早期肩关节疼痛轻和功能改善迅速等优点,可临床推广.

目的:探究弹性髓内钉固定术与皮质外骨桥技术对儿童肱骨干骨折的治疗效果,观察炎症反应水平及用药安全性.方法:选取2020年12月至2022年2月在我院接受儿童肱骨干骨折治疗的120例患儿,随机分为对照组和研究组(n=60).研究组患儿使用弹性髓内钉固定术,对照组患儿使用皮质外骨桥技术,治疗1 d后,采用酶联免疫吸附法检测血清肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、白介素-6(Interleukin-6,IL-6)、C-反应蛋白(C-reactive protein,CRP)水平;采用全自动生化分析仪检测骨钙素(Bone Gla-protein,BGP)、胶原羟基末端肽(Collagen hydroxyl terminal peptide,CTX)水平;采用肘关节Mayo功能评分标准(Mayo Elbow function score,MEPS)、膝关节评分标准(Hospital for special surgery,HSS)评估关节功能;同时观察术前和术后1 d相关手术指标以及术后并发症发生率.结果:与术前相比,两组患儿术后TNF-α、IL-6、hs-CRP、BGP、MEPS、HSS水平均显著升高,CTX水平显著降低(P<0.05),其中研究组更为显著(P<0.05);与对照组相比,研究组手术时间、住院时间、骨骼愈合时间较短;术中出血量较少、术后并发症发生率较低(P<0.05).结论:对儿童肱骨干骨折患儿采用弹性髓内钉固定术治疗效果更佳,可以降低患儿炎症反应水平,减少患儿的并发症发生率,且安全性较高,值得在临床中推广.

[目的]比较聚醚醚酮(polyether ether ketone,PEEK)与钛合金材质挤压螺钉前交叉韧带(anterior cruciate ligament,ACL)重建术对移植物-骨愈合的影响.[方法]2017年10月—2019年10月,ACL损伤患者106例纳入本研究.将患者随机分为两组,各53例.均采用LARS人工韧带行ACL重建术,PEEK组采用PEEK螺钉,而钛合金组采用钛合金挤压螺钉固定移植物.比较两组临床、实验室检测和影像资料.[结果]两组患者均顺利完成手术.与术前相比,末次随访时两组患者的Lachman试验和轴移试验的稳定性均显著改善,Lysholm评分和膝伸屈ROM增显著增加(P＜0.05).PEEK组在Lachman试验和轴移试验的稳定性,以及Lysholm评分和膝伸屈ROM均显著优于钛合金组(P＜0.05).实验室检测方面,与术前相比,术后2个月两组的血浆白蛋白、球蛋白,血清补体C3、补体C4水平比较均无显著变化(P＞0.05).相应时间点,两组间血浆白蛋白、球蛋白,血清补体C3、补体C4水平的差异均无统计学意义(P＞0.05).影像方面,随术后时间推移,两组骨隧道扩大显著增加(P＜0.05),相应时间点PEEK组骨隧道扩大均显著小于钛合金组(P＜0.05).[结论]PEEK挤压螺钉具有良好的生物相容性和力学特性,更有利ACL重建移植物与骨的愈合.

Objective:To investigate the ligament regeneration in the knee cavity and the osteointegration at the tendon-bone interface after anterior cruciate ligament (ACL) reconstruction using silk-collagen scaffold in a rabbit model.Methods:The silk-collagen scaffold was fabricated using degummed knitted silk scaffold and collagen Ⅰ matrix. The silk-collagen scaffold was rolled up to make a graft for replacing native ACL in the rabbit model. All specimens were harvested at 4 and 16 weeks postoperatively to evaluated ligament regeneration by hematoxylin and eosin (HE) and immunohistochemistry staining, and tendon-bone healing by HE and Russell-Movat staining. Micro-CT, biomechanical tests were also used to assess the tendon-bone healing process.Results:At 16 weeks postoperatively, HE and immunohistochemistry staining revealed that more aligned cell arrangement and more extracellular matrix (ECM) deposition in the silk-collagen scaffold in the knee cavity than those of 4 weeks postoperatively. At week 16, more bone formation which grew into the silk-collagen scaffold was observed, while new trabecular bone could be observed at 4 weeks after surgery. BV/TV=(39.25±1.51)%, bone mineral density (BMD)=(400.88±58.32) mg/cm 3, at 16 weeks postoperatively were significantly higher than those at 4 weeks [BV/TV=(19.36±2.29)% ( t=16.010, P<0.05), BMD=(245.04±17.68) mg/cm 3, t=5.718, P<0.05] after surgery. Higher signals indicating more bone mineral formation were detected in the specimens of 16 weeks than those of 4 weeks postoperatively, which were consistent with the results of biomechanical test [failure load, (25.87±4.57) N vs. (43.67±6.52) N, t=4.994, P<0.05; stiffness, (4.85±0.84) N/mm vs. (9.18±0.76) N/mm, t=8.556, P<0.05]. Conclusion:Silk-collagen scaffold induced ligament regeneration in the knee cavity and osteointegration at the tendon-bone interface after ACL reconstruction.

Objective:To construct an adenovirus containing bone morphogenetic protein (BMP)-4 and use its characteristic of ectopic bone formation in skeletal muscle to explore the in vivo effect of transplanting heterotopic autologous bone for bone defect repair. Methods:The BMP4 gene was constructed into AAV vector, and AAV-BMP4 was purified. AAV-BMP4 was adsorbed in Gelfoam and implanted into the femoral muscle pocket of SCID mice raised in the SPF breeding room of the Experimental Animal Center of Zhengzhou University. The activity of AAV-BMP4 was determined 4 weeks post operation. Apply AAV-BMP4 subcutaneously on the back of the mouse to observe the skeletal muscle induced ectopic bone formation. While the bone tissue is stable, the bone tissue is taken out and transplanted into the pre-prepared mouse skull defect model to observe the bone defect repair effect.Results:The purified AAV-BMP-4 virus particles with a concentration of 5×10 12 vp/ml were successfully constructed. The purified AAV-BMP-4 virus particles implanted into the femoral muscle pocket of mice can successfully induce the formation of ectopic bone tissue. A small amount of new bone tissue appeared 4 weeks after the AAV-BMP-4+ Gelfoam complex was implanted subcutaneously on the back of the mouse with an amount of 1 cm×2 cm×2 cm. Both X-ray and MicroCT examinations confirmed the formation of subcutaneous bone tissue on the back of the mouse. The bone tissue that was trimmed and transplanted into the mouse skull defect model did not show abnormal proliferation after being implanted in the defect, but continued to undergo slight changes in appearance over time, and the skull defect was well repaired. Conclusion:The AAV-BMP-4 constructed in vitro has good biological activity. AAV-BMP-4+ Gelfoam can effectively induce bone formation in skeletal muscle. The new bone tissue can successfully repair the animal model of skull defect. After the transplanted bone tissue was implanted into the skull defect, there was no overgrowth, and it was well integrated with the host bone.

目的 比较关节镜下Omnispan系统与FAST-fix 360°系统缝合修复内外侧半月板损伤的临床疗效与安全性.方法 回顾性分析自2015-02-2017-02于关节镜下缝合修复的124例内外侧半月板损伤,62例术中采用FAST-fix 360°缝合系统(A组),62例术中采用Omnispan缝合系统(B组).结果 124例均获得随访,随访时间平均16.7(12～28)个月.末次随访时所有患者关节无交锁症状,McMurray试验为阴性.2组手术时间、术中出血量、住院时间、并发症发生率,以及末次随访时疼痛VAS评分、Tegner评分、Lysholm评分、IKDC评分、膝关节活动度比较差异无统计学意义(P＞0.05).结论 关节镜下采用Omnispan缝合系统与FAST-fix 360°缝合系统治疗内外侧半月板损伤均具有良好的临床应用价值,术后患者膝关节功能恢复效果及安全性相近.

目的 研究重度膝关节骨性关节炎与胫骨内翻、外翻畸形的关系.方法 选取2014年8月至2017年8月郑州大学第一附属医院行全膝人工关节表面置换术治疗的42例(51膝)重度骨性关节炎患者作为B组,选取同时期在郑州大学第一附属医院行下肢全长正位片检查的27例(54膝)非骨性关节炎患者作为A组.分别量取两组患者胫骨平台内翻角,以胫骨平台内翻角>9°为内翻畸形,胫骨平台内翻角<-9°为外翻畸形,比较两组胫骨内翻、外翻畸形发生率.以胫骨平台内翻角的大小来衡量胫骨内翻、外翻畸形的程度,比较两组胫骨内翻、外翻畸形程度的差异.结果 A组胫骨内翻畸形19例(35.2％),外翻畸形5例(9.3％).B组胫骨内翻畸形28例(54.9％),外翻畸形3例(5.9％).B组内翻畸形发生率高于A组,差异有统计学意义(P<0.05);两组外翻畸形发生率比较,差异无统计学意义(P>0.05).A组胫骨内翻畸形患者(19膝)胫骨平台内翻角为(15.54±4.22)°,胫骨形态正常患者(30膝)胫骨平台内翻角为(1.59±5.72)°,胫骨外翻畸形患者(5膝)胫骨平台内翻角为(-11.75±2.36)°;B组胫骨内翻畸形患者(28膝)胫骨平台内翻角为(15.43±4.92)°,胫骨形态正常患者(20膝)胫骨平台内翻角为(0.71±5.63)°,胫骨外翻畸形患者(3膝)胫骨平台内翻角为(-11.64±1.10)°.两组胫骨内翻畸形、胫骨形态正常、胫骨外翻畸形患者胫骨平台内翻角比较,差异无统计学意义(P>0.05).结论 重度膝关节骨性关节炎与胫骨内翻畸形有关,与胫骨内翻、外翻畸形的程度无关.

Background:The tenotomy and fixation of the long head of the biceps (LHB) has become a main surgical treat-ment of LHB tendinitis. It is widely considered that the most reliable fixation is the suture anchors and interface screw extru-sion, but the clinical efficacy of the two surgical methods needs further discussion. Objective:To compare arthroscopic suture anchor fixation with mini-incision subpectoral interface screw fixation in the treatment of LHB tendonitis. Methods:Twenty patients with LHB tendinitis undergoing surgical treatment in our hospital from November 2015 to April 2016 were enrolled in this study. Of them, 14 cases underwent arthroscopic fixation with suture anchor and 11 cases with mini-incision subpec-toral interface screw tenodesis. The intraoperative bleeding, operation time, SST and ASES scores at 3 days, 1 month and 3 months after operation were compared between the two groups. Results:The mean duration of follow-up was (6.2 ± 1.7) months in all these patients (range, 3-9 months). The class A healing was gotten in all incisions. No infection or implant loos-ening was found. There was no significant difference in the SST or ASES score at 1 and 3 months postoperatively between groups (P>0.05). But there were significant differences in the amount of bleeding, operation time, and postoperative 3-day SST and ASES scores between two groups (P<0.05). Conclusions:Mini-incision subpectoral interface screw fixation has the advantages of shorter operation time, less bleeding and earlier pain improvement than arthroscopic suture anchor fixation.

Background:Total knee arthroplasty (TKA) has become one of main treatments for knee joint diseases. Regard-ing to the patients with dysplasia of femoral condyle, it needs more consideration to choose proper surgical methods. Objec-tive:To measure the medial-lateral diameter and anteroposterior diameter of the femoral condyle, explore the influence of the ratio between anteroposterior diameter and medial-lateral diameter on TKA, and also to compare clinical efficacy of two different ways to femoral condylar osteotomy. Methods:Three hundred patients who was diagnosed as osteoarthritis or rheu-matoid arthritis and treated by TKA between January 2013 and January 2015 were enrolled in this study. The ratio between medial-lateral diameter and anteroposterior diameter of the femoral condyle was measured and calculated according to pre-operative knee X-ray radiographs, then the data were compared with artificial prosthesis'. The patients whose ratio more than 0.9 were selected and divided them into two groups. In group A, 11 patients took osteotomy with intramedullary long location bar. In group B, intramedullary short location bar was used for osteotomy in 10 patients. KSS score, knee flexion, femoral notch, and prosthesis flexion were compared between two groups after surgery. Results:The incision healed well in both groups. There was no infection, no loosening or fracture of prosthesis. There was no significant difference in the post-operative KSS score between groups (P>0.05). But there were significant differences in the femoral condyle front notch, femoral prosthesis flexion and range of motion of the knee between groups (P<0.05). The mean duration of follow up was 19 months (range, 12-48 months). Conclusions:For patients who have larger ratio between anteroposterior diameter and me-dial-lateral diameter of the femoral condyle, intramedullary short location bar is a better choice in TKA. In this way, we can not only keep the stable flexion-extension of prosthesis, but also reduce the possibility of fracture around prosthesis.

Objective To explore the effects of p53 upregulated modulator of apoptosis (PUMA) on apoptosis in the mouse knee joint osteoarthritis cartilage.Methods The osteoarthritis cell model was made by using mouse artificial chondrocytes treated with interleukin (IL)-1β,and small interfering RNA (siRNA) of PUMA was transfected into chondrocytes.The expression of PUMA and the apoptosis were detected by Western blotting and Hoechst staining at baseline and after transfection.Results PUMA protein expression in control group was 6.11 times of blank group,and that in control group was 2.02 and 3.30 times of experimental groups.The apoptosis rate in blank group,control group,and experimental groups A and B was 3.6％,29.6％,9.0％ and 13.2％ respectively.SiRNA of PUMA had been transfected into chondrocytes successfully.PUMA protein expression was suppressed,and apoptosis of chondrocytes decreased.Conclusion PUMA gene has taken part in the apoptosis of chondrocytes in mice with osteoarthritis.

Objective To investigate the effectiveness of celecoxib (CLX) combined with diacerein (DC) in the treatment of osteoarthritis (OA) and the potential mechanism.Methods The rat OA models were established,and treated with CLX,DC,and CLX combined with DC as CLX group,DC group,and CLX + DC group.The levels of interleukin (IL)-1β,nitric oxide (NO),c-Jun N-terminal kinase (JNK),mitogen activated protein kinase kinase 1 (MEKK1),and mitogen activated protein kinase kinase 7 (MKK7) were detected.Results As compared with CLX group or DC group,IL-1β and NO levels were significantly reduced in CLX + DC group (P ＜ 0.05) [for IL-1β,(30.75 ± 2.00),(20.22±0.70),and (14.91 ±0.80) ng/dl;for NO,(13.75 ±0.97),(14.22 ±0.87),and (9.91 ±0.70) nmol/mg].CLX + DC distinctly inhibited the activity of Caspase-3 as compared with CLX or DC alone (P＜0.05).CLX + DC depressed the JNK signaling pathway by the inhibition of MEKK1,MKK7 and JNK (P ＜ 0.05).As compared with CLX group or DC group,chondrocyte apoptosis was markedly suppressed,and the JNK signaling pathway significantly inactivated in CLX + DC group.Conclusion CLX combined with DC has a distinct inhibitory effect on inflammatory signaling pathway and has curative effects on OA.

目的 探讨关节镜下关节腔粘连松解术后注射玻璃酸钠对改善关节活动度的疗效.方法 对30例关节镜术后3～6个月内发生关节粘连的患者应用关节镜行膝关节粘连松解术,术后3d给予关节腔注射玻璃酸钠1次,对比注射前后膝关节活动度情况.结果 关节腔注射玻璃酸钠后膝关节活动度平均改善10.2°.结论 关节镜术后3～6个月内发生关节粘连患者经关节镜松解术后给予注射玻璃酸钠是进一步改善膝关节活动度的有效措施.

肩锁关节脱位(dislocation of the acromioclavicular joint)十分常见,多见于年轻人的运动创伤,其稳定性靠关节囊、肩锁韧带和喙锁韧带的共同维持作用.根据有无喙锁韧带断裂临床将其分为半脱位和全脱位,对于全脱位多采用手术切开复位,在修补或重建喙锁、肩锁韧带的同时给以内固定治疗,手术的目的是达到肩锁关节复位及确实内固定,并维持其位置[1].2009年9月至2011年9月,郑州大学第五附属医院采用AO锁骨钩状钢板治疗TossyⅢ型肩锁关节脱位24例,取得良好临床效果,现报告如下:

目的:研究保留或切除髌下脂肪垫对全膝关节置换术(total knee arthroplasty,TKA)术后髌骨高度的影响.方法:将86例骨性关节炎患者(116膝)分为A、B两组.A组为保留髌下脂肪垫组(59膝),B组为切除髌下脂肪垫组(57膝).应用屈膝30°的侧位X线片,测量术前及术后随访时的Insall-Salvati比值以反映髌骨高度.结果:A组术前及术后随访时的Insall-Salvati比值差异无统计学意义(P＞0.05),B组术前及术后随访时的Insall-Salvati比值差异有统计学意义(P＜0.05).结论:在TKA术中切除髌下脂肪垫会造成TKA术后髌骨高度下降,导致低位髌骨及髌腱短缩.

目的观察应用钽金属重建棒植入治疗早期股骨头缺血性坏死的中期临床疗效,探讨此治疗方案的有效性。方法分析2009年2月至2011年7月采用髓心减压多孔钽棒植入治疗早期股骨头坏死的32例(42髋)患者的临床资料。ARCO分期标准Ⅰ期3髋,Ⅱ期36髋,ⅢA期3髋。采用VAS髋关节疼痛视觉模拟评分、Harris髋关节功能评分、股骨头塌陷指数等评估术后患髋功能的改善情况。结果随访23 5 2个月,中期生存率97.62%,末次疼痛VAS评分较术前明显减低(P=0.00),末次.Harris评分较术前明显提高(P=0.00),术前及末次所测得股骨头塌陷率相差不大(P>0.05)。结论钽金属重建棒植入是治疗早期股骨头缺血性坏死的有效方法 ,可显著改善关节功能,阻止病变进展。

背景:Fastin锚钉已被广泛用于肩袖损伤、韧带损伤等治疗,但用于半月板修复方面国内报道较少.目的:探讨关节镜下应用带线锚钉治疗外侧半月板前角损伤的方法和临床疗效.方法:回顾性分析经MRI诊断并经关节镜下确诊外侧半月板前角损伤适合行缝合修复的22例患者的临床资料,所有患者行关节镜下带线锚钉固定缝合,通过症状、体征、Lysholm及国际膝关节评分委员会评分对其临床效果进行评价.结果与结论:患者均获得随访,时间7-28个月(平均19.3个月),无严重并发症发生,Lysholm评分和国际膝关节评分委员会评分分别由治疗前的(45.20±7.47)分和(41.55±8.91)分升高到治疗后的(90.60±5.46)分和(91.85±1.09)分(P <0.05),说明关节镜下应用带线锚钉治疗半月板前角损伤能够达到良好的临床效果.

Background: Fastin anchors have been widely used in repairing rotator cuff injury, ligament injury and so on, but rarely reported for meniscus repair. Objective: To evaluate the methods and clinical effectiveness of arthroscopic repair with anchors for anterior horn injury of the lateral meniscus. Methods: Retrospective analysis was performed on the clinical data of 22 patients who had been diagnosed with anterior horn injury of the lateral meniscus through MRI and definitely diagnosed through arthroscopy, all of them was suitable for repairing and received arthroscopic repair with anchors, the clinical effect was evaluated through symptoms, signs, Lysholm and International Knee Documentation Committee system. Results and Conclusion: All the patients were followed-up for 7-28 months (19.3 months). There were no severe complications. The Lysholm and International Knee Documentation Committee systems showed that the scores ascended respectively from (45.20±7.47) and (41.55±8.91) before surgery to (90.60±5.46) and (91.85±1.09) after surgery (P < 0.05). These indicate that the methods of arthroscopic repair with anchors for anterior horn injury of the lateral meniscus can get a good clinical effect.

膝关节单髁置换术(UKA)与全膝置换术(TKA)同时起步于20世纪70年代,TKA已在全球范围内成为一种成熟的、疗效确切的于术方式,而UKA发展速度相对较慢.20世纪90年代以来,UKA在操作技术、病例选择、假体及器械的设计等方面都有了明显的改进,从而使单髁置换的中远期优良率和发展速度明显提高,综合文献报道,UKA假体10年生存率为85％ ～95％,20年生存率为80％ ～ 90％.据Riddle等报道,世界范围内UKA数量近10年迅速增加,平均每年增加32.5％左右.本文拟对膝关节单髁置换的研究进展进行综述.

<正>盘状半月板又称盘状软骨,是半月板形态的异常。盘状半月板体部厚大、近似圆形,其在关节内活动受限,不利于膝关节负荷传导,活动中在各种剪切应力作用下,极易发生磨损、变性、甚至撕裂。目前公认亚洲人的盘状半月板发病率高于西方人[1]。在我国,不同地区、种族之间发病率差异很大,男性与女性发病率之