Steroid-induced femoral head avascular necrosis (SFHN), a devastating orthopedic condition characterized by ischemic bone collapse, urgently requires interventions addressing both impaired angiogenesis and compromised osteogenesis. Here, we developed an icariin (ICA)-functionalized β-tricalcium phosphate (β-TCP) composite scaffold through an innovative low-temperature rapid prototyping (LT-RP) technique. This strategy fundamentally resolves the critical limitation of conventional high-temperature sintering that compromises bioactivity through thermal degradation. Additionally, by adjusting the ratio of α-TCP to β-TCP, we optimized the mechanical properties of the scaffold, enhancing its suitability for bone repair and ensuring that its degradation rate matches the rate of new bone formation. Furthermore, gelatin was introduced into the porous structure of the scaffold, successfully encapsulating ICA, allowing for sustained release during bone repair. This innovative design significantly improved the osteogenic and angiogenic effects of the scaffold. Animal experiments showed that the ICA-loaded reconstruction scaffold effectively promoted new bone formation and angiogenesis, enhancing the integration between the implant and bone tissue. This bioengineered approach establishes a paradigm for reconstructing necrotic subchondral bone while preserving joint biomechanics.

目的:评价全膝关节置换术(total knee arthroplasty,TKA)与关节镜下滑膜切除术(arthroscopic synovectomy,AS)治疗晚期膝关节色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)的临床疗效和安全性.方法:以"色素沉着绒毛结节性滑膜炎""关节镜""膝关节置换"为中文检索词,以"pigmented villonodular synovitis""arthroscope""endoscopes""total knee arthro-plasty""knee replacement arthroplasties""replacement,total knee""knee arthroplasty"为英文检索词,以计算机检索为主,手工检索、参考文献追溯为辅,检索中国知网、维普网、万方数据库及PubMed、Embase、the Cochrane Library建库至2021年2月收集的TKA与AS治疗晚期膝关节PVNS的相关文献.筛选文献、提取数据,并对纳入的研究进行质量评价后,进行Meta分析.结果:初检共检出文献36篇,其中中文文献29篇,英文文献7篇;经筛选后最终纳入文献8篇,均为中文文献.Meta分析结果显示,TKA组术后膝关节Lysholm评分高于AS组[I2=3％,P=0.310,MD=7.93,95％CI(5.72,10.13),P=0.000],膝关节活动度大于AS组[I2=19％,P=0.300,MD=27.93,95％CI(25.36,30.50),P=0.000],PVNS复发率低于AS组[I2=0％,P=0.940,OR=0.14,95％CI(0.04,0.53),P=0.004];2组患者并发症发生率比较,差异无统计学意义[I2=0％,P=0.970,OR=0.49,95％CI(0.23,1.04),P=0.060].结论:对于晚期PVNS,采用TKA治疗在缓解膝关节疼痛、改善膝关节功能、降低PVNS复发率方面优于采用AS治疗,而2种方法的并发症发生率相当.

Objective:To evaluate the short term efficacy of 160 biological revision handle in femoral revision.Methods:The patients who underwent the femoral revision of Chunli 160? handle in Guangdong Hospital of Traditional Chinese Medicine from August 2017 to September 2019 were retrospectively analyzed. The clinical and imaging manifestations before and at the last follow-up were evaluated and compared with the patients who underwent the revision of Johnson’s Solution? handle at the same time. The efficacy score of artificial hip joint (Harris score) and the hip score of Oxford University were evaluated before and at the last follow-up (OHS score). The paired sample t test was used, and independent sample t test was used for inter-group comparison.Results:A total of 35 patients who met the criteria were enrolled with completed follow-up, including 18 patients in the Chunli 160? handle group (the observation group) and 17 patients in the Solution? handle group (the control group). The Harris score of the observation group increased from preoperative (34±8) to postoperative (72±7) (t =-13.91, P<0.001), the control group increased from preoperative (30±6) to postoperative (68±11) (t =-10.98, P<0.001). The OHS score of the observation group decreased from preoperative (30±8) to postoperative (16±9) (t =9.40, P <0.001). The OHS score of the control group decreased from preoperative (34±2) to postoperative (16±2) (t =16.05, P<0.001) There was no statistically significant difference in the postoperative Harris score and OHS score between the two groups (t =-1.41, 0.19, both P>0.05). Imaging showed that the prosthesis was firmly fixed, and there was no significant difference in prosthesis sinking distance and prosthesis loosening rating between the two groups (Z =-0.857, -0.474, both P>0.05) .Conclusions:The 160? biological revision handle performs well in the short-term follow-up of hip revision patients. The short-term curative effect is equivalent to that of solution handle, and the long-term curative effect needs to be further observed.

[目的]系统评价针灸疗法与口服西药对照治疗围绝经期失眠症的临床疗效和安全性.[方法]计算机检索中国知网期刊全文数据库(CNKI)、维普期刊数据库(VIP)、万方数据知识服务平台(Wanfang)、PubMed、Web of Science、Cochrane Library等数据库.搜集并筛选相关的针灸疗法与西药对照治疗围绝经期失眠症疗效比较的随机对照研究,使用RevMan 5.3软件系统评价纳入研究的方法学和Meta分析.[结果]共纳入34项研究,其中,高质量研究14项,包含治疗组1459例及对照组1417例.本研究结果显示:针灸疗法治疗围绝经期失眠症总有效率[OR=2.79,95％CI(2.22,3.50),P<0.00001]、匹兹堡睡眠质量指数量表评分[MD=-2.09,95％CI(-2.91,-1.27),P<0.00001]、改良Kupperman评分方面[MD=-4.41,95％CI(-6.38,-2.45),P<0.0001]均优于口服西药的对照组,差异有统计学意义;亚组分析结果提示,单纯针刺治疗总有效率高于对照组[OR=2.57,95％CI(1.86,3.55),P<0.00001],差异有统计学意义.针灸疗法治疗的不良反应事件发生率低于对照组[RR=0.32,95％CI(0.18,0.54),P<0.0001].纳入文献存在发表性偏倚的可能.[结论]针灸疗法治疗围绝经期失眠症的临床疗效和安全性均高于口服西药,值得在临床推广.但由于纳入文献中低质量研究占多数,结论可信度一般,此结果有待于更多高质量的随机对照试验研究进行考证.

13 tricalcium phosphate (13-TCP) is a common biological ceramic in bone tissue engineering due to its excellent biocompatibility and biodegradability. However, owing to its inherent properties of poor injectability and forming ability, the application of TCP in extrusion 3D printing is quite limited. To solve this problem, we innovatively printed gelatin and PVA (Polyvinyl alcohol) binary systems by taking advantage of the ability of gelatin to solidify rapidly at low temperatures and the ability of PVA to effectively improve phase separation during extrusion. Here, we fabricated a series of novel Gel-PVA-TCP scaffolds by incorporating different concentrations of PVA (5%, 10%, 15%) through 3D printing. Collectively, the addition of PVA made differences in three ways. First, compared to the PVA-free system, the novel printing system significantly improved the printability of TCP paste. The printing temperature was decreased to 35-45 degrees C by doping different concentrations of PVA. Next, the novel printing system maintained the excellent forming ability and printing precision of the scaffolds. Compared to the macropores of scaffolds without doping PVA (456.1 +/- 11.2 mu m), the macropores of Gel-PVA-TCP were 486.1 +/- 26.5, 446.1 +/- 15.2, and 443.7 +/- 26.3 mu m. Last, after sintering, the scaffolds with different concentrations of PVA exhibited similar compressive strength (3.82 +/- 0.22, 3.34 +/- 0.23, 3.74 +/- 0.38, 3.47 +/- 0.48 Mpa) and distinct micropores (4.44 +/- 0.7, 1.54 +/- 0.3, 2.59 +/- 0.6, 3.59 +/- 1.0 mu m) on the surfaces of the scaffolds. Moreover, it was found that differences in the microstructure significantly facilitate the adhesion of bone marrow mesenchymal stem cells to scaffolds. Hence, the methods we provided hold a great promise for application in 3D printing techniques.

Abstract Background Enhanced recovery after total knee arthroplasty (TKA) has been suggested to enhance postoperative recovery. The use of multimodal cocktail periarticular injection (MCPI) to control the pain of TKA has gained wide acceptance. MCPI containing corticosteroids is believed to be an effective solution because of its local anti-inflammatory effects and ability to reduce the local stress response postoperatively. However, there is conflicting evidence about its benefits. This trial aims to compare MCPI containing a high dose of corticosteroid, MCPI containing anormal dose of corticosteroid, and MCPI without a corticosteroid during TKA to assess the effectiveness of MCPI containing corticosteroid in postoperative pain relief, functional improvement, rescue analgesia and side effects. This will provide evidence regarding the effectiveness of high-dose corticosteroids on prolonged pain control and better recovery after total knee arthroplasty. Methods/design This trial is a double-blinded randomized, placebo-controlled study. A total of 234 patients will be randomized into 3 groups to receive a high dose of betamethasone MCPI (group H), a normal dose of betamethasone MCPI (group N), and a nonbetamethasone MCPI (group C). the following indexes will be recorded and analyzed: knee pain at rest and bending at 90° at 6 h, 24 h, 48 h, 72 h, 5 days, 14 days, and 30 days after surgery; 1-minute walking ability and circumference around patella at 2, 4, 7, 14, and 30 days after surgery; HSS score at 14 and 30 days after surgery; C-reactive protein and blood sedimentation as well as blood sugar at 2, 4, 7, 14, 30 days after surgery; additional morphine analgesics consumption; and side effects. Discussion The results from this study will provide clinical evidence on the effectiveness of MCPI-containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and side effects as well as evidence on the efficacy of high-dose corticosteroids for leading to prolonged pain control and better recovery after TKA. Trial registration Chinese Clinical Trial Registry ChiCTR2000038671. Registered on 27 September 2020

Background Enhanced recovery after total knee arthroplasty (TKA) has been suggested to enhance postoperative recovery. The use of multimodal cocktail periarticular injection (MCPI) to control the pain of TKA has gained wide acceptance. MCPI containing corticosteroids is believed to be an effective solution because of its local anti-inflammatory effects and ability to reduce the local stress response postoperatively. However, there is conflicting evidence about its benefits. This trial aims to compare MCPI containing a high dose of corticosteroid, MCPI containing anormal dose of corticosteroid, and MCPI without a corticosteroid during TKA to assess the effectiveness of MCPI containing corticosteroid in postoperative pain relief, functional improvement, rescue analgesia and side effects. This will provide evidence regarding the effectiveness of high-dose corticosteroids on prolonged pain control and better recovery after total knee arthroplasty. Methods/design This trial is a double-blinded randomized, placebo-controlled study. A total of 234 patients will be randomized into 3 groups to receive a high dose of betamethasone MCPI (group H), a normal dose of betamethasone MCPI (group N), and a nonbetamethasone MCPI (group C). the following indexes will be recorded and analyzed: knee pain at rest and bending at 90° at 6 h, 24 h, 48 h, 72 h, 5 days, 14 days, and 30 days after surgery; 1-minute walking ability and circumference around patella at 2, 4, 7, 14, and 30 days after surgery; HSS score at 14 and 30 days after surgery; C-reactive protein and blood sedimentation as well as blood sugar at 2, 4, 7, 14, 30 days after surgery; additional morphine analgesics consumption; and side effects. Discussion The results from this study will provide clinical evidence on the effectiveness of MCPI-containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and side effects as well as evidence on the efficacy of high-dose corticosteroids for leading to prolonged pain control and better recovery after TKA. Trial registration Chinese Clinical Trial Registry ChiCTR2000038671. Registered on 27 September 2020

目的:系统评价一期关节镜手术对比二期手术治疗肩袖损伤合并关节僵硬的有效性及安全性.方法:通过计算机系统检索中国知网、万方资源数据、维普数据库、PubMed、Web of Science、The Cochrane Library和Embase数据库.查找相关的随机对照试验.进行文献质量评价并采用RevMan 5.3软件进行系统评价.结果:共纳入3篇研究,包括169例患者.由于纳入文献数量少且结局指标有差异,采用描述性系统评价.研究所纳入的3个研究显示末次随访时2组患者的关节活动度、美国肩肘外科协会评分量表(ASES)评分和视觉模拟量表(VAS)评分均较术前显著改善(P<0.05),且组间差异无统计学意义(P>0.05).而在术后早期一期组活动度稍差于二期组.结论:一期手术组治疗肩袖损伤合并关节僵硬疗效确切,且与二期组相比,在末次随访时的活动度、ASES评分、VAS评分及肌力等方面无明显差异.然仍需要更多高质量研究来增强论证的强度.

Enhanced recovery following total knee arthroplasty (TKA) has been advocated to enhance postoperative recovery. Multimodal cocktail periarticular injection (MCPI) use for pain control in TKA has gained wide acceptance. MCPI-containing corticosteroids are believed to be an effective solution owing to their local anti-inflammatory effects and ability to reduce the local stress response postoperatively. However, there is conflicting evidence regarding its benefits. This trial aims to compare MCPI with a high dose of corticosteroid, normal dose of corticosteroid, and non-corticosteroid during TKA, to assess the effectiveness of MCPI containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and side effects and provide evidence that high-dose corticosteroids result in prolonged pain control and better recovery following TKA. This is a double-blinded, randomized, placebo-controlled study. A total of 234 patients scheduled for TKA will be recruited. During surgery, before wound closure, 80 ml of the cocktail analgesic will be injected into the muscle and joint capsule for local infiltration analgesia; the participants will be randomly assigned to three groups to receive a high dose of betamethasone MCPI (group H), normal dose of betamethasone MCPI (group N), and non-betamethasone MCPI (group C). The following indices will be recorded and analyzed: the strongest knee pain experienced during 90° flexion at 6 h, 24 h, 48 h, 72 h, 5 days, 14 days, and 30 days after surgery; 1 min walking ability; and circumference around the patella at 2, 5, 14, and 30 days after surgery; Knee Society knee score at 14 days and 30 days after surgery; C-reactive protein and blood sedimentation; blood sugar 2, 5, 14, and 30 days following surgery; rescue analgesic consumption; and adverse events. If any participant withdraws from the trial, an intention-to-treat analysis will be performed. The results of this study will provide clinical evidence on the effectiveness of MCPI-containing corticosteroids in postoperative pain relief, functional improvement, rescue analgesia, and adverse events, as well as provide evidence on the efficacy of high-dose corticosteroids in prolonged pain control and better recovery following TKA. Chinese Clinical Trial Registry, ChiCTR2000038671 . Registered on September 27, 2020.

目的 基于转录组测序分析鹿茸治疗骨关节炎大鼠后的基因表达差异以及对相关信号通路的影响.方法 将10只SD大鼠随机分为实验组和对照组,采用经典Hulth方法制备大鼠右膝骨关节炎疾病模型.造模6周后,实验组给予鹿茸(420 mg·kg-1)灌胃给药,对照组给予等量生理盐水灌胃,隔天灌胃1次,连续6周.末次灌胃给药2 h后,取各组大鼠右侧膝关节软骨,提取RNA进行RNA-Seq测序,对表达差异的基因进行筛选及KEGG功能注释分类和GO富集分析.结果 共筛选出3226个表达差异的基因(|log2FC|≥1,Q值<0.001).与对照组比较,实验组上调的基因有711个,下调的有2615个.KEGG基因分类和GO富集分析表明,上调基因主要参与调控骨骼肌发育、骨形态发生、骨矿化和骨成熟;下调基因主要参与调节细胞的凋亡和自噬、血管生成和炎症反应.结论 发现了鹿茸干预骨关节炎的一些关键基因和通路,如Ckm、Tnni2、Myh4、Myl1、Mylpf、Casq1、Actn3、S100a8及Ngp等基因,以及凋亡和自噬的信号通路、血管生成和肌肉收缩通路等,鹿茸可能通过这些基因和通路发挥治疗效果,这些差异基因可能成为骨关节炎的基因治疗靶点.

目的 从信号转导系统与受体学说角度,研究鹿茸对大鼠各脏腑cAMP/cGMP、TGF-β水平的影响,探讨其与归经的相关性.方法 选择3月龄健康雌性SD大鼠24只,体质量(200±20)g,随机分为4组(鹿茸低、中、高剂量组及空白对照组).常规喂养1周后,除正常组外采用经典Hulth方法制备骨关节炎疾病模型,造模6周后模型大鼠按分组不同给予鹿茸低、中、高剂量灌喂2周,空白对照组予等量生理盐水灌喂,通过酶联免疫吸附实验和免疫组织化学实验检测鹿茸灌喂后组内脏组织cAMP/cGMP及TGF-β受体的表达水平,通过比较各内脏组织cAMP/cGMP及TGF-β受体相对表达量变化程度,分析鹿茸对各内脏组织的作用趋势.结果 鹿茸低剂量组脾脏cAMP/cGMP水平明显升高,差异有统计学意义(P＜0.05);鹿茸中剂量组肾脏、心脏cAMP/cGMP水平明显升高,差异有统计学意义(P＜0.05);鹿茸高剂量组肝脏、卵巢cAMP/cGMP水平明显升高,差异有统计学意义(P＜0.05);cAMP/cGMP相对表达量由大到小排序为:肾、肝、卵巢、脾、心、脑、胃、肺、肠.鹿茸低、中剂量组肝、肾TGF-β受体表达水平明显升高,差异有统计学意义(P＜0.05);鹿茸低剂量组脾、胃,鹿茸中剂量组脾,鹿茸高剂量组肠、胃TGF-β受体表达水平明显下降,差异有统计学意义(P＜0.05);TGF-β受体相对表达量由大到小排序为:肾、肝、卵巢、肺、心、脑、肠、胃、脾.结论 鹿茸对大鼠信号转导系统水平变化及受体表达水平的影响作用以肾脏、肝脏为主,与传统鹿茸归经理论相符.

鹿茸为雄性梅花鹿或马鹿尚未骨化、带茸毛的幼角经制成的中药,相关药理学研究表明其中的成分可通过促进成骨细胞增殖的同时诱导破骨细胞凋亡,调节骨代谢.本文对近年来鹿茸提取物及复方制剂调节骨代谢方面的研究进行综述,包括基础研究、动物模型研究及临床研究,以期为运用鹿茸防治骨质疏松提供参考.

目的 比较中国广东地区骨关节炎(osteoarthritis,OA)患者与健康人群肠道菌群的宏基因组,初步分析其差异性及差异特征.方法 选取我院从2017年6～12月收集的29名健康人群,66例膝OA患者粪便样本,其中膝OA患者根据K-L分型分为轻度OA组17例,重度OA组49例.检测前进行对基线比较.样本提取DNA后,使用Simpson多样性指数分析群落多样性,使用LEfSe分析对群落关键物种进行筛选;差异物种GO分析及Pathway分析进行差异性菌群代谢功能预测.结果 3组在身高、年龄及体重上没明显差异(P>0.05);Simpson多样性指数分析表明轻度OA患者与健康人群肠道菌群多样性无显著差异,重度OA患者肠道微生物多样性显著低于健康人群.LEfSe分析发现,寡养单胞菌属(Stenotrphomonas)、黄单胞菌属(Xanthomonadacease)等18种菌群在膝骨关节炎患者人群中显著高丰度,毛螺旋菌属(Lachnospiraceae)、瘤胃球菌属(Ruminococcus)等6种菌群在膝骨关节炎患者人群中显著低丰度.寡养单胞菌属、黄单胞菌属两类菌群可以显著区分轻重型膝骨关节炎.差异物种GO分析提示寡养单胞菌属、黄单胞菌属等菌群的显著升高,对代谢类疾病、感染性疾病、心血管类疾病、免疫性疾病的发病具有增加的趋势.结论 广东地区膝骨关节炎患者肠道菌群丰度和某些菌群与健康人群有显著差异,寡养单胞菌属、黄单胞菌属两类菌群可以显著区分轻重型膝骨关节炎.

目的:观察全膝关节置换术(total knee arthroplasty,TKA)后关节腔内追加注射混合镇痛液能否延长术后镇痛时间.方法:采用回顾性配对研究方法,以30例仅在TKA术中接受关节周围浸润注射混合镇痛液患者为对照组、30例在术后第2天还接受了关节腔内追加注射混合镇痛液的患者为观察组.术后第2、3、4、5、7天,记录患者的静息和屈膝90°时的视觉模拟量表(Visual Analogue Scale,VAS)评分、1 min步行距离;记录术后7 d患者追加镇痛药物盐酸曲马多的使用情况;记录患者的不良反应.结果:观察组患者在术后静息VAS评分、追加镇痛药物使用方面与对照组患者无显著差异,但在术后屈膝90°VAS评分和1 min步行能力方面较对照组患者有显著改善.结论:关节腔内追加注射混合镇痛液能显著改善TKA术后患者膝关节屈伸运动时的疼痛程度和步行能力.

髌骨软骨母细胞瘤是临床上较罕见的原发性骨肿瘤,仅通过临床症状及影像学表现较难确诊,常与动脉瘤样骨囊肿相混淆.在治疗上则二者类似,使用病灶刮除植骨术均可以取得较好疗效. 1病例资料 28岁男性患者,因“右膝疼痛伴活动受限1年,加重2周”于2016年8月16日入院.患者诉1年前因外伤出现右侧膝关节疼痛,当时无肢体麻木,不伴活动受限,故未做特殊处理,后右膝反复疼痛,逐渐出现右膝活动受限,2周前患者右膝疼痛较前加重,剧烈活动及上下楼梯时疼痛明显,遂到我院门诊就诊,查右膝关节DR提示髌骨下部病灶,考虑良性病变,动脉瘤样骨囊肿可能(见图1).经门诊医师建议,患者进一步行MRI检查提示:a)右侧髌骨膨胀性骨质破坏,考虑良性骨肿瘤或肿瘤样病变,动脉瘤样骨囊肿可能;b)髌下脂肪缺轻微水肿;c)右膝内侧半月板后角变性损伤(Ⅱ度);d)右膝关节腔少量积液(见图2).故本院以“右侧髌骨动脉瘤样骨囊肿”将患者收入院治疗.

Background Pilose antler (PA) is a common Chinese medicine used to treat patients with osteoarthritis (OA) while its treating mechanism is still unknown. The purpose of our study is to clarify this mechanism by studying the effect of pilose antler on transcriptome genes expression in rats with knee osteoarthritis.MethodsTen Sprague Dawley (SD) rats are randomly divided into two groups, the pilose antler group (PA group) and the osteoarthritis group (OA group). The classic Hulth method was performed on the right knee of all the rats to establish the osteoarthritis model. Six weeks after the surgery, the PA group was given pilose antler and the OA group was given saline. This intervention lasted 6 weeks. Two hours after the last administration, cartilage tissues of all the rats were taken from their right knees. The samples were collected and sent to BGI, the genomic organization, to carry on the RNA-Seq measurement. The comparison of differentially expressed genes (DEGs), enrichment analysis, genes classification, and miRNA-mRNA linked network were studied within Dr.Tom system.ResultsSeveral DEGs(3226 in comparison between OA and PA group) were identified (|log2FC|≥1,Q value < 0.001). Compared with the OA group, 711 up-regulated genes and 2615 down-regulated genes were found in the PA group. According to the enrichment analysis, the up-regulated genes mainly enriched in muscle contraction and the down-regulated-genes are involved in inflammatory response. The miRNA-mRNA regulatory network was performed and the key genes were identified.ConclusionsOur studies have found that PA may alleviate the progression of OA through strengthening the muscle and positively regulate the inflammatory response. We also found some key genes, like Tnni2, Mylpf, Myl1, Actn3, Ifitm6, and Retnlg . These genes may be the potential target of pilose antler in the treatment of OA.

骨关节炎(osteoarthritis,OA)是一种常见的临床关节疾病[1],随着现代社会人群预期寿命的增加,本病的患病率和发病率均呈上升趋势[2].虽然目前对于OA的发病机制仍不明确,但炎症在其中扮演的重要角色则是毋庸置疑的.临床上治疗OA的目标主要是控制疼痛、维持或改善关节的活动性和功能,以及改善与健康相关的生活质量,而治疗方案一般采用教育、药物及手术等方式的组合[3],在针对发病机制方面的治疗仍有待研究.

西医治疗失眠易产生不良反应与依赖性等,而中医因其安全、简便、灵活等优点被广泛应用于临床,并取得显著疗效,现将临床中医治疗失眼的文献综述如下.