Recently, protease-activated receptor 2 (PAR2) has been proved to be involved in the inflammatory response including osteoarthritis (OA). In the present study, we found that PAR2 antagonist could remarkably improve the pathological condition of OA rats in vivo. In addition, we also found that PAR2 antagonist could suppress the production of inflammatory factors (TNF-α and Cox-2), decrease the levels of MMP-1 and MMP-13, and restrain the levels of P62 proteins and aggravate the expression of LC3-II both in vivo and in vitro. Besides, in vitro, PAR2 antagonist could increase the proliferation and colony formation of chondrocytes induced with IL-1β. Moreover, PAR2 antagonist could decrease the expression of expressions of p-p38, p-IκBα and p-NF-κB in vitro. However, PAR2 agonist exhibited the opposite effects. Furthermore, SB203580, a p38 MAPK inhibitor, could remarkably promote the proliferation of chondrocytes induced with IL-1β, could alleviate the production of TNF-α and Cox-2, could down-regulate the protein expressions of MMP-1 and MMP-13, and could decrease the expression of P62 and increase the expressions of LC3-II of chondrocytes induced with IL-1β. Importantly, SB203580 could reverse the effects of PAR2 agonist on the functions of chondrocytes induced with IL-1β. Taken together, the present data suggest that down-regulation of PAR2 can ameliorate OA through inducing autophagy via regulation of MAPK/NF-κB signaling pathway in vivo and in vitro, and PAR2 can be considered as a potential candidate to treat OA.

膝骨性关节炎(knee osteoarthritis,KOA)是膝关节的慢性退变性疾病.KOA的主要病理改变是关节软骨的进行性破坏,软骨下骨质丢失.目前临床上对于早中期KOA的治疗方法十分有限.富血小板血浆(platelet-rich plasma,PRP)是外周血多次离心后的血小板浓缩物,在医学专业应用近三十年,近十年逐渐应用于骨科修复软骨、肌腱和韧带等,成为治疗KOA的热点.PRP治疗KOA的可能机制主要包括通过释放多种生长因子、促进蛋白多糖和胶原蛋白的合成以及刺激骨髓间充质干细胞和内源性透明质酸(hyaluronic acid,HA)的生成,达到修复软骨、延缓KOA进展的目的.多数研究表明,相对于传统的关节腔内注射药物和口服非甾体抗炎药(Non-steroidal anti-inflammatory drugs,NASIDs),关节内注射PRP可有效改善KOA病人的临床症状,但是关于PRP的作用时间、使用剂量和注射次数尚无统一标准.本文通过回顾目前关于PRP治疗KOA的基础、动物及临床研究,对PRP的生物学特性、作用机制、临床疗效及存在的问题进行综述.

目的:探讨磁共振成像(MRI)对半月板不同部位撕裂的诊断效能及影响因素.方法:回顾性分析2008年6月至2018年6月本院骨科收治的358例单侧半月板撕裂患者的临床资料,患者均行MRI和关节镜检查,以关节镜检查结果为金标准,分析MRI诊断半月板不同部位撕裂的准确率及其影响因素.结果:MRI诊断半月板撕裂内侧前角准确率94.4％,内侧后角准确率94.7％,内侧体部准确率93.9％,内侧后根准确率93.4％,外侧前角准确率92.5％,外侧后角准确率96.4％,外侧体部准确率94.7％,外侧后根准确率92.7％,Ramp损伤准确率92.2％.MRI对前角撕裂的漏诊率要明显高于后角和体部撕裂(P＜0.05).采用x2检验分析影响MRI对半月板撕裂诊断准确性的可能因素,结果显示:MRI对内侧半月板撕裂诊断的误漏诊影响因素为年龄、撕裂部位、撕裂类型和撕裂长度(P＜0.05);MRI对外侧半月板撕裂诊断的误漏诊影响因素为撕裂部位、撕裂类型和撕裂长度(P＜0.05).结论:MRI作为目前临床上诊断半月板撕裂最常用的无创方法,具有很高的临床诊断价值,但易受年龄、撕裂部位、撕裂类型和撕裂长度的影响,造成误诊和漏诊.

目的 观察发散式体外冲击波治疗跖筋膜炎的临床效果是否优于传统方式.方法 将2016年7月～2017年3月在南京明基医院骨科门诊连续治疗的符合纳入标准的60例患者依照随机数字表法随机分为冲击波治疗组和传统治疗组(对照组),每组30例.冲击波组采用发散式冲击波治疗,冲击波压强2.5～4.0 bar,每次治疗2000次冲击,每周1次,共3次.对照组外敷氟比洛芬巴布膏联合跖筋膜拉伸锻炼.比较两组治疗前、治疗后1、4、12、24周的视觉模拟评分(VAS),治疗前和末次随访时美国足踝外科协会(AOFAS)足功能评分,并比较两组治疗结束后24周的优良率.结果 在治疗结束后1、4、12、24周时冲击波组VAS评分均低于对照组,且差异有统计学意义(P＜0.05).在治疗结束24周后冲击波组功能评分高于对照组,差异有统计学意义(P＜0.05).冲击波组整体优良率高于对照组,差异有统计学意义(P＜0.05).结论 两种治疗方式对跖筋膜炎的疼痛及功能改善均有效果,但发散式体外冲击波治疗跖筋膜炎的效果优于外用非甾体镇痛药联合跖筋膜拉伸训练的传统治疗方式,是一种治疗跖筋膜炎的新选择.