Objective:To compare the early analgesic effects and the impact on knee joint function recovery after unicompartmental knee arthroplasty (UKA) between single adductor canal block (SACB) and continuous adductor canal block (CACB) combined with local infiltration anesthesia (LIA) using a prospective study. Methods:The patients with knee osteoarthritis admitted between April 2022 and December 2023 were enrolled as a subject. Among them, 60 patients met the selection criteria and were enrolled in the study. They were randomly assigned to the SACB group or CACB group in a ratio of 1:1 using a random number table method. There was no significant difference between the two groups ( P>0.05) in terms of age, gender, height, body mass, body mass index, affected side, and preoperative resting visual analogue scale (VAS) score and active VAS score, Oxford knee score (OKS), and American Hospital of Special Surgery (HSS) score. All patients received multimodal analgesia management using LIA combined with SACB or CACB. The operation time, pain related indicators (resting and activity VAS scores, number and timing of breakthrough pain, opioid consumption), joint function related indicators (quadriceps muscle strength, knee range of motion, OKS score, and HSS score), as well as postoperative block complications and adverse events were recorded and compared between the two groups. Results:There was no significant difference in the operation time between the two groups ( P<0.05). All patients in the two groups were followed up with a follow-up time of (9.70±4.93) months in the SACB group and (12.23±5.05) months in the CACB group, and the difference was not significant ( P>0.05). The CACB group had a significant lower resting VAS score at 24 hours after operation compared to the SACB group ( P<0.05). There was no significant difference in resting and active VAS scores between the two groups at other time points ( P>0.05). The CACB group had a significantly lower incidence of breakthrough pain compared to the SACB group [9 cases (30.00%) vs. 17 cases (56.67%); P<0.05). However, there was no significant difference in the timing of breakthrough pain occurrence and opioid consumption between the two groups ( P>0.05). Four cases in the SACB group and 7 cases in the CACB group experienced adverse events, with no significant difference in the incidence of adverse events between the two groups ( P>0.05). The CACB group had significantly better knee joint mobility than the SACB group at 1 and 2 days after operation ( P<0.05). There was no significant difference between the two groups in knee joint mobility on 0 day after operation and quadriceps muscle strength and OKS and HSS scores at different time points ( P>0.05). Conclusion:In UKA, the analgesic effects and knee joint function recovery are similar when compared between LIA combined with SACB and LIA combined with CACB. However, SACB is simpler to perform and can avoid adverse events such as catheter displacement and dislocation. Therefore, SACB may be a better choice.

Objective:To summarize the research progress of anterior cutaneous nerve injury and repair in knee arthroplasty. Methods:The relevant literature at home and abroad in recent years was reviewed and summarized from the anatomy of anterior cutaneous nerve, nerve injury grade, clinical manifestations, prevention and treatment of anterior cutaneous nerve. Results:The anterior cutaneous nerve injury is a common complication of knee arthroplasty. Because the anterior cutaneous nerve branches are many and thin, and mainly run between the first and second layers of fascia, this level is often ignored during surgical exposure. In addition, the knee arthroplasty does not routinely perform the exploration and repair of the cutaneous nerve. So the anterior cutaneous nerve injury is difficult to avoid, and can lead to postoperative skin numbness and knee pain. At present, studies have explored the feasibility of preventing its occurrence from the aspects of improved incision and intraoperative separation of protective nerve. There is no effective prevention and treatment measures for this complication. For patients with skin numbness after knee arthroplasty, the effectiveness of drug treatment is not clear. Local nerve block or nerve excision can be used to treat patients with painful symptoms after knee arthroplasty considering cutaneous pseudoneuroma. Conclusion:Knee arthroplasty is widely used and anterior cutaneous nerve injury is common in clinic. In the future, more high-quality clinical studies are needed to further explore the prevention and treatment measures of this complication and evaluate the clinical benefits obtained.

Developmental dysplasia of hip (DDH) usually associates with acetabular dysplasia and femoral head deformity. It causes a poor match between the acetabulum and the femoral head, which in turn leads to abnormal mechanotransduction in the lower limbs, eventually causing hip pain and developing hip osteoarthritis (HOA). (HOA). Total hip arthroplasty (THA) is currently the preferred method for advanced and severe adult DDH. However, because of the developmental abnormalities of the acetabular structure, including the anterolateral bony deficiency and the increased anteversion of the acetabulum, the optimal position of the acetabular cup and the methods of intraoperative stabilization remain controversial. This article reviewed the progress of the effect of installing acetabular cup between anatomical and lifted positions in THA, and provided references for installation and handling of acetabulum in the treatment of DDH with THA according to image classification, different types of prosthesis, biomechanics, bone mass and hip function.

目的:探究应用智能预控外科平台对骨科住院医师规范化培训医生进行临床教学的效果.方法:选取2017年9月至2019年9月在广州医科大学附属第一医院骨科接受规培的16名规培医生的各项考核评分.根据是否使用智能预控外科平台进行临床教学(大于半年)分为试验组及对照组.其中试验组有4名,研究生学历比例75.00％,入科成绩87.25±2.22分,对照组有12名,研究生学历比例83.33％,入科成绩86.17±3.56分.对所有规培医生的入科教育考核评分、全国水平测试分数、全国与省排名及规培医生对临床教学的满意度调查评分进行统计并比较分析.结果:16名规培医生均按照要求进行医院规培基地培训并完成国家水平测试.两组规培医生学历比例、入科教育成绩分数差异均无统计学意义(P>0.05),经过医院基地培训后,与未使用智能预控外科平台进行临床教学的对照组规培医生相比,使用智能预控外科平台进行临床教学的试验组规培医生在国家水平测试分数、国家水平测试省内排名占比、国内排名占比及对临床教学满意度调查评分均较高,且差异具有统计学意义(P<0.05).结论:应用智能预控外科平台对骨科规培医生进行临床教学具有良好效果,可提升骨科规培医生的临床知识水平,提高规培医生对临床教学的满意度.

OBJECTIVE:To investigate the influence of tibial component posterior slope angle (TCPSA) on the short- and mid-term effectiveness of unicompartmental knee arthroplasty (UKA). METHODS:The clinical data of the patients with anterior medial knee osteoarthritis (KOA) treated by UKA between May 2014 and May 2019 were retrospectively analysed. There were 10 males and 45 females with a median age of 68 years (range, 49-83 years). The body mass index (BMI) was 27.63-52.26 kg/m 2, with an average of 40.04 kg/m 2. There were 28 cases of left knee, 21 cases of right knee, and 6 cases of double knees. The disease duration was from 7 months to 12 years, with an average of 4.33 years. Measurements of posterior tibial slope (PTS) and TCPSA were performed on the knee joint X-ray films of patients before operation and at last follow-up, respectively. According to the postoperative TCPSA, patients were divided into TCPSA<4° group (group A), 4°≤TCPSA<9° group (group B), and TCPSA>9° group (group C) with the quartile method. Baseline data such as age, gender, BMI, and affected side were compared among the 3 groups, as well as the Hospital for Special Surgery (HSS) score, visual analogue scale (VAS) score, and range of motion (ROM) before and after operation. RESULTS:All 55 patients were followed up 17-72 months, with an average of 36 months. No complication such as prosthesis loosening, infection, tibial plateau collapse, and dislocation of the meniscus pad occurred. The preoperative PTS was (7.38±3.37)°, and the postoperative TCPSA was (6.25±3.22)°, showing no significant difference ( t=1.815, P=0.074). According to postoperative TCPSA, there were 12 knees in group A, 32 in group B, and 17 in group C. There was no significant difference in age, gender, BMI, affected side, and preoperative HSS scores, ROM, and VAS scores among the 3 groups ( P>0.05). At last follow-up, the HSS scores, ROM, and VAS scores of the 3 groups significantly improved when compared with preoperative ones ( P<0.05). There was no significant difference in the difference of the above indicators before and after operation among 3 groups ( P>0.05). CONCLUSION:The patients with anterior medial KOA may have good short- and mid-term effectiveness after UKA. Among the recommended range of TCPSA, there is no significant influence on the postoperative short- and mid-term effectiveness. Long-term effectiveness need to extend the follow-up time and expand the sample size for research verification.

Purpose:Osteoarthritis (OA) is an age-related degenerative disease associated with enhanced degradation of extracellular matrix (ECM) and decreased autophagy. Our study is aimed to explore how corosolic acid (CRA) affect cartilage ECM metabolism and the potential mechanism.Methods:Rat chondrocytes were pretreated with different concentrations of CRA (0, 2.5, 5, and 10 μM), and were stimulated with IL-1β (10ng/mL) for 24 h, subsequently. RT-qPCR, Western blot, and immunofluorescence were used to detect the expression of genes related to ECM metabolism and explore the potential molecular mechanism. The effect of CRA on articular cartilage was observed in the surgically induced OA rat model with the method of Safranin O/Fast green and immunohistochemical staining.Results:Results showed that CRA reversed the IL-1β-induced degradation of aggrecan and type II collagen and the high expression of MMP13 and ADAMTS5. Mechanistically, CRA enhanced autophagy through inhibiting the classical PI3K/AKT/mTOR signaling pathway. Furthermore, inhibition of autophagy partly abolished the protective effects of CRA on ECM synthesis in IL-1β-treated chondrocytes. Correspondingly, the protective effect of CRA was also confirmed in a rat OA model.Conclusion:Herein, we demonstrate that CRA can enhance autophagy by inhibiting PI3K/AKT/mTOR signaling pathway, prevent IL-1β-induced cartilage ECM degradation, and may be a potentially applicable candidate for the treatment of OA.

Objective:To investigate the incluence of abnormal anterior cruciate ligament (ACL) MRI on the efficacy of unicompartmental knee arthroplasty (UKA).Methods:This study used statistical methods such as t test, rank sum test, and analysis of variance to retrospectively analyse the patients with anterior medial knee osteoarthritis treated by UKA admitted from May 2014 to May 2019 in the department of joint surgery of The First Affiliated Hospital of Guangzhou Medical University.Inclusion criteria: diagnosed anteromedial knee osteoarthritis, knee MRI showed only medial compartment cartilage wear and ACL abnormality, intra-operative findings showed only anterior medial cartilage wear while ACL function was normal. Exclusion criteria: multi-compartment osteoarthritis, rheumatoid arthritis, infectious arthritis. The MRI results showed ACL conditions, which were divided into ACL-MRI normal group and ACL-MRI abnormal group. A total of 55 patients (61 knees), of which 26 cases (30 knees) had complete ACLs, and 29 cases (31 knees) had abnormal ACLs. For the two groups, the Hospital for Special Surgery knee score (HSS), visual analogue scale (VAS) and range of motion (ROM) were used to evaluate the knee joint functions before operation and the last follow-up situation after operation respectively.Whether the prosthesis was loosening or infected after the operation, and whether the gasket had abrasion, dislocation or other complications, were also observed.Results:All the patients were followed up for the longest time of five years, with an average follow-up time of (21±17) months. At the last follow-up of normal ACL-MRI group after surgery, the average HSS score was(75.9 ± 7.6). The average VAS score was 1.0(0.7, 1.3), and the average ROM was (109.9±9.9)°. Postoperative ACL-MRI was abnormal at the last follow-up of the group. The average HSS score was(77.7 ± 6.6). The average VAS score was 0.8(0.6, 1.1), and the average ROM was(108.0±10.6)°. All the data were significantly improved compared with the preoperative scores. There was no statistically significant difference between the two groups in knee range of motion, knee HSS score and pain score (P>0.05). No complication such as prosthesis infection, loosening, fat embolism, gasket wear, or dislocation occurred in the two groups.Conclusion:The patients with preoperative abnormal ACL MRI but the ACL is confirmed unbroken and good function during operation may have good short-term and mid-term effects after UKA, which still needs follow-up for the long-term results.

As one of the current effective treatments for single-compartment knee osteoarthritis (KOA): unicompartmental knee arthroplasty (UKA), its history can be traced back to the 1950s. In the early stage, due to the lack of understanding of this technique and other reasons, the postoperative effect of UKA was not very satisfactory, and the scope of surgical adaptation was narrow relatively. With the development of prosthesis design, material technology and surgical technology of the UKA, in terms of medium and long-term effects after surgery, UKA has been comparable to total knee arthroplasty (TKA). The indications and contraindications of UKA have also changed. Whether patients with injured anterior cruciate ligament can perform UKA is still divided. This article made a review of the above problems to provide reference for clinical work.

OBJECTIVE:To investigate the effect of body mass index (BMI) on the short- and medium-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of anterior medial compartmental osteoarthritis of knee joint. METHODS:The clinical data of 55 patients (61 knees) with anterior medial compartmental osteoarthritis of knee joint treated with minimally invasive UKA between May 2014 and May 2019 were retrospectively analyzed. According to BMI, the patients were divided into 3 groups: normal body mass group [group A, BMI 18.50-24.99 kg/m 2, 23 cases (25 knees)], overweight group [group B, BMI 25.00-29.99 kg/m 2, 23 cases (25 knees)], obesity group [group C, BMI 30.00-39.99 kg/m 2, 9 cases (11 knees)]. There was no significant difference in gender, age, sides, disease duration, and preoperative American Special Surgery Hospital (HSS) score, pain visual analogue scale (VAS) score, and knee range of motion (ROM) among 3 groups ( P>0.05). The operation time, intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week were recorded and compared among 3 groups. The HSS score, VAS score, and ROM were used to evaluate the knee function and pain improvement. RESULTS:There was no significant difference in the operation time, the intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week among 3 groups ( P>0.05). All the 55 patients were followed up 5-60 months, with an average of 24 months. No complication such as infection, fat embolism, or deep venous thrombosis of lower extremity occurred after operation. The anteroposterior and lateral X-ray films of the knee joint showed that no dislocation or loosening of the prosthesis occurred and the position of the prosthesis was good. At last follow-up, the HSS score, VAS score, and ROM of the 3 groups were significantly improved when compared with preoperative ones ( P<0.05); but there was no significant difference among 3 groups ( P>0.05). CONCLUSION:For obese and overweight patients with anterior medial compartmental osteoarthritis of the knee joint, the use of minimally invasive UKA can achieve satisfactory short- and medium-term effectiveness, and the long-term effectiveness needs further follow-up.

目的:探讨不同程度男性雄激素性脱发(androgenetic alopecia,AGA)患者的血清双氢睾酮(DHT)水平的差异,评价非那雄胺联合外用5％米诺地尔治疗男性AGA患者的疗效及研究影响AGA治疗效果的相关因素.方法:收集202例我院脱发专科门诊男性AGA患者及262例对照组,检测血清DHT水平,给予非那雄胺1 mg/d联合外用5％米诺地尔治疗,定期检测AGA患者DHT水平变化并进行疗效及相关性评估.结果:不同脱发程度患者的血清DHT水平之间差异无统计学意义.治疗3个月后患者血清DHT水平明显降低,定期随访患者中,发现疗效与患者年龄、治疗时间、脱发严重程度呈一定相关性,与家族史无明显相关性(P>0.05).结论:DHT与男性AGA的发病密切相关,但患者血清DHT水平对脱发程度的影响较小.非那雄胺1 mg/d联合外用5％米诺地尔治疗男性AGA疗效肯定.患者早期就诊、坚持长期治疗可以起到良好的治疗效果.