Introduction: The susceptibility modules and characteristic genes of patients with osteoarthritis (OA) were determined by weighted gene co-expression network analysis (WGCNA), and the role of immune cells in OA related microenvironment was analyzed. Materials and methods: GSE98918 and GSE117999 data sets are from GEO database. R language was used to conduct difference analysis for the new data set after merging. The formation of gene co-expression network, screening of susceptibility modules and screening of core genes are all through WGCNA. GO and KEGG enrichment analyses were used for Hub genes. The characteristic genes of the disease were obtained by Lasso regression screening. SSGSEA was used to estimate immune cell abundance in sample and a series of correlation analyses were performed. Results: WGCNA was used to form 6 gene co-expression modules. The yellow-green module is identified as the susceptible module of OA. 202 genes were identified as core genes. Finally, RHOT2, , FNBP4 and NARF were identified as the characteristic genes of OA. The results showed that the characteristic genes of OA were positively correlated with plasmacytoid dendritic cells, NKT cells and immature dendritic cells, but negatively correlated with active B cells. MDSC were the most abundant immune cells in cartilage. Conclusion: This study identified the Hippo signaling pathway, mTOR signaling pathway, and three characteristic genes ( RHOT2 , FNBP4, , NARF) ) as being associated with osteoarthritis (OA). These three genes are downregulated in the cartilage of OA patients and may serve as biomarkers for early diagnosis and targeted therapy. Proper regulation of immune cells may aid in the treatment of OA. Future research should focus on developing tools to detect these genes and exploring their therapeutic applications.

全膝关节置换术(TKA)是治疗中晚期膝关节骨关节炎的重要有效手段.随着人口老龄化加剧,越来越多膝关节患者需要接受人工关节置换手术.对于膝关节畸形的复杂膝关节患者,手术医师在选择初次TKA假体时常选用髁限制性膝关节假体,但这类膝关节假体仍存在截骨量大、手术时间长、假体周围感染风险高、翻修困难等不足.笔者在临床工作中发现,合理运用后稳定型(PS)假体行TKA治疗畸形膝关节可以减少上述不足,并能够取得满意的疗效.南昌大学第二附属医院运用PS膝关节假体行TKA治疗股骨髁前移、呈"反髁"畸形的复杂膝关节炎1例,将其诊治体会报告如下.

目的 研究不同入路全髋关节置换术(THA)治疗股骨头坏死(ONFH)的临床疗效.方法 选择 2017 年 1 月至2020 年 12 月在南昌大学第二附属医院骨科接受THA治疗的ONFH患者 66 例,采用照随机数字表法分为对照组和观察组各 33 例.对照组采用后外侧入路,观察组 33 例采用直接前方入路.比较两组围术期指标、疼痛程度、髋关节功能、生活质量及并发症.结果 观察组手术时间长于对照组,切口长度、卧床及住院时间短于对照组,术中出血及术后引流量少于对照组,差异有统计学意义(P＜0.05).两组术后VAS评分均显著降低,且观察组显著低于对照组,而HSS评分、QOL-BREF各项评分均显著升高,且观察组显著高于对照组,差异有统计学意义(P＜0.05).观察组并发症发生率为 3.03％,与对照组的 9.09％比较,差异无统计学意义(P＞0.05).结论 与后外侧入路相比,采用直接前方入路THA治疗ONFH对患者创伤小,可有效减轻疼痛程度,改善髋关节功能,提升生活质量,且并发症少,有助于术后康复.

目的:探讨股骨转子间骨折(IFF)术后患者应用金黄膏外敷的效果.方法:纳入2018年7月-2021年7月于南昌市洪都中医院就诊的90例IFF患者,采用随机数字表法将其分为对照组与观察组,每组45例.对照组术后予以常规镇痛、抗感染处理,并积极进行功能锻炼,观察组在对照组基础上加用金黄膏外敷治疗,两组均连续治疗7 d,并随访至治疗后3个月.比较两组临床疗效、肿胀程度、疼痛程度、髋关节功能及血液流变学指标.结果:观察组临床总有效率高于对照组(P<0.05).治疗7 d后,两组患肢与健肢周径差、VAS评分、全血低切黏度、全血高切黏度、血浆黏度均低于治疗前,且观察组均低于对照组,差异均有统计学意义(P<0.05);治疗后3个月,两组Harris评分均高于治疗前,且观察组高于对照组,差异均有统计学意义(P<0.05).两组治疗期间均未见明显不良反应.结论:IFF术后患者应用金黄膏外敷治疗,利于减轻患肢肿痛,促进血液循环及髋关节功能恢复,是一种安全、可靠的治疗方案.

目的 探讨手法整复联合生龙接骨胶囊治疗桡骨远端Colles骨折的临床应用价值.方法 将82例桡骨远端Colles骨折患者随机分为观察组和对照组,各41例.对照组予以手法整复治疗,观察组给予手法整复联合生龙接骨胶囊治疗,两组均随访至治疗后3个月.比较两组骨折愈合情况、疼痛及肿胀缓解时间、腕关节功能、骨代谢指标及并发症发生情况.结果 观察组总愈合率、腕关节功能优良率均高于对照组,疼痛缓解时间、肿胀缓解时间均短于对照组,治疗后碱性磷酸酶水平低于对照组、骨钙素水平高于对照组,差异均有统计学意义(均P＜0.05);观察组的并发症发生率低于对照组,但差异无统计学意义(P＞0.05).结论 手法整复联合生龙接骨胶囊可促进桡骨远端Colles骨折患者骨折愈合,缩短疼痛缓解时间及肿胀缓解时间,纠正骨代谢指标,促进腕关节功能恢复,并发症少,值得临床推广应用.

Osteoarthritis (OA) is one of the most prevalent pain-inducing and disabling diseases globally. Aging is a primary contributing factor to the progression of OA. Forkhead box protein O4 (FOXO4) is known to be involved in the cell cycle and apoptosis regulation. The aim of the present study was to investigate the association between FOXO4 expression and chondrocyte degeneration in rats. Chondrocytes were assigned to the control (4-week-old rats), natural degeneration (16-week-old rats) or induced degeneration (IL-1β-treated chondrocytes from 4-week-old rats) groups. Immunocytochemical analysis with β-galactosidase staining revealed a greater number of stained cells present in the natural and induced degeneration groups than in the control group. PCR analysis indicated lower mRNA expression levels of collagen type II α1 chain (Col2α) and higher levels of FOXO4, and western blotting revealed reduced Col2α protein expression levels and significantly elevated FOXO4 levels in the natural and induced degeneration groups, compared with those in the control group. The results of the present study revealed that FOXO4 expression was altered in the natural and induced degeneration groups, and further research and exploration are needed to clarify the underlying mechanism.

目的:探讨快速康复外科模式下肩关节镜治疗肩袖损伤术后早期康复效果.方法:分析2018年10月至2019年10月南昌大学第二附属医院收治的肩袖损伤患者52例,根据术前术后采取的治疗模式进行分组:快速康复组(n=27)患者术前及术后均根据快速康复理念进行围手术期管理;传统康复组(n=25)患者采取常规围手术期理念管理,两组患者均在同一团队下行同样手术方式治疗.测量和比较两组患者术前即刻、术后1天、术后第2天和术后第3天晨起空腹胰岛素值、空腹血糖值和C反应蛋白的变化,对比两组患者入院第1天及术后1、2、3个月的SAS焦虑评分、SDS抑郁评分、疼痛VAS评分、Constant评分和ASES评分的变化,以及患者对住院期间的满意程度.结果:①两组患者入院第1天SAS评分、SDS评分、VAS评分组间差异无统计学意义(P>0.05),术后各时间点快速康复组评分均低于传统康复组(P<0.05);②两组入院第1天及术后3月Constant评分和ASES评分组间差异均无统计学性意义,术后1个月及术后2个月Constant评分和ASES评分快速康复组均优于传统康复组(P<0.05);术后1、2、3个月两组的Constant评分和ASES评分组内比较均优于术前评分,差异具有统计学意义(P<0.05);③快速康复组患者术前空腹血糖高于传统康复组,差异具有统计学意义(P<0.05),两组术前空腹胰岛素及C反应蛋白差异无显著性(P>0.05);术后第1天、术后第2天、术后第3天两组空腹血糖、空腹胰岛素组间差异无显著性(P>0.05),而C反应蛋白则快速康复组患者显著低于传统康复组(P<0.05).④快速康复组患者较传统康复组患者对住院期间满意程度高(P<0.05).结论:快速康复外科能够减轻肩关节镜下肩袖修补手术患者的抑郁、焦虑和疼痛程度,提高患者住院满意度,改善早期肩关节功能康复的效果.

Knee osteoarthritis (KOA) is a chronic joint disorder involving the articular cartilage and tissues around the synovial joint. The key objective of this study was to determine the effect of miR-186-5p administration on the expression of pathogenic signalling in the chondrocytes using a surgical destabilization of the medial meniscus (DMM) model of KOA, and to testify the mechanism of P2X7-mediated regulation of RUNX2/ADAMTS5 axis by miR-186 in the KOA rats. After eight weeks of intra-articular injection of the miR-186-5p and negative control lentivirus samples, the knee cartilage tissues were subjected to histopathological analysis Safranin-O/Fast green staining. Further, the articular chondrocytes were separated and analysed for various proteins including P2X7, cathepsin-K, RUNX2 and ADAMTS5 using Western blotting method. We observed that the protein expressions of P2X7, cathepsin-K/RUNX2/ADAMTS5, and also MMP-13 were upmodulated in the KOA rats, while intra-articular miR-186-5p lentivirus administration prevented these aberrations. Hence, the study concludes that miR-186 orchestrates P2X7 expression and the P2X7-mediated cathepsin-K/RUNX2/ADAMTS5 axis and regulates the pathogenesis of KOA. In light of this evidence, we propose that molecular therapeutic interventions targeting miR-186 activation might attenuate osteoarthritic cartilage degeneration.

半月板是膝关节的重要组成结构之一,它起到了缓冲震荡、润滑以及稳定膝关节的作用.当半月板受到损伤时,患者会出现膝关节疼痛、肿胀、屈伸活动受限等症状.这些临床症状会严重影响到患者的日常生活质量,不仅在生理上折磨着患者,并且在心理上也造成极大的伤害.临床上,保守治疗主要为口服非甾体类药物、热敷和理疗等;手术治疗主要为半月板切除或半月板缝合修复,但其治疗效果仍不够理想.随着医学科技的进步及研究者们不断探索,研究者们发现富血小板血浆(Platelet-rich plasma,PRP)在治疗半月板损伤上有着显著的疗效.PRP富含血小板、多种生长因子、纤维蛋白等,可以有促进半月板损伤修复,可以促进膝关节内炎症吸收,还可以改善膝关节功能,有着很好的临床应用前景.

目的 探讨经股内侧肌下方入路(SVA)行全膝关节置换术(TKA)的临床疗效.方法 选取南昌大学第二附属医院2012年9月至2014年6月收治的膝关节骨关节炎患者78例,均行人工TKA治疗.将所有患者分为两组(各39例):A组给予微创SVA行TKA治疗,B组给予传统的内侧髌旁入路行TKA治疗.比较两组的手术时间、手术切口长度、术后2d引流量、术后可直腿抬高时间、术后视觉模拟评分法(VAS)评分和膝关节Harris评分(HSS).结果 A组手术切口长度、术后2d引流量、术后可直腿抬高时间、术后1周VAS评分和术后1周HSS均优于B组,差异均有统计学意义(P＜0.01);两组的手术时间和术后3个月、2年的VAS评分和HSS比较,差异均无统计学意义(P＞0.05).结论 经微创SVA行TKA可减少手术创伤,减少术后失血,减轻术后疼痛,促进术后早期膝关节功能恢复.

目的 比较膝关节单髁置换术(UKA)与关节镜联合胫骨高位截骨术(HTO)治疗膝关节内侧间室骨性关节炎的临床疗效.方法 将35例膝关节内侧间室骨性关节炎患者按入院的先后顺序分为观察组(n=17)和对照组(n=18).观察组行UKA,对照组行关节镜联合HTO.观察2组手术时间,术前和术后1周,术后1、3、6、12个月的美国特种外科医院膝关节评分(HSS评分)、视觉模拟量表(VAS)评分、关节活动度(ROM)及术后并发症.结果 观察组手术时间为(78.0±9.3)min,短于对照组的(110.0±12.5)min,差异有统计学意义(P<0.05).观察组术后1周和术后1、3个月HSS评分、VAS评分均高于对照组,切口愈合不良发生率低于对照组(均P<0.05).对照组术后1周和术后1个月ROM均优于观察组(均P<0.05).结论 UKA治疗膝关节内侧间室骨性关节炎可取得较好的疗效.

Perioperative visual loss (POVL) is an infrequent, devastating complication. Increased recognition and discussion of this complication is reported in recent literature, most notably following spinal and cardiac surgery. The most common causes are ischemic optic neuropathy, central retinal artery occlusion, and cortical blindness. Here, we present a case of a 54 y old female who developed acute visual loss in her eyes after lateral position total hip arthroplasty that might explain this complication.

Background: Gamma-glutamyl carboxylase (GGCX) was apparently decreased in cartilage tissue from OA patients. However, whether GGCX overexpression has functions in regulating chondrocytes from osteoarthritis (OA) model is still unknown. Objective: This study aimed to explore the effects of GGCX gene overexpression on cell differentiation of chondrocytes from osteoarthritis (OA) rabbits, and to assess the mechanisms. Methods: Chondrocytes were isolated from OA rabbit and identified by Alizarin red staining. The isolated chondrocytes were divided into three groups: normal control, GGCX overexpression and vehicle. Lenti-viral encoding GGCX vector was applied to overexpress GGCX expression. Apoptosis of the cells after viral transfection was detected by flow cytometry. GGCX, matrix metalloproteinase 13 (MMP13), type X collagen, type II collagen, tumor necrosis factor (TNF) and interleukin-1 beta (IL-1 beta) were detected by real-time PCR and western blot. Results: Compared with vehicle, lenti-viral encoding GGCX significantly elevated GGCX expression in OA chondrocytes in both mRNA and protein levels (P<0.05). Subsequently, GGCX overexpression remarkably increased type II collagen, while decreased MMP13, type X collagen, TNF and IL-1 beta expression in both mRNA and protein levels (P<0.05). Especially, GGCX overexpression prohibited the apoptosis of OA chondrocytes compared with vehicle (P<0.05). Conclusion: GGCX overexpression could regulate the balance of extracellular matrix, promote proteoglycan synthesis in chondrocytes, which might be related to the decreased apoptosis. This study provides new therapeutic concept for osteoarthritis.