目的 探讨高迁移率族蛋白1(HMGB1)通过PTEN诱导假定激酶1(PINK1)/帕金蛋白(Par-kin)介导的线粒体自噬对骨髓干细胞的趋化及成骨分化的影响.方法 将人骨髓间充质干细胞(hBM-SCs)分为7组:control组、siRNA-NC组、siRNA-HMGB1组、pcDNA-NC组、pcDNA-HMGB1组、pcDNA-HMGB1+siRNA-NC组、pcDNA-HMGB1+siRNA-PINK1组.采用Transwell检测细胞迁移能力;茜素红染色检测各组细胞中钙结节数目;ELISA检测骨桥蛋白(OPN)、碱性磷酸酶(ALP)的含量;RT-qPCR检测各组细胞中成骨细胞特异性转录因子(Osterix)、HMGB1及Runt相关转录因子2(RUNX2)、转录因子CCAAT/增强子结合蛋白(C/EBPα)、过氧化物酶体增殖物激活受体γ(PPARγ)水平;透射电镜检测线粒体自噬小体数目;Western Blot检测hBMSCs中Parkin及微管相关蛋白1A/1B-轻链3(LC3Ⅱ/Ⅰ)、选择性自噬接头蛋白62(P62)和自噬关键分子酵母Atg6同系物(Beclin1)等线粒体自噬相关蛋白的表达.结果 HMGB1通过PINK1/Parkin介导的线粒体自噬对hBMSCs的趋化作用研究表明:与pcDNA-NC组相比,pcDNA-HMGB1组HMGB1表达、细胞迁移率、线粒体自噬数目及自噬相关蛋白Beclin-1、LC3B-Ⅱ/Ⅰ的表达增加,Parkin、P62等蛋白的表达降低(P＜0.05);与siRNA-NC组相比,siRNA-HMGB1组HMGB1表达、细胞迁移率、线粒体自噬数目及Beclin-1、LC3B-Ⅱ/Ⅰ等表达降低,Parkin、P62表达增高(P＜0.01).HMGB1通过PINK1/Parkin介导的线粒体自噬对hBMSCs的成骨分化作用研究结果显示:与pcDNA-NC组相比,pcDNA-HMGB1组钙结节数量、Osterix及RUNX2含量、ALP及OPN的表达升高(P＜0.01),PPARγ、C/EBPα的表达降低(P＜0.05);与pcDNA-HMGB1+siRNA-NC组相比,pcDNA HMGB1+siRNA-PINK1组钙结节数量、Osterix及RUNX2含量、ALP及OPN的表达降低(P＜0.05),PPARγ、C/EBPα的表达升高(P＜0.05).结论 HMGB1高表达能通过PINK1/Parkin介导的线粒体自噬促进hBMSCs的趋化、成骨细胞分化及抑制成脂细胞分化,可能是骨质疏松症的潜在治疗靶点.

The anterolateral ligament, a distinct structure connecting the lateral femoral epicondyle to the anterolateral proximal tibia, is gaining attention because of its possible function in ensuring internal rotational stability of the tibia. To study the prevalence and precise anatomical characteristics of the anterolateral ligament and its relationship to adjacent structures in a Chinese population, a total of 20 amputated knee specimens were collected. The anterolateral regions of the knees underwent detailed surgical dissection, followed by precise measurement of the anterolateral ligament and its adjacent structures. Histological analysis of the anterolateral ligament was performed using hematoxylin and eosin (H&E) staining. A thin soft tissue deep to the iliotibial band running obliquely across the lateral fibula ligament and connecting the lateral head of the gastrocnemius with the tibia, termed the 'gastrocnemius-tibial ligament' or superficial layer of the anterolateral ligament, was observed in 18 of the 20 specimens, corresponding to a prevalence of 90%. Furthermore, a well-defined anterolateral ligament deep to the gastrocnemius-tibial ligament and distinct from the lateral fibula ligament was found in all 20 knees (prevalence, 100%). The independent gastrocnemius-tibial ligament and anterolateral ligament had separate femoral originations at the lateral head of the gastrocnemius and the lateral femoral epicondyle, and the same osseous tibial insertion at the midpoint between Gerdy's tubercle and the most lateral aspect of the fibular head. H&E staining showed that both the anterolateral ligament and gastrocnemius-tibial ligament were ligaments consisting of collagenous bundles. In the Chinese Han population, the gastrocnemius-tibial ligament and anterolateral ligament may form a complex at the anterolateral aspect of the knee, which is likely involved in ensuring the internal rotational stability of the tibia.

目的:探究同种异体半月板移植联合富血小板血浆(platelet-rich plasma,PRP)关节腔内注射治疗半月板全切除或次全切除术后患者的临床效果.方法:本研究回顾性分析了27例患者,根据是否行PRP关节腔内注射分为A组与B组,其中A组为单纯行半月板移植术的患者,共15例(男9例,女6例,手术时平均年龄29.7岁);B组为行半月板移植术联合PRP关节腔注射的患者,共12例(男4例,女8例,手术时平均年龄33.6岁).所有患者均在术后半年、1年及以后的每年随访,并行体格检查、影像学检查及International Knee Documentation Committee(IKDC)评分、Lysholm评分、Western Ontario and McMaster Univer-sities Osteoarthritis Index(WOMAC)评分、Tegner评分和Visual Analog Scale(VAS)疼痛评分.结果:术后的Tegner评分在2组中没有统计学差异(P＞0.05);B组在术后半年的Lysholm评分、WOMAC评分及VAS疼痛评分较A组高(P＜0.05),但术后1年及2年2组无统计学差异(P＞0.05).B组在术后半年及术后1年的IKDC评分均高于A组(P＜0.05),术后2年2组无统计学差异(P＞0.05).术后2年A组的绝对外凸值为(1.43± 1.18) cm,B组为(1.88± 1.21) cm,2组无统计学差异(P＞0.05).2组在术后2年的Outerbridge分级无统计学差异(P＞0.05).2组各有1例患者术后功能评分较术前下降:A组1例术后2年出现局部软骨Ⅳ度磨损;B组1例术后出现中度股四头肌萎缩.结论:同种异体半月板移植术联合PRP关节腔内注射相比单纯行同种异体半月板移植术,可以在术后1年内更有效地减轻术后疼痛,改善患膝功能.

Background: The aim of this study was to report the short-term clinical and imaging outcomes of lateral meniscus allograft transplantations (LMAT) combined with intra-articular platelet-rich plasma (PRP) injection. Methods: Thirty-three patients who had undergone LMAT combined with intra-articular PRP injection were evaluated. The Lysholm, International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index, Tegner activity level scale and visual analog scale for pain scores were used to evaluate the outcomes. Magnetic resonance imaging scans were performed postoperatively to assess graft position and chondral degeneration/damage. Results: A total of 31 of the original 33 patients were evaluated over a mean follow-up period of 37.0 months. Patients demonstrated statistically significant improvements in all scoring data from the pre-operative to two-year follow-up period. The mean postoperative extrusion was 1.59 +/- 1.20 mm (range 0-3.9 mm). There were no significant differences in the distribution of the grade of chondral damage between the pre-operative and two-year follow-up periods. Three patients (9.7%) showed no improvements or had lower evaluation scores. One patient underwent matrix-induced autologous chondrocyte implantation at one year after LMAT. Conclusion: Lateral meniscus allograft transplantation combined with intra-articular PRP injection resulted in statistically significant improvements in all functions and pain scores, and clinical improvements in Tegner, IKDC, and Lysholm values during short-term follow-up. A further case-control study with a larger sample size and longer follow-up is required to obtain an overall assessment of the benefits of PRP on MAT patients. Level of evidence IV. (C) 2018 Published by Elsevier B.V.