Currently, there are two methods of treating subtrochanteric femur fractures: intramedullary nailing and extramedullary plate fixation. However, it remains to be seen whether internal or external fixation is the primary treatment for subrotator femur fractures in adults. In this meta-analysis, we reviewed the effects of internal and external fixation on the treatment of subrotator and subrotator fractures. Until July 2023, the researchers have been researching the Cochrane Library, Embase, Web of Science and PubMed, with English as their only language. The aims of the study are as follows: (1) to assess the efficacy of internal and external fixation for the treatment of postoperative wound infections in adult patients with subrotator femur fractures; (2) to assess the efficacy of various types of internal fixation for the treatment of adult patients with subrotator femur fractures, including postoperative complications, infections, and operative time. Meta-analysis showed that there was no significant difference in the treatment of subrotator fracture with internal versus external fixation in terms of wound infections, intra-operative bleeding, length of incision, and operative time were not significantly different. Therefore, more research is needed to support these findings with a number of large, high-quality randomized studies.

目的 探讨加味独活寄生合剂治疗膝骨关节炎的可能作用机制.方法 46只雄性新西兰大白兔随机分为空白组(8只)、常规模型组(19只)和3MA自噬抑制剂造模组(19只).常规模型组使用高分子树脂石膏绷带固定兔右侧后肢建立膝骨关节炎模型,3MA自噬抑制剂造模组在上述造模基础上加用自噬抑制剂3MA关节腔注射造模,造模周期为6周,两个造模组均造模成功各16只.将常规造模组分为模型组和加味独活寄生合剂组,3MA自噬抑制剂组分为3MA组和3MA+加味独活寄生合剂组,每组8只.加味独活寄生合剂组和3MA+加味独活寄生合剂组均给予加味独活寄生合剂单次生药量为2.26 g/kg灌胃,其余各组予以3.4 ml/kg蒸馏水灌胃,每日2次,持续4周.给药结束后观察各组兔膝关节软骨大体情况,苏木素-伊红(HE)染色检测软骨组织病理学变化,并分别通过Pelletier评分、Mankin评分进行量化评估;检测各组兔关节软骨组织中自噬相关蛋白[自噬相关基因7(ATG7)、自噬关键分子酵母Atg6同系物1(Beclin-1)、微管相关蛋白1轻链3(LC3)]及凋亡相关蛋白[B淋巴细胞瘤-2(Bcl-2)、半胱氨酸蛋白酶3(Caspase3)]mRNA及蛋白表达水平.结果 与空白组比较,模型组兔膝关节软骨病理损伤明显,Pelletier评分及Mankin评分升高,软骨组织中 Beclin-1、LC3、ATG7、Bcl-2、Caspase-3 mRNA表达均升高,Beclin-1、LC3、ATG7、Caspase-3蛋白表达升高(P＜0.05或P＜0.01).与模型组比较,加味独活寄生合剂组关节软骨损伤改善,Pelletier评分及Mankin评分降低,软骨组织中Beclin-1、LC3、ATG7、Bcl-2 mRNA及蛋白表达升高,Caspase-3 mRNA及蛋白表达降低(P＜0.05或P＜0.01).与加味独活寄生合剂组比较,3MA+加味独活寄生合剂组Pelletier评分、Mankin评分升高,软骨组织中Beclin-1、LC3、ATG7、Bcl-2 mRNA及蛋白表达降低,Caspase-3 mRNA表达升高(P＜0.05或P＜0.01).结论 加味独活寄生合剂对膝骨关节兔的关节软骨具有保护作用,其机制可能是通过诱导软骨组织自噬、抑制细胞凋亡实现的.

Osteoarthritis (OA) is a common degenerative disease with few treatments. In traditional Chinese medicine (TCM), Radix Angelicae biseratae (RAB) is commonly used to treat OA. Nodakenin (Nod) is one main coumarin active component in RAB and exhibits anti-inflammatory, anti-oxidative, and anti-apoptotic effects. Reactive oxygen species (ROS) produced by mitochondria play a vital role in the pathogenesis of OA. We hypothesized that Nod might ameliorate cartilage degradation and inflammatory responses by regulating the mitochondrial Drp1/ROS/NLRP3 axis. With this, the effects of Nod on a mouse model of knee OA and activated primary chondrocytes were assessed. The results showed that Nod intervention improved bone volume, lowered trabecular separation, and increased trabecular number in the subchondral bone. Nod decreased the Osteoarthritis Research Society International (OARSI) scores and increased collagen II-positive areas in the articular cartilage of the tibial plateau. Compared with OA mice, Nod-treated animals exhibited lower levels of inflammatory factors in the serum and synovitis of the knee joint. In vitro results indicated that Nod suppressed dynamin-related protein 1 (Drp1) phosphorylation and massive ROS production by Drp1-dependent mitochondrial fission in lipopolysaccharide-stimulated chondrocytes. Moreover, Nod inhibited the mRNA levels of inflammatory cytokines (COX 2, IL-1β, and TNF-α), nod-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome, and matrix metalloproteinase 13 expression in activated chondrocytes. In conclusion, Nod attenuates cartilage degradation and inflammatory responses in mice with OA by regulating the mitochondrial Drp1/ROS/NLRP3 axis, suggesting its potential for OA therapy.

骨关节炎为临床常见的慢性筋骨退行性疾病,也是致残的主要原因之一,由于发病率高且发病机制仍未阐明,如何防治该病成为亟待解决的难题.自噬是细胞维持代谢平衡以及细胞器更新的重要自我平衡机制,随着相关研究的不断深入,发现自噬在骨关节炎的进展过程中有不可忽视的作用.中医学在防治骨关节疾病中有着显著疗效,随着中医药现代化进程的推进,不断涌现的研究证实中药可通过调控细胞自噬水平发挥治疗OA的作用.本文就中药通过调控自噬治疗骨关节炎的相关研究进行综述,以期为后续中药防治骨关节炎的深入研究提供思路.

Objective: To compare the effect of three kinds of traditional Chinese medicine injection (zhengqing fengtongning injection, shenmai injection, cervus and cucumis polypeptide injection) on knee osteoarthritis with the method of Network meta-analysis. Methods: Two researchers independently used computers to search for randomized controlled clinical trials of zhengqing fengtongning injection, shenmai injection, or cervus and cucumis polypeptide injection for the treatment of knee osteoarthritis published in CNKI,VIP,WANFANG DATA,CBM and PubMed databases (since the date of database establishment to February 2020). After the methodological quality of included researches were evaluated, and the valid data were extracted, statistical analysis was performed With RevMan5.3 and R 3.53. Results: There were including 9 RCTs, which involving 720 patients.The results of network Meta-analysis showed that: All three traditional Chinese medicine injections effects are approximately equal. The probability ranking chart shows that Zhengqingfengtongning injection may have the best effect. Conclusions: Three commonly used traditional Chinese medicine injections can effectively treat knee osteoarthritis, of which Zhengqingfengtongning injection is probably the most effective. Due to the small number of literatures included in this study and the single outcome index, we still need to treat the results of this study with caution. It is suggested that more high-quality, long-term follow-up studies should be carried out for this kind of treatment in the future, so as to provide solid evidence support for the popularization of these treatment measures.

目的:使用贝叶斯网状meta分析方法综合比较3种常用中药注射液(正清风痛宁注射液、参麦注射液、鹿瓜多肽注射液)治疗膝骨关节炎的疗效.方法:从数据库知网、维普、万方、CBM和PubMed中检索发表的使用正清风痛宁注射液、参麦注射液、鹿瓜多肽注射液中任意一种治疗膝骨关节炎的临床随机对照试验文献(建库至2020年2月份).结合纳入标准对获得的文献进行遴选、质量评价及提取相关数据后,RevMan5.3及R 3.53软件完成数据分析.结果:最终纳入合计720例患者的9个随机对照试验,网状meta结果显示:3种中药注射液的疗效大致相等,概率排序图显示正清风痛宁注射液疗效可能是最好的.结论:3种常用中药注射液均能有效治疗膝骨关节炎,正清风痛宁注射液可能是其中最有效的.本次研究纳入的文献结局指标较为单一,仍需谨慎地对待本次研究结果,建议以后对于此类治疗开展更多高质量、长期随访的研究,为这些治疗措施的推广提供坚实的证据支持.

目的 探讨消炎散中活血化瘀药含药血清对成软骨诱导下兔间充质干细胞(Mesenchymal stem cells,MSCs) Wnt/β-catenin信号通路及SOX9的影响.方法 提取并培养MSCs,先分为成软骨细胞诱导剂组和未成软骨细胞诱导剂组,每组又分为不加血清组、含药血清组、空白血清组、sFRP-3组.采用流式细胞仪检测细胞周期情况,运用RT-PCR、West-ern Blotting检测Wnt信号通路相关Wnt5a、β-catenin,SOX9基因及蛋白水平表达的变化.结果 RT-PCR及WesternBlotting显示,活血化瘀含药血清抑制诱导前MSCs表达Wnt5a、β-catenin mRNA和蛋白,促进SOX9 mRNA和蛋白表达,而对诱导后的MSCs促进WntSa、β-catenin mRNA和蛋白表达,抑制SOX9 mRNA和蛋白表达.结论 消炎散中活血化瘀药含药血清可通过作用Wnt/β3-catenin信号通路,改变SOX9的表达水平,进而影响MSCs的软骨分化.

基于"玄府气液学说"从中医微观探讨神经性皮炎血虚风燥证的病因病机,认为该病病位核心在于玄府,阴血虚耗、玄府郁闭为该病的病机关键,治疗应以"养血润燥、开通玄府"为原则,强调养血开玄法的重要性.

腰椎间盘突出症是临床常见病、多发病,属于中医学"腰腿痛""筋伤"等范畴.气化理论是中医基础理论中的一种,对腰椎间盘突出症的临床治疗具有重要的指导意义.本文基于气化理论对腰椎间盘突出症的病机与治疗方法进行了探讨,认为气化失司是腰椎间盘突出症的核心病机,温阳以助气化是治疗腰椎间盘突出症的重要方法.

跟痛症又名足跟痛,是以足底后跟部疼痛为主要临床表现的一种疾病,其发病年龄多在40岁以上,尤以肥胖者或运动员为多。患者往往由于足部疼痛,活动范围及活动量减少,导致许多慢性疾病的形成。顿足疗法是一种民间疗法,是传统医学中足部疗法的一种,对跟痛症具有较好的疗效。现对顿足疗法治疗跟痛症的机制进行探讨,为临床治疗本病提供参考。