Abstract Objective Previous studies have shown that knee arthritis is a disease influenced by environmental and genetic factors. In this paper, we mainly investigate the association between SNPs in the DVWA gene region and the susceptibility to KOA in north Chinese Han people. Methods We performed two-center cross-sectional observational study that included 103 Chinese Han patients with KOA and 128 healthy Chinese Han volunteers. We investigated four SNPs (rs11718863, rs7639618, rs7651842 and rs7639807) in the DVWA gene region and extracted the genes using QIAamp DNA Mini Kit. We amplified the target gene fragment and sequenced the genotype.The corresponding frequency were counted and the counting results were statistically analyzed. Results The patient group was significantly older than the control group, and the difference was statistically significant(P < 0.001). There were no statistically significance between-group differences in gender, height, weight, or BMI (P > 0.05, respectively). The chi-square test was used to analyze the four SNPs of DVWA gene, and rs11718863 and rs7639618 polymorphism was statistically different between the two groups(P = 0.04, P = 0.04, respectively). The rs11718863 and rs7639618 was consistent with Hardy-Weinberg equilibrium. Logistic regression analysis showed that KOA risk was significantly increased in the rs11718863 TT genotype (3.31, 95%CI 1.32, 8.34, P = 0.011) and the rs7639618 TT genotype (OR 2.86 ,95% CI 1.16, 7.04, P = 0.023). After age adjustment, the same result was observed in the rs11718863 SNP(OR 2.79, 95% CI 1.04, 7.43, P = 0.041), and the risk of KOA disappeared in the rs7639618 SNP (OR 1.50, 95% CI 0.79, 2.86, P = 0.217). The rs7651842 and rs7639807SNP were monomorphic for the T and C allele respectively. Conclusions We found that the rs11718863 SNP was associated with KOA. The TT genotype and T allele were the highest risk factors for the development of KOA in the north Chinese Han population.

目的 探讨 COG5 基因多态性并分析其与汉族人群膝关节骨关节炎(knee osteoarthritis,KOA)易感性的关系.方法 收集 2017 年 1 月至 2018 年 12 月在中国康复研究中心北京博爱医院和首都医科大学附属北京朝阳医院就诊的原发性 KOA 患者 96 例为 KOA 组,选择年龄相当的 118 例门诊健康志愿者作为对照组,对 2 个标记多态性(rs3815148 和 rs3757713)进行了基因分型.比较两组之间的基因型频率和等位基因分布,并分析单核苷酸多态性(single-nucleotide polymorphism,SNP)与 KOA 易感性之间的关联.结果 rs3815148 和 rs3757713 多态性在 KOA 组和对照组均符合 Hardy-Weinberg 平衡(P>0.05).rs3815148 和rs3757713 基因型频率和等位基因分布的组间差异有统计学意义(P<0.05).KOA 组 G 等位基因频率明显高于对照组,而 TT 基因型明显低于对照组.结论 rs3815148 和 rs3757713 多态性 G 等位基因可能是 KOA 的一个风险因子,但是 TT 基因型可能是 KOA 的一个保护因素.

Objective we screened and identified key genes and pathways related to the synovial inflammatory response in KOA to better study the molecular mechanism of action.Methods Two main datasets from a professional comprehensive gene expression database were downloaded; namely, GSE55235 and GSE55457. GEO2R is a tool for analysis of differentially-expressed genes (DEGs) based on the Gene Expression Omnibus (GEO) database, and we used this to identify DEGs, then performed RNAseq from samples of KOA and normal synovium (Experimental Group, EG). Based on these three datasets, a total of 49 DEGs were identified, consisting of 36 downregulated genes and 13 upregulated genes. GO enrichment analysis and KEGG enrichment analysis of data were performed with the help of Webgestalt and metascape. Cytoscape software was used to import the PPI network, and then the first five percent of genes were tagged as Hub genes.Results Three hub genes–FOSL2, NR4A1, and ATF3–were identified and may be involved in the pathogenesis of KOA.Conclusions This study analyzed DEGs and hub genes in inflamed KOA synovium, which may help us understand the pathogenesis of KOA and provide candidate targets for diagnosis and treatment of OA.

目的 分析儿童下肢截肢及其康复的流行病学特点与临床特征,阐述儿童截肢的原因及截肢后并发症的情况.方法 选择2016年1月至2021年3月北京博爱医院收治的下肢截肢儿童51例,分析截肢原因与截肢后并发症的相关性.结果 创伤性截肢占58.82％,主要原因为交通事故(70％);疾病性截肢占41.18％,主要原因为先天性肢体畸形(80.95％).创伤性截肢后发生残端并发症的可能性较预期更高(P<0.05);疾病性截肢后发生残端并发症的可能性较预期更低(P<0.05).结论 交通事故是儿童创伤性截肢的主要原因,其临床特征是不良残端发生率高,主要原因是软组织异常,大部分病例需要通过残端修整术改善不良残端而达到装配假肢恢复行走的目的.先天性胫骨假关节是儿童疾病性截肢的主要原因,往往经历长期的保肢治疗后仍不能避免截肢的结局.

目的 探讨持续性护理干预对老年股骨粗隆间骨折股骨近端抗旋髓内钉(PFNA)内固定术后肢体功能康复和护理质量的影响.方法 2017年2月至2018年11月,本院100例行PFNA内固定术的老年股骨粗隆间骨折患者随机分为对照组(n=50)和观察组(n=50),分别采用常规护理干预和持续性护理干预3个月.干预前、后分别用Harris评分和疼痛视觉模拟量表(VAS)进行评定,比较术后护理效果.结果 干预后,两组Harris评分均显著升高(t>45.98,P<0.001),观察组显著高于对照组(t=15.03,P<0.001);两组VAS评分均显著下降(t>16.33,P<0.001),观察组显著低于对照组(t=9.749,P<0.001).干预后,观察组临床护理优良率高于对照组(Z=-2.272,P=0.023).结论 持续性护理干预可以显著改善老年股骨粗隆间骨折PFNA内固定术后患者患肢功能,提高护理满意度.

目的 探讨初次全膝关节置换术(TKA)后放置与不放置引流对术后快速康复的影响.方法 回顾性分析2018年1月至2020年9月本院接受初次TKA的膝骨关节炎患者80例.A组(n=40)术后常规放置引流管,B组(n=40)术后不放置引流管,比较两组术后血清炎症因子指标、术后疼痛评分、术后并发症发生率、术后离床活动时间、住院时间、膝关节功能评分、膝关节活动度和世界卫生组织生活质量简表评分.结果 术后第1～3天,两组C反应蛋白水平无显著性差异(t<0.410,P>0.05).术后12～48 h,两组疼痛VAS评分无显著性差异(t<0.300,P>0.05).A组术后并发症发生率为5.0％,B组为2.5％,无显著性差异(χ2=0.346,P>0.05).B组术后离床活动时间、住院时间均显著短于A组(t>4.863,P<0.001).两组手术后的膝关节功能评分、膝关节活动度和生活质量评分均显著增加(t>6.099,P<0.001),但两组间比较均无显著性差异(P>0.05).结论 TKA后放置与不放置引流不影响患者的术后并发症、膝关节功能改善情况和生活质量提高情况,但不放置引流可加快患者术后康复,促使患者尽早出院.

Objective:This work aims to explore the relationship between leg length discrepancy (LLD) and the onset and imaging features of primary knee osteoarthritis (KOA) to provide a theoretical basis for the prevention and treatment of this disease.Methods:Clinical and imaging data of 141 patients with primary KOA who underwent total knee arthroplasty (TKA) were analyzed retrospectively from June 2017 to August 2019 in Beijing Bo'ai Hospital. Among these patients, 19 were males and 122 were females with an average age of(67.8±9.4)years and body mass index (BMI) of (26.8±2.9) kg/m 2. Prior to the operation, the whole legs were examined by CT, and bilateral leg length, anatomical femoral-tibial angle (AFTA), and pelvic tilt angle (PTA) were measured by Webviewer software. The K-L grade of KOA severity was evaluated using weight-bearing X-ray. The patients were categorized into LLD (LLD>5 mm) and control groups (LLD<5 mm) according to the magnitude of LLD. The LLD group was further divided into long and short leg sides according to lower limb length. The incidence of LLD in patients with KOA was evaluated, and the differences in sex, age, BMI, and PTA were compared between the two groups. In the LLD group, the association of LLD with age, BMI, and PTA was evaluated by Spearman correlation analysis, and the differences of AFTA, K-L grade, and TKA operation location (long or short leg side) were compared. Results:Among the 141 patients with KOA, 68 patients presented as LLD with incidence rate of 48.2%. The PTA (3.93°±3.13°) of LLD group was higher than that of control group (2.31°±2.06°), and the difference was statistically significant ( t=3.654, P<0.05). In the LLD group, the AFTA of the short leg side (4.74°±7.02°) was larger than that of the long leg side (2.0°±5.69°), and the difference was statistically significant (χ 2=2.554, P<0.05). The operation rate of TKA in the short leg side was 89.7% (61/68), which was significantly higher than that in the long leg side at 57.4% (39/68), and the difference was statistically significant (χ 2=16.753, P<0.05). No statistically significant difference in K-L grade was observed between the short and long leg sides ( P>0.05). In the LLD group, Spearman correlation analysis showed that LLD was positively correlated with PTA, and the difference was statistically significant ( r s=0.547, P<0.01). No correlation was observed among LLD, BMI, and age ( r s=0.082, 0.075, all P values>0.05). Conclusions:LLD has high incidence in patients with primary KOA and usually occurs on the short leg side and may lead to pelvic tilt. When the magnitude of LLD is high, the deformity becomes severe. Early active intervention may be important in the prevention of KOA.

OBJECTIVETo identify differentially expressed serum proteins that could serve as sensitive biomarkers of heterotopic ossification in patients with traumatic brain injury.METHODSFrom August 2014 to December 2015, 18 patients with traumatic brain injury were enrolled in the study, and blood samples were collected. Patients with traumatic brain injury were divided based on the presence (n=9 patients, heterotopic ossification group) or absence (n=9 patients, traumatic brain injury group or control group) of heterotopic ossification. Protein expression profiles were compared using 2-dimensional electrophoresis. Differentially expressed proteins were examined using matrix-assisted laser desorption/ionization and time-of-flight tandem mass spectrometry (MALDI-TOF/TOF). The differentially expressed proteins identified were further confirmed by Western blotting.RESULTSSeven protein spots were differentially expressed between heterotopic ossification and traumatic brain injury groups in 2-dimensional electrophoresis analysis. Vitamin D binding protein (Gc protein), retinol binding protein 4 (RBP4) and haptoglobin expression decreased significantly in the heterotopic ossification group compared with the control group (p < 0.05), and this was further confirmed by Western blotting.CONCLUSIONLower levels of expression of Gc protein, RBP4 and haptoglobin may be closely related to heterotopic ossification after traumatic brain injury. These proteins may be potential biomarkers of heterotopic ossification secondary to traumatic brain injury.

OBJECTIVE:To investigate the association between SNP in the BTNL2 gene region and the susceptibility to osteoarthritis of the knee.METHODS:The blood samples of 103 knee osteoarthritis and 134 healthy subjects were collected. Four SNP in the BTNL2 gene region were selected, whole DNA was extracted using the QIAamp blood DNA purification mini reagent, the BTNL2 gene fragment was amplified and sequenced, and the genotype and corresponding frequency were counted. The results were statistically analyzed.RESULTS:The four SNP (rs41521946, rs28362677, rs28362678, rs28362675) in the BTNL2 gene region were analyzed using a chi-square test (mutation heterozygote, homozygous, and normal homozygote), and the genotypes of the four mutation points were found to be statistically significant (P=0.003, 0.013, 0.005, and 0.045, respectively). Among the four SNP, the first three SNP were in Hardy-Weinberg equilibrium, and a multivariate logistic regression analysis was used to correlate them with knee osteoarthritis (P=0.003, 0.013, 0.005, respectively). rs28362675 was not in Hardy-Weinberg equilibrium but was associated with knee osteoarthritis (P=0.045), which might be smaller samples or an ethnicity differential allelic variation. The P values of the statistical analysis of age and height in the baseline data of both groups were less than 0.05. Considering the possible impact on the results, they were used as covariates in the analysis. The SNP of rs41521946 and rs28362677 showed a significant change in their associations with mutations, and the genotype P values of rs41521946 (AC+AA)/CC and rs2836267 (AG+AA)/GG were 0.002, 0.006, respectively.CONCLUSION:Four SNP (rs41521946, rs28362677, rs28362678, rs28362675) in the BTNL2 gene region were significantly associated with knee osteoarthritis, and the target population might be significantly affected by rs28362675.

Objective The primary purpose of this study was to investigate the effect of bone cement use on the intra-operative deviation in limb alignment in total knee arthroplasty ( TKA) .Methods A retrospective review of 45 cases with anteroposterior view of knee radiographs after TKA was undertaken to confirm the distribution characteristics of cement on tibial side;hinge prosthesis and revision cases were excluded .Whether the thickness imbalance of bone cement ( cement-wedge sign ) influenced the accuracy of limb alignment was articulated .Results A total of 45 subjects were analyzed , angle a ≤1°in four cases, angle a was 1°to 3°in three cases, angle a ≥3°in two cases.Conclusion Bone cement can influence the accuracy of limb alignment , and can help the surgeon make a correction in the doughy stage to improve alignment and reduce outliers .

Objective To explore the efficacy of arthroscopic treatment for acute avulsion fracture of posterior cruciate ligament (PCL) using double titanium plate TightRope. Methods From December 2014 to January 2015, two cases with acute avulsion fracture of PCL were treated with double titanium plate TightRope under arthroscopy, after assessment of three dimensional reconstructive CT and MRI. Rehabili-tation was carried out after operation. Results One case succeeded with double titanium plate TightRope, and rehabilitation could be per-formed early postoperatively. Another case failed in TightRope fixation, and accepted two internal hollow screws fixation instead. Rehabili-tation was delayed until two weeks postoperatively. The function of the knee was satisfactory in the former patient after three months, who could extend the knee in a normal range, without pain or locking. The same effect was gained in the latter patient after four months. Conclu-sion For acute tibial avulsion fracture of PCL with larger and intact fragment without osteoporosis, arthroscopic restoration and fixation with double titanium plate TightRope offers the opportunity to achieve anatomic reconstruction and rigid fixation for early rehabilitation in adult patients.

Multifocal osteonecrosis (MFON) is defined as disease involving three or more separate anatomic sites concurrently or consecutively.It is a rare clinical condition, which is found to occur in approximately 3% of patients with osteonecrosis.Typically, most patients have about six joints involved.Corticosteroid use is often reported as the most common risk factor in 90% of patients with multifocal osteonecrosis.In multifocal osteonecrosis, femoral head involvement is found to occur most commonly, followed by the knee, shoulder, and talus.For patients with high-risk factors, attention should be paid to MFON.It is necessary to increase the other joints of the imaging screening to avoid missed diagnosis.This will be beneficial to get early diagnosis and reasonable treatment, which will help to obtain the best clinical results.

The present study aimed to explore the potential diagnostic role of diffusion tensor magnetic resonance imaging (DTI) in the early stage of modified corticosteroid-induced osteonecrosis of the femoral head (ONFH). A total of 20 beagles were randomly classified (1:1) into either an experimental group (LM), which were intramuscularly injected with lipopolysaccharide (LPS) and methylprednisolone (MPS) on three consecutive days, or control (CON) group, which were injected with saline. Magnetic resonance imaging (MRI) and DTI were performed at pre-induction and 8 and 12 weeks post-induction. Apparent diffusion coefficient (ADC) values in the range of interest in the femoral head were quantified using DTI. Proximal femora were examined for ONFH at 8 and 12 weeks. The results demonstrated that ONFH developed in four beagles at 8 weeks and in six beagles at 12 weeks, whereas no ONFH was detected in the CON group. No abnormalities were detected by MRI and DTI, and no mortality occurred. In beagles with ONFH in the LM group, the ADC values were 4.7±0.2×10-4 and 4.8±0.3×10-4 mm2/sec at 8 and 12 weeks, respectively, which were significantly increased compared with the CON group (2.5±0.3×10-4 and 2.4±0.3×10-4 mm2, respectively) and the LM group without ONFH (2.6±0.4×10-4 and 2.4±0.3×10-4 mm2, respectively) (P<0.05). The results of the present study indicated that intramuscular injection of LPS and MPS may lead to early-stage ONFH in beagles. As such, the detection of locally elevated ADC values in the femoral head may aid in the early diagnosis of ONFH.

目的：探讨关节镜下骨刺切除结合射频消融技术治疗跟痛症的临床效果。方法回顾性分析2011年1月至2013年1月共18例顽固性跟痛症患者的临床资料，所有患者都接受了关节镜下骨刺切除结合射频消融技术治疗。分别采用疼痛视觉模拟评分（visual analogue scale，VAS）和美国足踝外科协会（American orthopaedic foot and ankle soci-ety，AOFAS）后足评分对患者术前和术后患足的疼痛和功能进行评估。结果本组均获随访，随访时间10~16个月，平均12个月。VAS 平均评分从术前的（7.17±0.38）分降至术后的（2.01±0.16）分，AOFAS 后足功能评分从术前的（57.69±10.94）分升至术后的（86.89±8.19）分，术前术后评分比较，差异具有统计学意义（P <0.05）。结论关节镜下骨刺切除结合射频消融技术治疗跟痛症的效果令人满意，值得临床推广应用。

目的:评价踝关节45°轴斜位MRI扫描诊断下胫腓前韧带(anterior inferior tibiofibular ligament,AITFL)慢性损伤的应用价值,为临床诊断AITFL损伤提供有效方法.方法:2011年3月～2013年2月,前瞻性搜集31例慢性踝关节前外侧撞击综合征患者临床资料:男15例,女16例;年龄22～63岁,平均34.5岁.所有患者经至少6个月以上的保守治疗无效后行踝关节镜手术.受伤至手术时间为7～10个月,平均8.4个月.术前摄踝关节X线片及行常规MRI以及45°轴斜位MRI扫描诊断AITFL损伤情况.以术中关节镜下探查AITFL损伤情况作为金标准,与术前MRI扫描结果进行统计学比较分析.结果:手术探查16例存在AITFL损伤,15例未见损伤.术前常规MRI诊断AITFL损伤的灵敏度75％,特异度66.7％,Youden指数42.3％,Kappa值0.418.术前45°轴斜位MRI扫描诊断AITFL损伤的灵敏度87.5％,特异度93.3％,Youden指数80.8％,Kappa值0.807;45°轴斜位MRI扫描各指标均显著高于常规MRI扫描(P＜0.05).Kappa值显示45°轴斜位MRI扫描与手术探查结果的一致性和可靠性较高.结论:单纯根据常规MRI扫描诊断AITFL损伤可靠性低,45°轴斜位MRI诊断AITFL损伤可靠性高、准确性好,有重要的临床参考价值.

肩关节是人体活动范围最大的关节，其功能状态对人的生活质量影响极大。临床上，继发性肩关节僵硬是肩部疾患、创伤和术后常见的并发症，导致肩关节疼痛和活动受限。尽管其病因和严重程度并不相同，但是却严重影响患者的日常活动。不像冻结肩，继发性肩关节僵硬的病程无法预测。近年来，尽管人们不断进行基础实验和临床实践研究，继发性肩关节僵硬的病因和发病机制仍未完全明了，对于该病的最佳治疗方法也没有形成统一的意见。本文就其诊治进展及相关问题作一综述。

The management of heterotopic ossification (HO) is controversial. Although some reports have investigated assessment and surgical resection techniques for HO affecting one or more joints, the cases of multijoint stiffness secondary to HO are rare. This article describes a rare case of HO affecting both upper limbs of a 32-year-old man that severely interfered with activities of daily living. We present the rehabilitation management of this case and the functional outcome 1 to 2 yr after excision of the ossific masses.

BACKGROUND:Static compressure effect between the fracture fragments was generated by fixation itself (tension band wire and screw), but dynamic compression effects were generated during flexion. Mechanical strength and stability of patel ar fracture fixation have obvious advantages. However, there are lacks of quantitative comparative studies on static and dynamic compression effects of these fixation methods. <br> OBJECTIVE:To observe strength changes and clinical significance of static and dynamic compression using four fixation techniques. <br> METHODS:Standardized transverse patel ar fracture models were created with fresh cow patel as. The patel as were randomly divided into four groups:fixation was accomplished with modified tension band wiring (wire group);modified tension band with braided cable (cable group);interfragmentary screws (screw group);cannulated screw tension band with wire (cannulated screw group). Before fracture fixation, Fuji pressure-sensitive film was laid among fracture fragments to measure the pressure among fracture fragments after fixation, i.e., static and dynamic compression. Model of each group was measured as fol ows:(1) after fixation, the fixation was removed, and the Fuji pressure-sensitive film was taken out;(2) after fixation, material testing machine was used. Samples underwent a three-point bending test with a 5 000 N load, simulating dynamic compression during knee flexion. Subsequently, Fuji pressure-sensitive film was taken out. Each Fuji pressure-sensitive film was tested using prescale FPD-8010E software. Thus, average pressure among broken bone ends was obtained, and statistical analysis was performed. Static and dynamic compression among broken bone ends was compared in each group. <br> RESULTS AND CONCLUSION:Average static compression was significantly lower in the wire group than in the cable group, screw group and cannulated screw group (P<0.05). Under 5 000 N load of dynamic compression, similar compression among broken bone ends was visible among wire group and cable group, screw group and cannulated screw group (P>0.05). Dynamic compression was higher than static compression in the wire group (P<0.05). Results verified that compared with modified tension band wire fixation technique, cable or screw could evidently increase static compression among broken bone ends, but simultaneously weaken dynamic compression among broken bone ends.

Objective: To discuss the necessity of adding content about evidence-based medicine into rehabilitation medicine undergraduate education. Methods: 95 students of 2011-2012 clinical rehabilitation medicine undergraduate classes were divided into control group and observation group randomly according to balloting method. The control group was taken traditional teaching mothod,while the observation group was taken evidence-based medical teaching method. The teaching effectiveness of two groups was evaluated.Results:(1) In control group, the master degree of etiology, diagnostic tests, therapeutic trials, adverse drug reactions, disease prognosis,clinical economics, health technology assessment and clinical decision analysis were significantly lower than those of the observation group(P 0.05);(2)In control group, the test scores, clinical skills assessment results and student questionnaire scores were significantly lower than those of the observation group(P 0.05);(3)In control group, the rate of consulting teacher or senior doctor, reading magazines and retrieving from MEDLINE within 3 weeks were significantly lower than those of the observation group(P0.05).Conclusion: Evidence-based medicine teaching model is significantly better than the traditional teaching mode. It should be popularized in rehabilitation medical education.

Heterotopic ossification is the bone formation outside skeletal system,which can lead to serious motor dysfunction. This paper reviewed the definition,pathogenesis,incidence,clinical manifestations and diagnosis,advance in prevention and treatment of heterotopic ossification to investigate the effective method in prevention and treatment of heterotopic ossification.