Effectiveness of total knee arthroplasty using three-dimensional printing technology for knee osteoarthritis accompanied with extra-articular deformity

目的探讨3D打印技术辅助人工全膝关节置换术(total knee arthroplasty,TKA)治疗合并关节外畸形的膝骨关节炎(knee; osteoarthritis,KOA)的临床疗效。方法2013年3月2015年12月,收治15例(18膝)合并关节外畸形的KOA患者。男6例(6; 膝),女9例(12膝);年龄55~70岁,平均60.2岁;病程7~15年,平均10.8年。单膝12例,双膝3例。膝关节学会评分系统(KSS)临床; 评分为(57.441.06)分,功能评分为(60.881.26)分。膝关节活动度为(72.220.18)°。下肢力线偏移(18.890.92)°; 。合并股骨侧畸形8例(10膝),胫骨侧畸形5例(5膝),股骨侧及胫骨侧畸形2例(3膝)。术前3D打印骨骼模型、截骨导航模板并设计手术方案,选择合; 适的膝关节假体后实施TKA。结果手术时间65~100 min,平均75.6 min;术中出血量50~150 mL,平均90.2; mL。术后均未出现切口愈合不良、感染、血栓等并发症。患者均获随访,随访时间12~30个月,平均22个月。末次随访时,X线片示假体位置均良好,未发; 现松动、下沉;下肢力线偏移(2.000.29)°,与术前比较差异有统计学意义(t=13.120,P=0.007);KSS临床评分为(87.500; .88)分、功能评分为(81.941.41)分,与术前比较差异有统计学意义(t=27.553,P=0.000;t=35.551,P=0.000); ;膝关节活动度为(101.941.42)°,与术前比较差异有统计学意义(t=31.633,P=0.000)。结论对于合并关节外畸形的KOA,采用; 3D打印技术辅助TKA,可达到个体化治疗、降低手术难度,有效矫正畸形,恢复患者膝关节功能的目的。Objective To evaluate the effectiveness of total knee arthroplasty (TKA); using three-dimensional (3D) printing technology for knee osteoarthritis; (KOA) accompanied with extra-articular deformity. Methods Between March; 2013 and December 2015, 15 patients (18 knees) with extra-articular; deformity and KOA underwent TKA. There were 6 males (6 knees) and 9; females (12 knees), aged 55-70 years (mean, 60.2 years). The mean; disease duration was 10.8 years (range, 7-15 years). The unilateral knee; was involved in 12 cases and bilateral knees in 3 cases. The clinical; score was 57.441.06 and the functional score was 60.881.26 of Knee; Society Score (KSS). The range of motion of the knee joint was; (72.220.18)°. The deviation of mechanical axis of lower limb was; (18.890.92)° preoperatively. There were 8 cases (10 knees) with; extra-articular femoral deformity, 5 cases (5 knees) with; extra-articular tibial deformity, and 2 cases (3 knees) with; extra-articular femoral and tibial deformities. Bone models and the; navigation templates were printed and the operation plans were designed; using 3D printing technology. The right knee joint prostheses were; chosen. Results The operation time was 65-100 minutes (mean, 75.6; minutes). The bleeding volume was 50-150 mL (mean, 90.2 mL). There was; no poor incision healing, infection, or deep venous thrombosis after; operation. All patients were followed up 12- 30 months (mean, 22; months). Prostheses were located in the right place, and no sign of; loosening or subsidence was observed by X-ray examination. At last; follow-up, the deviation of mechanical axis of lower limb was; (2.000.29)°, showing significant difference when compared with; preoperative one (t=13.120, P=0.007). The KSS clinical score was; 87.500.88 and function score was 81.941.41, showing significant; differences when compared with preoperative ones (t=27.553, P=0.000;; t=35.551, P=0.000). The range of motion of knee was (101.941.42)°,; showing significant difference when compared with preoperative one; (t=31.633, P=0.000). Conclusion For KOA accompanied with extra-articular; deformity, TKA using 3D printing technology has advantages such as; individualized treatment, reducing the difficulty of operation, and; achieving the satisfactory function

Effects of Serum Medicated with Duhuo Jisheng Decoction on the Induced Degeneration of Articular Chondrocytes in Vitro Culture Based upon “caveolin-p38MAPK” Signal Pathway

目的:观察独活寄生汤含药血清对兔退变软骨细胞“CAVEOlIn-P38MAPk“信号通路的调控作用,探讨独活寄生汤治疗骨关节炎的作用机制。方法:将20只3月龄新西兰兔随机分为生理盐水组(空白血清组)和独活寄生汤组(含药血清组),每组10只。分别在24 H、36 H、48 H不同采血时间点采集独活寄生汤含药血清和空白血清,将5%、10%、15%、20%不同浓度两种血清作用于体外培养第2代软骨细胞,确定含药血清最佳干预条件;建立体外退变软骨细胞模型,分别给予独活寄生汤含药血清(含药血清组)和空白血清(空白血清组)干预36 H,收集软骨细胞,运用WESTErn blOT法检测血清干预后退变软骨细胞CAVEOlIn-1、P38、P-P38蛋白表达,rT-PCr法检测血清干预后退变软骨细胞白细胞介素(Il)-1β、肿瘤坏死因子(Tnf)-α、基质金属蛋白酶(MMP)-3、MMP-13、CAVEOlIn-1 M rnA表达。结果:浓度为15%的36 H采血时间点含药血清的促增殖作用最明显;退变软骨细胞中存在“CAVEOlIn-P38MAPk“信号通路的激活,独活寄生汤含药血清可抑制CAVEOlIn-1、P-P38蛋白表达及Il-1β、Tnf-α、MMP-3、MMP-13、CAVEOlIn-1 M rnA的表达,差异有统计学意义(P<0.05)。结论:独活寄生汤能通过抑制“CAVEOlIn-P38MAPk“信号通路的激活及其下游效应分子,从而有效抑制软骨细胞凋亡。Objective:To observe the effects of serum medicated with Duhuo Jisheng Decoction on the induced degeneration of articular chondrocytes in vitro culture based upon "caveolin-p38MAPK" signal pathway and probe the mechanism of Duhuo Jisheng Decoction in the treatment of osteoarthritis.Methods:20 March old New Zealand rabbits were randomly divided into normal saline group(blank serum group)and Duhuo Jisheng Decoction group(drug containing serum group),10 rats in each group.The second generation of cartilage cells was cultured in vitro using different time points of sample collection such as 24 h,36 h and 48 h,serums medicated with 5%,10%,15% and 20% concentrations of Duhuo Jisheng Decoction and blank serums.The best intervention time of medicated serum was determined,which was then used to deal with the degenerating chondrocytes.The degenerated cartilage cell models in vitro were established,which were intervened by the serum medicated with Duhuo Jisheng Decoction(drug containing serum group)and the blank serum(blank serumgroup)after 36 h,collecting chondrocytes.The Western Blot method was used to detect the expression of degenerated cartilage cells caveolin-1 and p-p38 protein after serum intervention.The RT-PCR method was usedto detect the expression of degenerated cartilage cells IL-1β,TNF-α,MMP-3,MMP-13 and caveolin-1 m RNA after serum intervention.Results:The concentration of 15% and 36 h sampling time point serum on the proliferation;the activation of "caveolin-p38MAPK" signaling pathway in the degeneration of cartilage cell,Duhuo Jisheng decoction containing serum can inhibit the expression of caveolin-1,p-p38 protein expression and IL-1β,TNF-α, MMP-3,MMP-13,caveolin-1,m RNA,the difference was statistically significant(P < 0.05).Conclusion:Duhuo Jisheng decoction can inhibit the "caveolin-p38MAPK" signal pathway and its downstream effector molecules, which can effectively inhibit the apoptosis of cartilage cells.国家自然科学基金资助项目(81302986); 福建省卫生厅青年科研课题资助计划项目(2012-2-69); 福建省自然科学基金(2013J01389); 福州市卫生系统科技计划(2013-S-wq6

直接前侧入路全髋关节置换是否导致髋臼前壁偏心磨挫?（英文）

背景:目前有学者认为直接前侧入路行髋关节置换术会导致髋臼前壁的过度磨挫,但是缺少确切的临床证据来证实。目的:试验拟通过髋臼CT影像测量,观察比较直接前侧入路与后外侧入路行全髋置换髋臼前后壁偏心磨挫情况的差异。方法:纳入2015年10月至2017年12月在厦门大学附属福州第二医院由同一主刀医生行初次关节置换患者共60例,直接前侧入路组及后外侧入路组各30例(各占50%)。采用影像阅读系统收集并测量所有病例手术前后髋臼前壁、后壁横断面积,髋臼前后壁高、髋臼横径及髋臼前倾角的变化,以评价髋臼骨储量相关指标的变化。参加研究的人员均具有骨科手术5-10年的临床经验,手术医生职称为副主任医师以上。试验经厦门大学附属福州第二医院伦理委员会批准,批准时间2017-06-01。试验方案经患者和相关家属知情同意,并签署知情同意书。结果与结论:术后髋臼骨储量相关指标变化:两组术后前后壁横断面积、髋臼前后壁高度均小于术前(P0.05)。直接前侧入路组术后髋臼前壁面积高于后外侧入路组(P0.05)。结果证实:与后外侧入路行全髋置换相比,直接前侧入路术后髋臼前壁面积变大,其他髋臼前后壁骨储量参数指标变化不显著,试验推测直接前侧入路行全髋关节置换并不是导致髋臼前壁偏心磨挫的危险因素,未来还需多中心、前瞻性的随机对照研究来进一步验证。the Natural Science Foundation of Fujian Province,No.2017J01333(to FEY)~