ObjectiveTo systematically evaluate the efficacy and safety of intra-articular injection of hyaluronic acid for knee osteoarthritis. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), WanFang Data, CBM, and CNKI were searched to collect randomized controlled trials (RCTs) about intra-articular injection of hyaluronic acid for knee osteoarthritis from inception to February 2016. The meta-analysis was conducted using RevMan 5.3 software. ResultsA total of 17 RCTs involving 4 070 patients were included. The results of metaanalysis showed that: there were no significant differences in WOMAC pain scores (7 weeks: MD=-0.01, 95%CI -0.46 to 0.44, P=0.98; 13 weeks: MD=-0.01, 95%CI -0.46to 0.43, P=0.95; 26 weeks: MD=0.32, 95%CI -0.04 to 0.67, P=0.08), stiffness scores (7 weeks: MD=0.10, 95%CI -0.26 to 0.45, P=0.59; 13 weeks: MD=0.24, 95%CI -0.11 to 0.60, P=0.17; 26 weeks: MD=0.06, 95%CI -0.09 to 0.22, P=0.42), and life function scores (7 weeks: MD=-0.20, 95%CI -0.75to 0.36, P=0.49; 13 weeks: MD=-0.02, 95%CI -0.57 to 0.52, P=0.93; 26 weeks: MD=0.30, 95%CI -0.07 to 0.67, P=0.11) between the hyaluronic acid group and the control group in 7-, 13- and 26 weeks. However, the hyaluronic acid group was superior to the control group in 50-step test (MD=-0.49，95%CI -7.36 to -3.61，P<0.000 01). ConclusionCurrent evidence suggests that intra-articular injection of hyaluronic acid has better effect than control treatment for pain at movement. However, due to the limited quantity of the included studies, the above conclusion still need to be verified by more high quality studies．
Objective To review the research progress of C terminal propeptide of collagen type II (CTX-II), a osteoarthritis (OA) biomarker. Methods Domestic and international l iterature about CTX-II was reviewed extensively and summarized. Results CTX-II is investigated broadly and has the best performance of all currently available biomarkers. CTX-II is a truly useful biomarker for early diagnosis, prognosis, and measurement of treatment response in OA. Conclusion Single CTX-II may be not sufficient for early diagnosis and prognosis of OA, so a combination of CTX-II and other biomarkers or diagnosis methods is needed.
Objective To investigate the rotational mismatch of total kneereplacement with medial 1/3 of tibial tuberosity as bony landmark in osteoarthritic patients with varus or valgus deformity. Methods Axial images on computed tomography of 62 knees (including 55 varus deformities and 7 valgus deformities) in 32 Chinese osteoarthritic patients who had total knee arthroplasty were analyzed, compared with that of 10 healthy knees. On images of the distal femur, the angle between the lines of surgical epicondylar axis(SEA) and posterior condylar axis was measured as posterior condylar angle (PCA), and on images of the proximal tibia, a baseline for the anteriorposterior axis of each component was drawn based on the SEA for the femur and the medial 1/3 of the tibial tuberosity for the tibia. The angle between these lines (Angle α) was defined as therotational mismatch between the components when they were aligned to the anatomic landmarks of each bone. Results The sulcus of medial epicondyle of femur could be identified on CT images of over 80% osteoarthritic knees; the median value of PCA was +2.36°, with an individual variation of 0° to +7.5°. Angle α was +6.45±3.68°(range, 0° to +11.8°) in 10 healthy knees, which increased significantly to +10.85±10.47°(range, 0° to +28.1°)in 55 varus knees (P＜0.05), which also increased significantly to +11.6±7.3°(range, -6.5° to +26.8°) in 7 valgus knees (P＜ 0.05). Conclusion With the medial 1/3 of the tibial tuberosity as the rotational landmark for the tibial component, there was a tendency to align the tibial component in external rotational position relative to the femoral component in knees with normal alignment, the rotational mismatch increased in Chinese osteoarthritic knees with varus and valgus deformity.
目的:研究双醋瑞因联合盐酸氨基葡萄糖和双氯芬酸钠治疗骨性关节炎的可行性及安全性。方法:选取100例骨性关节炎患者,随机分入双醋瑞因组联合双氯芬酸钠组(A组)、盐酸氨基葡萄糖联合双氯芬酸钠组(B组)、单用双氯芬酸钠组(C组)和双醋瑞因组联合双氯芬酸钠和盐酸氨基葡萄糖组(D组)四组中,用药12周后观察治疗前后临床疗效和综合疗效评分。结果:1.四组治疗方案在VAS评分、关节疼痛度评分方面均有良好改善率;2D组治疗方案优于A、B、C三组。结论:双醋瑞因联合盐酸氨基葡萄糖和双氯芬酸钠治疗骨性关节炎是可行、安全、优效的方案。
Objective To evaluate the short-term results of reconstruction of stiff elbow under arthroscopy technique in patients with elbow osteoarthritis. Methods Between March 2006 and March 2009, 38 cases of elbow osteoarthritis with contracture were treated under arthroscopy technique. There were 26 males and 12 females with an average age of 47.8 years (range, 26-66 years). Unilateral side was affected in all cases, including 13 cases at the left side and 25 at the right side with 30 patients on the dominant side. The disease duration was more than 6 months. X-ray examination showed that 31 patients had free body, and 28 had osteophytosis. Seven patients had ulnar neuritis. The arthroscopy functional reconstruction was performed including synovectomy, free body removal, and osteocapsular arthroplasty. Results All incisions healed by first intention. All patients were followed up 6-10 months (mean, 8 months). Transient radial nerve injury occurred in 1 case, re-adhesion of elbow joint in 1 case, and heterotopic ossification of brachial ulnar joint in 1 case at 6 months after operation. In 1 patient compl icated by ulnar neuritis, the disorder of ulnar nerve was not improved, nervous symptoms disappeared after the re-operation of ulnar nerve relaxation after 2 months. The range of motion, Mayo Elbow Performance Score (MEPS), and visual analogue scale (VAS) for pain at 3 and 6 months had significant differences when compared with those before operation (P lt; 0.05), but had no significant difference between two time points after operation (P gt; 0.05). According to MEPS functional criteria, the results were classified as excellent in 20 cases, good in 15 cases, fair in 2 cases, and poor in 1 case at 6 months after operation, and the excellent and good rate was 92.1%. No new free body or osteophytosis occurred after operation by X-ray examination. Conclusion The arthroscopy is an effective technique to reconstruct the function of stiff elbow, which can obviously improve the range of motion and the function of elbow joint, and has good short-term results.
ObjectiveTo systematically review the association between angiotension-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and osteoarthritis (OA) by using meta-analysis and trial sequential analysis (TSA). MethodsThe PubMed, EMbase, CNKI, CBM, VIP, and WanFang Data were searched up to October 12th, 2016 for case-control or cohort studies on the correlation between ACE I/D polymorphism and OA risk. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis and TSA analysis were performed using Stata 13.1 software and TSA v0.9 soft ware. ResultsA total of six case-control studies involving 1 165 OA patients and 1 029 controls were included. The results of meta-analysis showed that the ACE I/D was associated with OA risk (DD+DI vs. II: OR=1.72, 95%CI 1.02 to 2.90, P=0.04; DI vs. II: OR=1.65, 95%CI 1.06 to 2.56, P=0.03). Subgroup analysis of ethnicity showed that, in Caucasians, the ACE I/D was associated with OA risk (DD vs. DI+II: OR=2.10, 95%CI 1.54 to 2.85, P<0.01; DD+DI vs. II: OR=3.11, 95%CI 2.20 to 4.39, P<0.01; DD vs. II: OR=4.01, 95%CI 2.68 to 6.00, P<0.01; DI vs. II: OR=2.65, 95%CI 1.06 to 2.56, P<0.01; D vs. I: OR=2.11, 95%CI 1.72 to 2.58, P=0.73). And TSA showed that all of the cumulative Z-curve strode the conventional and TSA threshold value which suggested the result of the association between ACE I/D polymorphism and OA in Caucasians was very reliable. However, the association did not exist in Asians (DD vs. DI+II: OR=0.80, 95%CI 0.60 to 1.07, P=0.13; DD+DI vs. II: OR=1.08, 95%CI 0.87 to 1.35, P=0.49; DD vs. II: OR=0.86, 95%CI 0.62 to 1.20, P=0.38; DI vs. II: OR=1.18, 95%CI 0.93 to 1.50, P=0.19; D vs. I: OR=0.93, 95%CI 0.83 to 1.14, P=0.73). And the results of TSA displayed that all of the cumulative Z-curve did not strode both TSA threshold value and required information size line excepting for DD vs. DI+II genetic model which suggested that the sample-size in Asians was insufficient. ConclusionsThe ACE D allele maybe a risk factor for OA in Caucasians. However, the association between ACE I/D polymorphism and OA risk in Asians still need more studies to prove.
Objective To compare the effectiveness and complications of various surgical techniques in the treatment of the osteoarthritis of the trapeziometacarpal joint. Methods We searched MEDLINE (1966 to 2005), Cochrane Controlled Trials Register (Issue 3, 2005) and CBM (1978 to 2005), and handsearched the references of relevant studies. Only randomized controlled trials were included. We assessed the methodological quality of the included studies, extracted data, and performed quantitative and qualitative analyses. Results Seven studies were included, and all had some methodological shortcomings. There was b evidence that in the short term, ligamentous reconstruction, tendon interposition (LRTI) and trapeziectomy alone provide similar results with regard to pain relief, grip and pinch strength, range of thumb motion, hand function and overall satisfaction of patients, but more complications occur with LRTI than with trapeziectomy alone. Conflicting evidence was found about whether LRTI resulted in less subsidence of the first metacarpal bone than trapeziectomy alone. There was moderate evidence that LRTI and ligament reconstruction without tendon interposition (LR) did not have significant differences in thumb strength, patient satisfaction and subsidence of the first metacarpal bone. Limited evidence showed that LR produced better functional scores than LRTI and similar results in pain relief to LRTI. Conflicting evidence supported that LR resulted in greater motion range of thumb than LRTI. Only limited evidence showed that effectiveness was similar between LRTI and Swanson implant. We did not find randomized controlled trials about other surgical techniques. Conclusion Not enough evidence supports superiority of one technique over another. More high quality randomized controlled trials and long term follow-up are necessary.
Objective The changes of the aquaporins 1 (AQP-1) expression may be related to the chondrocyte apoptosis. To explore the correlation between the expression of AQP-1 and chondrocyte apoptosis by observing the expression of the AQP-1 and the Caspase-3, so as to provide experimental evidence for the further study in the pathogenesis of osteoarthritis (OA). Methods Seventy-two 8-week-old clean grade male Sprague Dawley rats, weighing 286-320 g (mean, 300 g), were randomly divided into the operated group (n=24), the sham-operated group (n=24), and the control group (n=24).OA models were made by amputating the anterior cruciate l igament and medial collateral l igament, and partial excision of medial meniscus in operated group; the articular cavity was exposed only in sham-operated group; and no treatment was given in control group. The general condition of the rat was observed after model was establ ished. At 1, 2, 4, and 8 weeks, the specimens of knee joints were harvested to perform the gross and histological observations; the mRNA expressions of AQP-1 and Caspase-3 were determined by real-time fluorescent quantitative PCR; and the activity of the Caspase-3 protease was detected. The correlations between the expression of AQP-1 mRNA and the expressions of Caspase-3 mRNA and protease were analyzed. Results Totally 6 rats died after operation, and the rats were suppl ied immediately; the other rats survived to the end of experiment. The appearance and structure of knee articular cartilage were normal in control group and sham-operated group. While in operated group, the cartilage had a rough surface with fissure and vegetation, and fibrosis and irregular cell arrangement were seen on the surface of cartilage. There were significant differences in the Mankin score between the operated group and sham-operated group, control group at 2, 4, and 8 weeks (P lt; 0.05). There was no significant difference in expressions of the AQP-1 mRNA and Caspase-3 mRNA, and the activity of the Caspase-3 protease among 3 groups at 1 week after operation (P gt; 0.05); while the expressions of the AQP-1 mRNA, Caspase-3 mRNA, and the activity of the Caspase-3 protease in operated group were significantly higher than those in sham-operated group and control group at 2, 4, and 8 weeks after operation (P lt; 0.05), andthere was an increased trend over time. There was significantly positive correlation (r=0.817, P=0.000) between the expressions of AQP-1 mRNA and Caspase-3 mRNA, and the regression equation was y=0.426 7x2+0.051 5x; meanwhile, there was also significantly positive correlation (r=0.945, P=0.000) between the expression of AQP-1 mRNA and the activity of Caspase-3 protease, and the regression equation was y=15.423 0x+4.392 8. Conclusion The up-regulation of AQP-1 expression in OA cartilage may be related to the chondrocyte apoptosis, and the changes of AQP-1 expression may involve in the pathogenesis of OA.
Objective To analyze the outcomes and complications after total knee replacement(TKR) with posterior stabilized prosthesis(PS) and to investigate the influencing factors relating to outcomes. Methods From January 1998 to August2004, 60 cases (74 knees) of osteoarthritis underwent TKR with PS. The outcomeswere evaluated according to the HSS(hospital for special surgery) scoring. The difference in outcomes between patients with post-operative complications and without complications were compared. Pearson correlation was used to analyze post-operative outcomes and the pre-operative factors relating to patients. Results All 74 knees werefollowed up 42.5months(24 to 94 months). The scores for HSS, pain, function, ROM muscle strength, flexion deformity and stability of knees after operation were 84.2±14.2, 25.7±6.9, 17.9±4.3,13.1±2.0，9.2±0.8，8.1±0.4 and 9.3±0.1 respectively. They were improved to some extents, especially pain alleviation was remarkable. The excellent and good rate for outcome assessment was 90.5%. Among 74 knees, 10 cases suffered from postoperative complications, including 1 case of common peroneal nerve paralysis, two cases of wound faulty union, one case of wound infection, one case of joint infection, one case of stiff knee, two cases of deep vein thrombosis and 2 cases of patellofemoral joint complications. The excellent and good rate of outcome in patients with complications(60%) was much lower than that in patients without complication(95.3％),and there was significant difference betweenthem (P＜0.05). Analysis for correlation showed that postoperative HSS score was positively correlative with the postoperative HSS score, pain and function score of knees. The correlation value was 0.523，0.431 and 0.418 respectively(Plt;0.01). Whereas, postoperative HSS score was not correlative with ROM, muscle strength, flexion deformity, stability of knee, age, weight andbody mass index(P＞0.05). Conclusion TKR with PS is an effective method for severe osteoarthritis. The outcomes after TKR have a positive correlation with the HSS score, pain and function score of knees before surgery. Complicationsassociating with surgery have a negative influence on outcomes.
【摘要】 目的 观察盐酸氨基葡萄糖治疗腰椎关节突关节骨性关节炎（lumbar zygapophyseal joint osteoarthritis，LZOA）的临床疗效及安全性。 方法 2009年1月-2010年1月，对90例LZOA患者随机分成治疗组和对照组，各45例。治疗组口服盐酸氨基葡萄糖，6周为1个疗程，治疗3个疗程，前2周均加用洛索洛芬钠；对照组患者仅给予洛索洛芬钠口服12周。比较两组治疗后2、6周及3、6、12个月的疗效及安全性。 结果 治疗后6周、3个月，治疗组与对照组症状均明显改善，对照组改善更明显。治疗6个月后，治疗组评分持续下降，到12个月时与治疗前比较差异有统计学意义（Plt;0.01）；而对照组评分则逐渐增高，到12个月时与其治疗前比较差异无统计学意义（Pgt;0.05）。两组的不良反应率分别为6.67%、15.56%，差异有统计学意义（Plt;0.01）。 结论 盐酸氨基葡萄糖治疗LZOA疗效确切，且安全性良好。【Abstract】 Objective To observe the clinical efficacy and safety of glucosamine hydrochloride on lumbar zygapophyseal joint osteoarthritis (LZOA). Methods From January 2009 to January 2010, 90 patients with LZOA were randomly divided into therapeutic group and comparative group, with 45 patients in each group. Patients in therapeutic group were treated with oral administration of glucosamine hydrochloride for 3 courses (6 weeks for one course; adding loxoprofen for the early 2 weeks). Patients in comparative group were treated with oral administration of loxoprofen for 12 weeks. The efficacy and safety between the two groups was compared. Results Symptoms in both group were relieved after 6-week and 3-month treatment. More obvious relief was observed in the comparative group. The scoring of therapeutic group kept decreasing after 6-month treatment. The efficacy showed significant improvement after 12-month treatment compared with which before the treatment was significant（Plt;0.01）. The scoring in comparative group kept increasing, which showed no significant difference after 12-month treatment（Pgt;0.05）. The adverse effect rate was 6.67% and 15.56% respectively in two groups, which was significant different（Plt;0.01）. Conclusions Glucosamine hydrochloride provides good efficacy and safety for patients with LZOA.