补肾活血通络针刺法联合中药熏洗疗法治疗肝肾亏虚型膝骨关节炎临床观察

目的 观察补肾活血通络针刺法联合中药熏洗疗法治疗老年性膝骨关节炎（knee osteoarthritis,KOA）的临床疗效。方法 将76例KOA患者按照随机数字表法分为对照组和观察组,每组38例;对照组采用西医常规治疗,观察组在对照组治疗基础上采用补肾活血通络针刺法联合中药熏洗疗法治疗;观察两组患者治疗前后视觉模拟量表（visual analogue scale,VAS）评分,西安大略和麦克马斯特大学骨关节炎指数（the Western Ontario and McMaster University osteoarthritis index,WOMAC）,Lequesne MG评分,关节液白细胞介素（interleukin,IL）-1β、IL-6、肿瘤坏死因子（tumor necrosis factor,TNF）-α水平,血清环氧化酶-2（cyclooxygenase-2,COX-2）、基质金属蛋白酶-3（matrix metalloproteinase-3,MMP-3）水平的变化情况及临床疗效。结果 两组患者治疗后VAS评分、WOMAC、Lequesne MG评分均较治疗前显著降低（P＜0.05）,且观察组降低程度较对照组更显著（P＜0.05）。两组患者治疗后关节液IL-1β、TNF-α、IL-6水平,血清COX-2、MMP-3水平均较治疗前显著降低（P＜0.05）,且观察组降低程度较对照组更显著（P＜0.05）。观察组疗效优于对照组（P＜0.05）。结论 补肾活血通络针刺法联合中药熏洗疗法可显著改善KOA患者临床症状,减轻疼痛,改善膝关节功能。     

3D Finite Element Model of Human Knee Injuries in the Traffic Accident

Objective To explore the injury mechanism of the human knee in a traffic accident by estab lishing a 3D finite element （FE） model. Methods The FE model, composed of femur, tibia, fibula, patel la, meniscus, knee ligaments and surrounding soft tissues, was reconstructed by CT scanning data from a male volunteer. Validation was performed by the lateral impact simulation, and the stress and strain re sults were obtained to be compared with those previously reported for injury prediction. Results The re suits derived from the FE model were found to be similar with those previously reported, most of the ligaments and meniscus wounded at 40 m/s collision, which was readily observed. Conclusion The simu lation results generated by FE model can be effectively used for the injury mechanism analysis of initial contact.     

关节内注射透明质酸钠联合健骨逐瘀汤加减外敷治疗膝骨性关节炎50例

目的 观察中药外敷结合关节内注射治疗膝骨性关节炎（knee osteoarthritis,KOA）的临床疗效。方法 将96例KOA患者随机分为治疗组（50例）和对照组（46例）。对照组患者膝关节腔内注射25 mg透明质酸钠注射液治疗,并予等速肌力基础康复训练;治疗组在对照组基础上加用健骨逐瘀汤封包泡煎外敷。每1周为1个疗程,共治疗5个疗程。观察治疗前后美国特种外科医院（Hospial for Special Surgery, HSS）膝关节功能评分和临床疗效。结果 与治疗前比较,治疗组患者HSS各条目评分明显增加（P<0.05）,对照组患者膝关节评分除肌力、稳定性2个条目无显著改善外,其余条目评分均有显著增加（P＜0.05）;两组治疗后各条目评分差值比较,差异有统计学意义（P＜0.05）。两组临床疗效分布比较,差异有统计学意义（P＜0.05）。结论 关节内注射联合健骨逐瘀汤加减外敷对于KOA具有止痛、改善膝关节功能和减轻临床症状的作用。     

消肿方治疗膝关节骨关节炎疗效观察

目的 观察中药消肿方内服治疗膝关节骨关节炎的疗效。方法 将220例膝关节骨关节炎患者随机分为治疗组和对照组,治疗组120例采用中药“消肿方”内服,对照组100例采用硫酸氨基葡萄糖内服,治疗4周后评定疗效。结果 治疗组愈显率为88.3%,对照组愈显率为68.0%,两组愈显率比较,差异具有统计学意义(P<0.05)。结论 中药消肿方对膝关节骨关节炎具有较好疗效。     

针刀骨减压合消痹颗粒治疗膝关节骨性关节炎46例

目的 观察针刀骨减压联合中药内服治疗膝关节骨性关节炎的临床疗效。方法 将92例膝关节骨性关节炎患者随机分为治疗组和对照组,每组各46例,治疗组予以骨减压联合消痹颗粒内服,对照组予以关节腔注射玻璃酸钠注射液。治疗5周后,观察并比较两组的临床疗效,并采用膝关节骨性关节炎症状分级量化评分、西安大略和麦克马斯特大学骨性关节炎指数（Western Ontario and McMaster Universities osteoarthritis index,WOMAC）和简式McGill疼痛问卷（short-form McGill pain questionnaire, SF-MPQ）评价两组的疗效。结果 治疗组总体临床疗效显著优于对照组(P＜0.05),治疗组在降低膝关节骨性关节炎症状评分、WOMAC评分和SF-MPQ各维度评分方面显著优于对照组(P＜0.05,或P＜0.01)。结论 针刀骨减压联合中药内服治疗膝关节骨性关节炎疗效显著,可改善症状、减轻疼痛、提高患者生活质量。     

动力灸治疗肝肾亏虚型膝骨关节炎疗效观察

目的 观察动力灸治疗肝肾亏虚型膝骨关节炎（knee osteoarthritis ,KOA）的临床疗效。方法 将符合纳入标准的60例肝肾亏虚型KOA患者随机分为试验组与对照组,每组30例。试验组给予动力灸治疗,对照组予以普通针刺治疗,两组均每天治疗1次,连续治疗21 d为1个疗程。1个疗程结束后比较两组患者治疗前后视觉模拟量表（visual analogue scale,VAS）评分、西安大略和麦克马斯特大学骨关节炎指数（the Westem Ontario and McMaster Universities Osteoarthritis Index, WOMAC）、中医证候评分及临床疗效,并记录两组不良反应情况。结果 治疗后两组患者VAS评分、WOMAC评分、中医证候评分较治疗前均明显改善（P<0.05）,且试验组改善程度明显优于对照组（P<0.05）;试验组临床疗效明显优于对照组（P＜0.05）。对照组有1例患者出现晕针情况,而试验组患者均未出现不良反应。结论 动力灸治疗肝肾亏虚型KOA疗效确切,不良反应少,能有效地缓解膝关节疼痛,改善患者的生活质量。     

Comparative and Correlation Studies of Biochemical Substances in Vitreous Humor and Synovial Fluid

Vitreous humor (VH) and synovial fluid (SF) become optional postmortem samples for biochemistry investigation. However, few studies have explored SF as a potential source, and there is still controversy whether the biochemical concentrations in bilateral VH are the same. We explored the concentrations of biochemical substances in both VH and SF, and compared between both sides and between the fluids. We also correlated the biochemical concentrations in both fluids. All samples were centrifuged after collection and the supernatant fluids were used for the analysis. The results indicated no significant difference in the constituent concentrations between the fluids from both sides (p > 0.05). Sodium, potassium, chloride, and magnesium concentrations were significantly higher in the VH, but in vice versa for glucose, uric acid, and creatinine concentrations (p < 0.001). Sodium, potassium, glucose, lactate, urea, uric acid, and creatinine concentrations between both fluids showed significant correlation (p < 0.05), but not chloride and magnesium concentrations.     

应用膝关节MRI T_2加权脂肪抑制像推断活体年龄

目的探索膝关节MRI T2加权脂肪抑制像(T2-FS)在法医年龄推断中的应用价值,建立安全可靠的四川汉族年龄推断方法。方法收集膝关节MRI 324例(男性170例,女性154例),年龄范围为10~30岁。采用西门子1.5T磁共振仪摄片,MRI参数:T2-FS TSE序列,矢状位。将股骨远端、胫骨近端骨骺发育分为6个等级并赋分,分析各指标性别差异及年龄相关性,建立年龄推断回归模型。结果男女性股骨远端、胫骨近端MRI等级与年龄呈正相关性,股骨远端与年龄的相关性男性0.687,女性0.661;胫骨近端与年龄的相关性男性0.684,女性0.488。股骨远端骨骺完全闭合,骺线消失的最小年龄男性18.42岁,女性19.36岁;胫骨近端男性骺线消失的最小年龄为16.93岁,女性为14.68岁。股骨远端等级1~3、5、6和胫骨近端等级1~3、5年龄分布性别差异不显著。分别建立男女年龄推断模型,男性年龄推断平均绝对误差(MAD)=2.90岁;女性年龄推断MAD=3.30岁。结论膝关节MRI T2-FS影像可作为活体年龄推断的指标之一,股骨远端等级6可作为判断18岁的指标之一。     

悬灸得气治疗肿胀型膝关节骨性关节炎临床研究

目的 观察悬灸得气与否对膝关节骨性关节炎的疗效差异,为临床辨敏施灸提供科学依据。〖JP〗方法 纳入膝关节骨性关节炎（肿胀型）患者60例,依据在悬灸过程中患侧内、外膝眼穴有无得气现象（热感透至膝关节腔内）为标准,将患者分为得气组34例和非得气组26例,每日悬灸1次,每次悬灸时间为40 min,共治疗30 d。分别于治疗结束后即刻与治疗结束后3个月进行疗效评价。结果 治疗后即刻和治疗后3个月,两组患者关节周径和临床症状总积分均较治疗前明显减少（P<0.05）,得气组关节周径和临床症状总积分均明显小于非得气组（P<0.05）;得气组临床疗效均明显优于非得气组（P<0.05)。结论 悬灸治疗肿胀型膝关节骨性关节炎能有效改善临床症状,悬灸得气者的即刻和远期临床疗效明显优于非得气者。