ABSTRACT
Objective@#To compare the efficacy of intra-articular injection of autologous platelet-rich plasma (PRP) with that of sodium hyaluronate for patients with knee osteoarthritis (KOA).@*Methods@#Fifty KOA patients were randomly divided into a PRP group (n=25) and a sodium hyaluronate group (n=25). Those in the PRP group were injected intra-articularly with 5 ml of autologous PRP every 2 weeks for 6 consecutive weeks, while the sodium hyaluronate group was given intra-articular injections of 2 ml of sodium hyaluronate once a week for 6 weeks. Both groups performed isokinetic strength training three times a week for 6 weeks. Before as well as 6 weeks, 3 months, 6 months and 12 months after the treatment, both groups were followed and evaluated using the Western Ontario and McMaster University osteoarthritis index (WOMAC). A Biodex System 4 isometric muscle strength testing system was used to evaluate the knees′ peak torque (PT) in flexion and extension, total power (TW), and average power (AP).@*Results@#Before the treatment there were no significant differences in pain, stiffness or average WOMAC score between the two groups. Afterward significant improvement was observed in the pain, stiffness and WOMAC scores of both groups. Compared with the sodium hyaluronate group, significantly greater decreases in the average WOMAC pain score were observed in the PRP group after the different intervals. That was also true of the average stiffness scores and the overall average WOMAC scores after 6 and 12 months. The flexor and extensor PT, TW and AP at the angular velocities of 60°/s and 90°/s also improved significantly in both groups after 6 weeks and 12 months, with the improvement of the PRP group significantly greater than that in the control group at the same time points.@*Conclusion@#Intra-articular injection of either autologous PRP or sodium hyaluronate can effectively alleviate the clinical symptoms of KOA when combined with isokinetic strength training. However, PRP is the more effective. Its use is worthy of clinical application and promotion.
ABSTRACT
Objective To compare the efficacy of intra-articular injection of autologous platelet-rich plasma (PRP) with that of sodium hyaluronate for patients with knee osteoarthritis (KOA). Methods Fifty KOA patients were randomly divided into a PRP group ( n=25) and a sodium hyaluronate group ( n=25) . Those in the PRP group were injected intra-articularly with 5 ml of autologous PRP every 2 weeks for 6 consecutive weeks, while the sodium hyaluronate group was given intra-articular injections of 2 ml of sodium hyaluronate once a week for 6 weeks. Both groups performed isokinetic strength training three times a week for 6 weeks. Before as well as 6 weeks, 3 months, 6 months and 12 months after the treatment, both groups were followed and evaluated using the Western Ontario and McMaster University osteoarthritis index ( WOMAC) . A Biodex System 4 isometric muscle strength testing system was used to evaluate the knees' peak torque (PT) in flexion and extension, total power (TW), and average power (AP). Results Before the treatment there were no significant differences in pain, stiffness or average WOMAC score be-tween the two groups. Afterward significant improvement was observed in the pain, stiffness and WOMAC scores of both groups. Compared with the sodium hyaluronate group, significantly greater decreases in the average WOMAC pain score were observed in the PRP group after the different intervals. That was also true of the average stiffness scores and the overall average WOMAC scores after 6 and 12 months. The flexor and extensor PT, TW and AP at the angular velocities of 60°/s and 90°/s also improved significantly in both groups after 6 weeks and 12 months, with the improvement of the PRP group significantly greater than that in the control group at the same time points. Conclu-sion Intra-articular injection of either autologous PRP or sodium hyaluronate can effectively alleviate the clinical symptoms of KOA when combined with isokinetic strength training. However, PRP is the more effective. Its use is worthy of clinical application and promotion.
ABSTRACT
Objective To explore the early clinical effects of lumbar discectomy associated with annulus repair in the treatment of lumbar disc herniation.Methods A prospective study was conducted to review 56 patients with lumbar disc herniation who accepted discectomy surgery in Subei People's Hospital of Jiangsu Province from January 2014 to September 2015,including 28 cases of discectomy associated with annulus repair (repair group) and 28 cases of discectomy (control group).Oswestry disability index and visual analog scale scores were recorded.Simultaneously,incision length,operative time,blood loss,hospitalization time,surgical complications,and postoperative recurrence of lumbar disc herniation were recorded.Results All patients completed the follow-up for 12 to 18 months (14.5 ± 1.3).There was no difference between the repair and control groups in the incision length,blood loss and hospitalization time (P ＞ 0.05).The operative time of the repair group was longer than that of the control group,but the difference was not statistically significant (P ＞ 0.05).The Oswestry disability index and visual analog scale scores for lumbar and lower limb pain significantly decreased in both groups after surgery (P ＜ 0.05).The visual analog scale scores at 24 hours and 3 days after surgery in the repair group were less than that in the control group (P ＜ 0.05).The satisfactory rate of treatment in the repair group was slightly higher than that in the control group,but the difference was not statistically significant (P ＞ 0.05).There was no recurrence in the repair group,but 2 recurrence cases in the control group (P ＞ 0.05).Conclusions These findings indicate that discectomy associated with annulus repair is a safe and reliable method to obtain remarkable early clinical results and can reduce the recurrent rate in the treatment of lumbar disc herniation.
ABSTRACT
BACKGROUND: Percutaneous vertebroplasty has been gradual y used to treat Kümmel disease because of less trauma and quick pain relief, but there is stil a high rate of bone cement leakage. OBJECTIVE: To investigate the clinical efficacy of percutaneous vertebroplasty with high-viscosity bone cement plus hyperextension position reset for treatment of Kümmel ’s disease. METHODS: The clinical data of 17 patients with Kümmel ’s disease were retrospectively analyzed, including 5 males and 12 females, aged 55-83 years, and al underwent percutaneous vertebroplasty with high-viscosity bone cement plus hyperextension position reset. The visual analog scale, Oswestry disability index score, vertebral body height and vertebral kyphosis angle were determined. The bone cement leakage, pulmonary embolism, adjacent vertebral fractures and other complications were recorded. RESULTS AND CONCLUSION: At the 12th Oswestry disability index scores and vertebral kyphosis angle of patients were significantly lower than those before treatment (P < 0.05), the vertebral body height was significantly higher than that before month of follow-up, the visual analog scale scores, treatment (P < 0.05). After treatment, there were three cases of bone cement leakage, which had no special discomfort and neurological symptoms, and one case of new fractures. These results demonstrate that hyperextension position reset combined with percutaneous vertebroplasty with high-viscosity bone cement in treatment of Kümmel ’s disease can effectively relieve back pain, improve function of the lower back, partial y restore vertebral height and reduce kyphosis angle.
ABSTRACT
BACKGROUND:Vertebroplasty and kyphoplasty have been widely applied in the treatment of osteoporotic thoracolumbar compression fracture. However, cement leakage is a major problem in the application of this technology, especial y for the vertebral posterior wal ruptured patients. OBJECTIVE:To investigate the therapeutic efficacy of high viscosity bone cement and vertebroplasty in the treatment of osteoporotic thoracolumbar compression fracture. METHODS:A retrospective study was conducted in 20 cases receiving high viscosity bone cement and vertebroplasty surgery for osteoporotic thoracolumbar compression fracture. Clinical outcomes were evaluated mainly with use of Visual Analog Scale for lower back pain. Function of lower back pain was assessed using Oswestry Disability Index questionnaire. Quality of life was evaluated using 36-Item Short Form Health Survey and Frankel score was applied to evaluate neurological function. The anterior vertebral height of the fractured vertebrae was assessed with X-ray. The bone cement leakage, pulmonary embolism, incidence of nearby vertebral fractures and other complications were evaluated during fol ow-up. RESULTS AND CONCLUSION:Al patients were fol owed up for 12-18 months. The anterior vertebral height of the fractured vertebrae, the lower back pain and function, and quality of life were improved significantly after treatment (P<0.05). Al patients got the same neurological symptoms before surgery. The bone cement dispersion was good after treatment, detected by X-ray and CT scan, only two cases appeared with bone cement leakage, but no clinical symptoms were found. There was no cement toxicity or al ergic complications, pulmonary embolism, infection, nerve injury or new fractures. The high viscosity bone cement used in the treatment of osteoporotic thoracolumbar vertebral compression fractures can significantly relieve thoracic back pain, improve lower back function and quality of life, and greatly reduce the risk of bone cement leakage.
ABSTRACT
In order to investigate the apoptotic pathway of rabbit annulus fibrosus (AF) cells induced by mechanical overload, an experimental air-pressure model was established in this study to pressurize the rabbit AF cells in vitro. Cells were randomly divided into five groups in which the cells were exposed to a continuous pressure of 1.1 MPa for different lengths of time (0, 5, 12, 24 and 36 h). The cell proliferation and apoptosis were detected by cell counting kit-8 (CCK-8) assay and flow cytometry; the alterations in mitochondrial membrane potential were measured by fluorescence microscopy and fluorescence spectrophotometer; the activities of caspase-8 and 9 were determined by spectrophotometry. The results showed that after the cells were subjected to the pressure for 24 or 36 h, the cell proliferation was inhibited; the ratio of cell apoptosis was increased; the mitochondrial membrane potential was decreased; the activity of caspase-9 was enhanced; no activity changes were observed in caspase-8. The results suggested that treatment with a pressure of 1.1 MPa for more than 24 h can lead to the proliferation inhibition and the apoptosis of rabbit AF cells in vitro, and the mitochondrial-dependent pathway is implicated in the pressure-induced AF cell apoptosis.
ABSTRACT
[Objective]To investigate the protective effect of Tanshinone IIA (TSⅡA) against interleukin-1β (IL-1β) induced obstruction of energy metabolism of rabbit annulus fibrosus cell in vitro.[Methods]Rabbit annulus fibrosus (AF) cells were cultured in 3-dimension alginate beads and randomly divided into 7 groups. Various concentrations of TSⅡA and IL-1β was added to the medium for intervention: no drug was added in group A as normal control, 4 μg/ml TSⅡA in group B, 10 μg/ml IL-1β in group C, and both 10 μg/ml IL-1β and different concentrations of TSⅡA in groups D-G (0.5 μg/ml, 1 μg/ml, 2 μg/ml and 4 μg/ml respectively). After 3 days of incubation, the cells were collected for measuring the activity of Na+-K+-ATPase and succinate dehydrogenase (SDH), MTT assay for cell proliferation, and AnnexinⅤ-PI staining for cell apoptosis.[Results]The activity of Na+-K+-ATPase of group G (10 μg/ml IL-1β+4μg/ml TS IIA; 3.23±0.28 U/mgprot) was increased significantly as compared with group C (10 μg/ml IL-1β; 1.118±0.15 U/mgprot, P＜0.01). The activity of SDH of group G was 12.48±0.97 U/mgprot, which was obviously higher than that of group C (3.03±0.60 U/mgprot, P＜0.01). The absorbance of MTT assay of group G (0.77±0.06) was significantly increased as compared with group C (0.31±0.07,P＜0.01). The absorbance of groups D-G increased as the concentration of TSⅡA increased. The apoptotic cell rate and dead cell rate of group G was 21.08±1.46% and 8.99±0.33%, which were both lower than that of group C (43.11±2.7,P＜0.01 and 11.71±0.32,P＜0.01).[Conclusion]TSⅡA is able to promote cell proliferation and decrease cell apoptosis of AF by alleviating IL-1β induced inhibition on cell energy metabolism.