ABSTRACT
Osteoarthritis (OA) is a common chronic debilitating disease among middle-aged and old people,which can occur in the hip,knee,ankle,spine and other joints,but it is most commonly seen in the knee.The clinical manifestations of the knee osteoarthritis (KOA) include pain,swelling,stiffness,joint deformity,seriously affectting the quality of life.Mechanical and metabolic factors have been shown to play roles in the initiation and progression of this disease,resulting in a slow,progressive pathological process,and the normal balance of anabolic and catabolic activities of the chondrocytes has been disrupted.The mechanical factors are the joint imbalance caused by cartilage degeneration and ligament damage,and biochemical factors are mainly the changes of the joint microenvironment caused by the dysregulation of chondrocytes and synovitis.Infrapatellar fat pad (IPFP)is situated in the lower part of patella and femoral condyle,between tibia condyle and the patellar ligament,and it is an intracapsular but extrasynovial elastic fiber adipose tissue.Researches have shown that besides the synovial membrane,ligament,cartilage and bone,IPFP may play an important role in the onset and progression of KOA and knee pain.IPFP has long been regarded as a structural fatty tissue without metabolic reactions,thus often been neglected,what's more,to get a clear vision in knee surgery,IPFP is often partially or totally resected,but recently owning to its potential biological mechanics,endocrine function,which can produce a variety of inflammatory cytokines,chemokines,rich in nerve fiber structure and IPFP-adipose derived stem cells,more and more scholars pay attention to the IPFP.IPFP may play a protective role in the early stage of KOA by cushioning shock,stabilizing lubrication,but this article emphatically explain how IPFP play a desctructive role in the initiation and progressionof KOA through leptin,adiponectin,and many other adipocytokines,or inflammatory mediators,so as to get further understanding of KOA,and discuss whether IPFP should be resected or not in knee surgery,providing a new method to the prevention and treatment of KOA.
ABSTRACT
BACKGROUND:The prognosis of chondrosarcoma is closely associated with tumor location, size, removal methods and biological characteristics. OBJECTIVE:To explore the choice of reconstruction materials for bone defects after chondrosarcoma resection based on the retrospective analysis of different resection methods. METHODS:We retrospectively analyzed clinical data from 82 cases of chondrosarcoma who had received hondrosarcoma resection at the Department of Orthopedics, Changzhen Hospital of Second Military Medical University from January 1999 to January 2010. Al the involved patients were confirmed pathological y as having chondrosarcoma, including 51 males and 31 females, with a mean age of 39.8 years (range, 15-68 years). Chondrosarcoma was found in the pelvis (n=26), spine (n=19), femur (n=19), tibia and fibula (n=8), and shoulder (including the humerus) (n=12). Preoperative X-ray, MRI or CT was taken as wel as ECT. Clinical data, resection methods, and fol ow-up results were col ected for multivariate analysis to screen the possible prognostic factors of chondrosarcoma. RESULTS AND CONCLUSION:For chondrosarcoma, different types of resection result in a quite difference in recurrence rates, metastasis and mortality rates. The initial resection which is done outside the boundaries can significantly reduce the recurrence rate, metastasis rate and mortality. Autogenous bone, al ograft bone, and prosthetic reconstruction materials are effective for functional reconstruction. Autologous bone graft is limited clinical y because of its limited sources and complications at donor site. Al ograft or prosthetic reconstruction of bone defects is an effective method. Limited number of clinical cases reported makes it difficult to determine the pros and cons of different reconstruction materials. The need for reconstruction depends on the defect site and size, and reconstruction method depends on the type of resection. The important criteria for the choice of reconstruction materials include both form and functional repair of bone defects, chondrosarcoma type and the patient’s request.