| Osteoarthritis(OA) is the clinical common disease, frequently-occurring disease,which is the most common joint-affecting disease and usually tends to occur on weight-bearing joints. It characterised by the progressive destruction of articular cartilage, subchondral bone sclerosis or cyst and osteophyte formation at joint margins. Knee joints are most likely involved and the clinical features of OA include severe pain, swelling, stiffness, functional limitation and mild, chronic non-specific synovial inflammation. OA has been reported as the leading cause of lower extremity disability among older people with an estimated lifetime risk for knee OA being approximately 40 % in men and 47 % in women, and creates an enormous social and economic burden.Though there have been a great number of researches on its pathogenesis, drug and surgical treatment, but it still not clearly understood.In order to have further understanding about how to assess the severity of the knee osteoarthritis, and in order to guide the clinical work, we studied the biomarker that associated with osteoarthritis, which can real-time, accurately reflect the severity of the illness, and can realize the early diagnosis. `We also proved the existence of non-uniform settlement phenomenon in X-ray film and discuss its significance. And on the basis of the theory of non-uniform settlement, we apply fibula bone cutting operation for treatment of knee osteoarthritis, while through follow-up, confirmed its clinical efficacy.Part 1 Relationship of calcitonin gene-related peptide(CGRP) in serum and synovial fluid with disease severity in knee osteoarthritis patientsObjective: The purpose of this study was to examine calcitonin gene-related peptide(CGRP) concentrations in serum and synovial fluid of patients with primary knee osteoarthritis(OA) and healthy controls and to explore their relationship with clinical and radiographic severity of OA.Methods: Sixty-five patients with primary knee OA and 21 healthycontrols were recruited. calcitonin gene-related peptide concentrations in the serum and synovial fluid were measured using human calcitonin gene-related peptide enzyme-linked immunosorbent assays that produced by Phoenix Pharmaceuticals, Inc. The radiographic severity of OA was evaluated using the Kellgren and Lawrence(KL) classification. The Western Ontario and McMaster University Osteoarthritis Index(WOMAC) was used to assess pain,stiffness and physical function.Rusults: Serum and synovial fluid calcitonin gene-related peptide concentrations tended to be higher with the increase in KL grades(r=0.565 and r=0.441, P<0.001, respectively), and were significantly positively correlated with KL grades, total WOMAC score and each subscale(pain,stiffness and physical function).Part 2 Relationship of calcitonin gene-related peptide(CGRP) in serum and synovial fluid with osteophyte formation in knee osteoarthritis patientsObjective: To study the relationship between calcitonin gene-related peptide concentration in serum and synovial fluid and knee osteophyte formation, and evaluate its role in osteophyte formation.Methods: Sixty-five patients with primary knee OA were recruited.calcitonin gene-related peptide concentrations in the serum and synovial fluid were measured using human calcitonin gene-related peptide enzyme-linked immunosorbent assays that produced by Phoenix Pharmaceuticals, Inc. The lateral/medial femoral condyle and tibia platform osteophyte score were evaluated using the Atlas of individual radiographic features in osteoarthritis.Results: CGRP concentration in serum and synovial fluid and knee osteophyte formation including total osteophyte score, medial and lateral compartment osteophyte score were all positively correlated.Part 3 Radiographic measures of non-uniform settlement phenomenon in patients with knee osteoarthritisObjective: In this study, we proposed for the first time the theory of“non-uniform settlement phenomenon” in tibial plateau, and carefullyexplored the role of non-uniform settlement of tibial plateau in the occurrence and progression of medial compartment knee osteoarthritis(OA) through investigating the relationship between the degree of non-uniform settlement and the radiographic severity of OA.Methods: 127 patients with knee medial compartment OA were recruited and examined with weight-bearing radiographs of the entire lower limb. We design the measurement method of non-uniform settlement. Firstly, the mechanical axes of the tibia was confirmed as Line a; Secondly, Line b was drawed from the lateral edge of tibia platform, perpendicular to the mechanical axes of tibia; Finally, the distance from the medial edge of platform to Line b was obtained as non-uniform settlement value. The radiographic severity of OA was evaluated using the Kellgren and Lawrence(KL) grading methods. The non-uniform settlement value, hip-knee-ankle angle, minimum medial joint space width, and condylar plateau angle were measured at the same time.Results: The non-uniform settlement value increases with the upgrading of KL grades(r=0.352, P<0.001), and is significantly correlated with the changes of hip-knee-ankle angle, minimum medial joint space width and condylar plateau angle(r=-0.527,-0.271, and 0.415, P<0.001, respectively).Part 4 Clinical research for the treatment of severe knee osteoarthritis based on “non-uniform settlement”Objective: To evaluate the preliminary clinical result of using fibular osteotomy in the treatment of severe knee osteoarthritis.Methods: Followed 15 patients with severe knee osteoarthritis between March 2013 and May who received fibular osteotomy operation, a total of 21 knees. Imaging evaluation, hospital for special surgery knee score and visual analogue score were evaluated. And we evaluate the efficacy of surgery one year later with the same evaluation criterion.Results: The symptoms of all patients were improved to a certain extent,11 patients were satisfied with the effect, 1 case of patients with postoperative complications of lower extremity deep vein thrombosis.Conclusion:1 The result demonstrated that CGRP in serum and synovial fluid was related to progressive joint damage in knee OA. CGRP can be selected as a biomarker for monitoring disease severity and could be a predictive role on prognosis and progression of knee OA.2 The result showed CGRP concentration was related to osteophyte formation, it can be used as a treatment target.3 These results suggest that the non-uniform settlement of tibial plateau could be an evaluable indicator of medial compartment knee OA, and be used in the early diagnosis and progression of OA.4 Fibular osteotomy surgery for the treatment of severe knee osteoarthritis is useful, and can alleviate the symptoms of patients. |
PDF Full Text Request