目的探讨关节镜辅助大多角骨部分切除联合襻钢板悬吊治疗EatonⅡ、Ⅲ期第1腕掌关节炎的临床疗效。方法回顾性收集2020年1月至2022年6月于深圳市第二人民医院诊治的EatonⅡ、Ⅲ期第1腕掌关节炎患者15例(16侧),男5例(双侧1例)、女10例,年龄为(56.7±6.4)岁(范围46~75岁)。术前X线片示关节间隙狭窄、周围骨赘形成,并向桡背侧脱位。行关节镜下部分大多角骨切除,采用高强线及指骨钢板自制襻钢板悬吊固定第1掌骨。记录重返工作时间,比较术前和末次随访时第1腕掌关节位置和掌骨下沉情况,疼痛视觉模拟评分(visual analogue scale,VAS)、拇指Kapandji评分、上肢功能评定表评分(disabilies of the arm,shoulder,and hand,DASH)及捏力、握力。结果15例随访时间为(19.6±6.3)个月(范围11~36个月)。术后即刻X线片证实腕掌关节均得到复位,第1掌骨高度维持满意。患者术后恢复日常活动时间为(18.69±3.70)d,恢复正常工作时间为(24.63±4.91)d。VAS由术前(6.56±1.15)分降至末次随访1.00(0.75,1.25)分,Kapandji评分由(8.00±0.82)分提升至8.00(7.25,9.00)分,DASH评分由(24.06±3.19)分降至4.00(3.00,5.00)分,除Kapandji评分外的差异均有统计学意义(Z=-4.905,P<0.001;Z=-0.121,P=0.905;Z=-4.846,P<0.001)。握力由术前16.4(14.13,18.68)kg提升至末次随访的(26.14±3.27)kg,捏力由(1.70±0.35)kg提升至(3.58±0.91)kg,差异有统计学意义(Z=-4.617,P<0.001;t=-7.669,P<0.001)。结论关节镜辅助大多角骨部分切除联合襻钢板悬吊第1掌骨治疗EatonⅡ、Ⅲ期第1腕掌关节炎创伤小、恢复快、并发症少,可保留腕掌关节活动度、维持关节稳定,能够有效缓解疼痛、改善功能。
骨关节炎(Osteoarthritis, OA)是老年人常见的关节疾病,主要临床表现为慢性疼痛、僵硬和功能障碍,其发病机制尚未完全明确。环状RNA (circRNA)是广泛存在于真核细胞中的一种非编码RNA,具有独特的共价闭合环状结构。近年来,研究发现circRNA在OA进展中起着重要作用,主要通过调节细胞外基质的代谢稳态、炎症反应以及软骨细胞的稳态来参与OA。此外,circRNA还通过细胞间外泌体机制、在软骨细胞中作为蛋白质支架以及甲基化修饰等方式影响OA的发生与发展。本文综述了circRNA的生物发生、特性和功能,探讨了circRNA在OA中的重要作用,并探索其在OA发病机制中的潜在应用。circRNA的发现及其在OA中的潜在作用为OA的早期诊断和病因治疗带来了新的希望。Osteoarthritis (OA) is a common joint disease in the elderly, primarily characterized by chronic pain, stiffness, and functional impairment, with its pathogenesis still not fully understood. Circular RNA (circRNA), a type of non-coding RNA widely present in eukaryotic cells, has a unique covalently closed circular structure. In recent years, studies have found that circRNA plays an important role in the progression of OA, mainly by regulating extracellular matrix metabolic homeostasis, inflammatory responses, and chondrocyte homeostasis. Additionally, circRNA influences the occurrence and development of OA through mechanisms such as intercellular exosome communication, serving as protein scaffolds in chondrocytes, and methylation modifications. This article reviews the biogenesis, characteristics, and functions of circRNA, discusses its significant role in OA, and explores its potential application in the pathogenesis of OA. The discovery of circRNA and its potential role in OA offers new hope for the early diagnosis and etiological treatment of OA.
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