关节镜下诊断与治疗滑膜软骨瘤病

1996－2000年对24例26个关节（膝、肘、踝关节）的滑膜软骨瘤病人施行了关节镜手术，22例24个关节获得平衡24．5个月随访，效果满意。所有病人都施行了镜下软骨瘤摘除术和病变滑膜切除术，仅有两个病人遗漏了2个游离体，无其它并发症。关节镜下游离体摘除和滑膜切除术是治疗滑膜软骨瘤病的良好方法。     

少见的髌下滑膜皱襞综合征3例报告

总结 3例少见的膝关节髌下滑膜皱襞综合征 ,对该疾患的病史、诊断及治疗进行了阐述 ,认为关节镜可以确诊 ,关节镜下和联合小切口手术切除病变皱襞是治疗的有效方法。     

膝关节髌内侧滑膜皱襞综合征的MRI诊断价值

目的 :探讨膝关节髌内侧滑膜皱襞的解剖及滑膜皱襞综合征的MRI表现,并与关节镜对照,为临床提供诊断依据。方法:选取关节镜术后证实为髌内侧滑膜皱襞的患者74例,术前行MRI表现,并与关节镜对照。结果:MRI诊断髌内侧滑膜皱襞的灵敏度为88.5%,特异度为95.4%,阳性预测值为95.8%,阴性预测值为76.9%。与关节镜对比,一致性检验结果 Kappa值0.75。结论:MRI诊断髌内侧滑膜皱襞与关节镜具有较高一致性,对膝关节髌内侧滑膜皱襞的诊断和分型具有重要价值。     

膝关节镜治疗膝关节滑膜结核的体会

<正>膝关节结核是全身肢体的第二大关节结核,其早期临床症状缺乏特异性,误诊误治率较高。我科2002年6月—2006年3月利用关节镜诊治膝关节滑膜结核15例,获得满意效果,现报告如下。     

3.0T MR多片技术双反转恢复序列对膝关节滑膜病变的诊断价值

【摘要】目的：探讨3.0T MR多片技术双反转恢复序列（MS-DIR）对膝关节滑膜病变的诊断价值。方法：搜集经关节镜及病理证实的膝关节滑膜病变患者38例,回顾性对比分析其术前膝关节增强扫描序列（T1WI-FS-CE）与MS-DIR序列影像资料,评估T1WI-FS-CE与MS-DIR序列图像在均匀度、病变显示、滑膜厚度测量值等方面的一致性。结果：38例膝关节滑膜病变MS-DIR序列均表现为稍高-高信号;MS-DIR与T1WI-FS-CE序列图像在均匀度方面差异有统计学意义(Z=-7.803,P＜0.001),在滑膜显示程度及图像整体质量上差异无统计学意义(P＞0.05);两种序列对图像主观评价有较高的一致性（K值分别为0.684、0.841）;两种序列相同层面、位置的滑膜厚度测量值有较好的一致性（＜95% LoA）。结论:3.0T MR MS-DIR序列与对比增强序列在膝关节滑膜病变的整体图像质量、细微结构显示、滑膜厚度测量方面有较高的一致性,MS-DIR序列结合常规序列扫描可用于膝关节滑膜病变的筛查与治疗后评估。     

膝关节空气造影后CT扫描诊断滑膜病变：附28例分析

笔者报告了２８例经手术和病理证实的膝关节空气造影后ＣＴ扫描诊断的滑膜病变，其中血管瘤１例、滑膜结核２例、滑膜皱襞综合征４例、色素沉着绒毛结节性滑膜炎３例、滑膜炎症８例、关节内游离体１０例。结果表明，膝关节空气造影后ＣＴ扫描在发现滑膜病变，特别对于滑膜血管瘤、滑膜结核的早期改变和关节内游离体位置的显示上要优于单纯膝关节空气造影。其诊断敏感性为９２．８％；特异性为９３．２％；准确性为９６．４％。     

膝关节结核的X线分析

膝关节结核，以滑膜型结核多见，且滑膜型结核的早期与非结核性滑膜炎症相似，容易误诊。等到关节软骨、软骨下骨质破坏，或形成关节周围软组织肿胀及形成瘘管时，症状虽然典型了，但已骨性强直或纤维性强直了，给病人带来了丧失劳动力的痛苦。若能早期诊断，早治疗，可以免除病人更大的痛苦。为此，将我院10年来14例膝关节结核作以下X线分析：     

超声检测类风湿关节炎膝关节滑膜改变及其血流的临床应用价值

目的：通过观察类风湿关节炎（rheumatoid arthritis ,RA ）膝关节滑膜病变的超声声像图表现,分析滑膜病变超声检查结果与RA活动度的相关性,探讨超声检查RA膝关节滑膜病变的临床应用价值。方法对38例RA患者患侧膝关节和20例正常对照者双侧膝关节行超声检查,根据DAS28评分结果将RA患者分组,分别对比各组与对照组的滑膜厚度,髌上囊积液;分析RA组超声检测结果与DAS28评分之间的相关性。结果 RA组滑膜厚度较对照组明显增厚,髌上囊积液明显增多（ P ＜0．05）。RA组膝关节滑膜厚度、关节积液及滑膜内血流信号分级与RA患者DAS28评分之间存在一定的相关性（ P ＜0．05）。结论超声检查对RA膝关节滑膜病变具有一定的的诊断价值,与DAS28评分的相关性较好,可以作为评估RA膝关节滑膜病变常规检查方法之一。     

四肢关节滑膜结核的X线及MRI表现

目的：分析四肢关节滑膜结核的X线特点,提高对早期四肢关节结核的诊断水平。方法：回顾性分析本院2003年3月－2013年6月经 MRI及手术证实的17例四肢关节滑膜结核的 MRI及X线片资料,总结四肢关节滑膜结核的X线征象。结果：17例四肢关节滑膜结核中,12例未单关节受累,5例为多关节受累。有显著X线表现者6例,表现为关节囊膨隆,关节囊周围脂肪垫受压缩小,关节周围软组织层次不清。结合 MRI 表现对应发现X线表现者有9例,其X线主要表现为受累骨皮质毛糙,骨皮质下骨质密度略高,骨质密度减低,未发现骨小梁断裂征象。2例未见明显 X 线征象。结论：分析和总结关节滑膜结核的X线表现对早期四肢关节滑膜结核的筛选具有重要价值。     

关节镜下滑膜切除术治疗踝关节弥漫性色素沉着绒毛结节样滑膜炎的疗效分析

目的:分析关节镜下滑膜切除术治疗踝关节弥漫性色素沉着绒毛结节样滑膜炎(PVNS)的疗效,分析复发因素。方法:2004年1月至2012年12月,收治共21例踝关节弥漫性PVNS,其中13例病变同时累及关节周围腱鞘组织。男性12例,女性9例,平均年龄33.9岁。21例患者均行踝关节镜下滑膜全切术,8例同时行切开手术切除关节外病变的组织,16例术后行局部放射治疗(总量1800~2000拉德)。进行了美国足踝外科学会(AOFAS)后足与踝评分和主观疗效评价。结果:术后病理证实21例均为PVNS,17例获得随访(24~120月,平均48.3月)。AOFAS评分术前63~77分、平均70.1分;术后为77~100分,平均88.6分。术后较术前差异有统计学意义(P<0.01)。主观疗效评价:优5例,良9例,中2例,差1例。3例出现关节肿痛,经MRI证实2例为关节外复发,1例关节内复发。结论:关节镜下滑膜切除术治疗踝关节弥漫性色素沉着绒毛结节样滑膜炎效果满意,病变累及范围可能是影响术后复发的因素。     

关节镜手术辅助放射治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的疗效分析

目的分析采用关节镜手术辅助放射治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的疗效。方法 10例膝关节弥漫型色素沉着绒毛结节性滑膜炎患者,采用关节镜下病变切除,术后辅助放疗,通过12~36个月的随访,观察治疗效果。结果 10例随访患者,术前Lysholm膝关节功能评分为（53.5±11.6）分,术后随访Lysholm膝关节功能评分为（85.7±10.7）分。结论关节镜手术辅助放射治疗对弥漫型膝关节色素沉着绒毛结节性滑膜炎是一种有效的方法。     

膝创伤后滑膜炎的关节镜治疗

目的 探讨关节镜在膝关节创伤后滑膜炎中的治疗作用。方法 1987年9月-2000年8月共收治36例，以膝关节肿胀为主要临床表现16例，以“机械型”疼痛为主者12例，两者均有8例，术前均经体检及X线检查，其中7例行MRI检查排除其他损伤，常规关节镜检查后行滑膜切除术。结果 局限性滑膜炎24例，弥漫性炎症12例，镜下表现分为渗出型7例，增生型23例，纤维型6例，9例发现其他病变，32例经平均3.7年随访，28例疗效评定为优良（87.5%)，临床表现关节肿胀为主和镜下渗出型及增生型者关节镜治疗效果较好。结论 关节镜手术治疗膝创伤后滑膜炎既可发现可能存在其他病变，又有良好的效果。     

色素沉着绒毛结节性滑膜炎诊断与治疗——附11例临床报道

对 11例弥漫型色素沉着绒毛结节性滑膜炎患者的临床资料进行了回顾性的随访。总结出MRI与B超是有效的诊断方法。MRI中T2像上低信号密度影是色素沉着绒毛结节性滑膜炎的特异性表现。在治疗方面 ,介绍了关节镜下次全滑膜切除术的方法 ,并对关节镜手术与切开手术进行比较。指出关节镜手术创伤小 ,并发症少 ,术中探查全面 ,术后容易康复的优点。推荐关节镜下次全滑膜切除术辅以术后放疗作为治疗弥漫型色素沉着绒毛结节性滑膜炎的有效方法。     

Arthroscopic view of transient synovitis of the hip joint: a case report

We present a case of a 13-year-old male patient with hip pain and limp. Inconclusive investigations and persistent symptoms resulted in the patient undergoing hip arthroscopy. At arthroscopy, a large focal cartilaginous defect of the femoral head with synovitis was seen and synovial biopsy confirmed the diagnosis. Arthroscopic debridement of the lesion, synovectomy and non-weight bearing for 6 weeks resulted in relief of symptoms. Transient synovitis is a common diagnosis in young children, but the extent of damage to the femoral head has not been previously described. Transient synovitis may not always respond to symptomatic treatment and hip arthroscopy may be useful in detecting the actual lesion and plan the treatment.     

Complex rehabilitation of patients suffering of degenerative dystrophic joint disease with the application of minimally invasive keyhole surgery

During the period of 2004-2009 in the 6th Central Military Clinical Hospital 343 arthroscopy were performed. Control set consisted of 128 patients who refused operative treatment or operative treatment couldn't be preformed because of contraindications. During the arthroscopy in 74% of cases old laceration of meniscus was diagnosed, in 18% infra-articular osteochondral fragments were eliminated, in 32% of cases arthroscopic synovectomy was preformed, in 10% of cases forage and mikrofrakturing of subchondral bone were performed, chondroplasty and sanitation of joint were done for every patient. Together with it, during the arthroscopy signs of synovitis were diagnosed. The results of treatment were estimated by the scale of Lysholm (1982) and by the scale IKDS (1995) in 1, 3, 6 and 12 months. In 75% the results were good and excellent.     

153 Sm-柠檬酸-羟基磷灰石滑膜切除术治疗类风湿关节炎膝关节积液

目的观察^153Sm-柠檬酸-羟基磷灰石（HA）滑膜切除术治疗类风湿关节炎（RA）持续性膝关节积液的疗效和安全性.方法常规抗风湿药物治疗无效的RA患者43例,共67个持续性积液的膝关节,行^153Sm-柠檬酸-HA滑膜切除术,观察其疗效和不良反应.结果注射后24 h 8例患者关节外放射性泄漏占注射总量的百分比均＜1%.随访至治疗后3、6、12、24和36个月,总有效率分别为65.7%、85.1%、77.6%、64.2%和56.7%.随访至36个月时,治疗有效的关节复发率为33.3%.治疗有效的关节表现为肿痛缓解,积液量减少,滑膜厚度减小,关节功能活动改善.不良反应主要为一过性关节肿痛加重.结论^153Sm-柠檬酸-HA滑膜切除术治疗RA持续性膝关节积液短期、中期疗效及安全性较好.     

Reactive synovitis of the knee joint: MR imaging appearance with arthroscopic correlation

Objective. To evaluate the use of routine MR imaging sequences in detecting and characterizing secondary reactive synovitis of the knee joint using arthroscopy as the standard of reference. Design and patients. Fifty consecutive patients with a history of knee pain who were referred for MR imaging and subsequently underwent arthroscopy of the knee comprised the study group. MR images were evaluated for the presence and appearance of synovitis reflected in synovial thickening and irregularity. Synovial thickening was graded on MR imaging as follows: 0=normal, 1=thin line of increased signal intensity, 2=increased signal intensity with frond-like or hair-like projections and a granular appearance of joint fluid. Standard knee imaging protocols were used. Results. The sensitivity, specificity, and accuracy of MR imaging in detecting synovitis compared with arthroscopy were 88%, 97%, and 95%, respectively. Grade 1 synovitis was best seen on proton-density-weighted images, demonstrating increased signal intensity of the synovium against the relatively low signal intensity of the joint fluid. Grade 2 synovitis was best seen on proton-density images and T2-weighted spin echo and fast spin echo images with fat saturation, demonstrating a granular and linear hair-like appearance of joint fluid. Axial and sagittal imaging planes were most helpful in the diagnosis of synovitis. Conclusion. Routine MR pulse sequences are useful in identifying the presence and extent of synovial abnormalities. The detection of different stages of synovial pathology should become an important part of the evaluation of the post-traumatic patient as treatment may be altered as a result. Received: 17 March 2000 Revision requested: 5 May 2000 Revision received: 8 June 2000 Accepted: 8 June 2000     

Arthroscopic treatment of sports-related synovitis of the ankle.

We describe nine cases of sports-related synovitis of the ankle joint with a followup of 24 to 44 months (average, 30.9). It affects young athletes and occurs after episodes of acute or recurrent inversion ankle sprains or undisplaced ankle fractures. The patients complain of morning pain and stiffness along with increased pain and swelling with attempted athletic participation. All ankles were stable and all failed to respond to at least 6 months of conservative treatment. The technetium bone scans were positive in eight of the cases. During arthroscopy, a hypertrophic anterior-chamber synovitis was found and treated by arthroscopic partial synovectomy. The results were excellent in eight of the patients in whom symptoms resolved, allowing full return to their previous sports, and fair in one case. The only complication was one superficial wound infection.     

The results of 394 consecutive cases of knee joint radiation synovectomy (radiosynoviorthesis) using 90 Y

The aim of this study was to assess the treatment results of 90Y radiation synovectomy for chronic exudative synovitis of knee joints. The retrospective data consist of 394 consecutive knee radiation synovectomies performed using 6 mCi (222 MBq) of 90Y. The assessment included 3-point custom pain and joint mobility scale, evaluation of joint’s circumference, binary joint’s temperature evaluation, patellar ballottement test, indications for puncture and its volume in applicable cases. 21 cases had to be forfeited due to missing data regarding follow-up. The final analysis of 373 treatment procedures performed in 253 patients yielded following results—at 6 months after treatment, 80.9% of the patients reported at least partial pain relief (including 33.3% with complete pain relief), which increased to 86.7% at one year. The pain intensity decreased over time, however, the outcomes were worse in older patients. The probability of pain recurrence was 15% at 6 months, and 28% at one year. It was highest in post-traumatic synovitis, and lowest in pigmented villonodular synovitis. The circumference of the treated knee joints decreased over the course of follow-up, however, the decrease was significantly lower in older patients. The fraction of patients with full knee joint mobility increased from 34.6 to 40.6% at 6 months and 49.2% at one year. The percentage of patients that required articular puncture decreased from 62.8% at baseline to about 35.6% at 6 months, and 32.8% at one year. Positive patellar ballottement was found in 68.5% before treatment and remained at about 40–50% during the course of follow-up. The increased temperature of the joint was reported in 51.2% at baseline and decreased to 33% at 6 months and 28.3% at one year. (1) Radiation synovectomy is a safe and effective method of treatment in patients with exudative synovitis, however, the pain recurrence rate is significantly higher in post-traumatic exudative synovitis compared to pigmented villonodular, undifferentiated, and rheumatoid arthritis. (2) Our results suggest that older patients have worse treatment results with radiation synovectomy compared to younger patients.     

Utility of Tc-99m human polyclonal immunoglobulin G scintigraphy for assessing the efficacy of yttrium-90 silicate therapy in rheumatoid knee synovitis

PURPOSE: The aim of this study was to determine the utility of Tc-99m human polyclonal immunoglobulin G (HIG) scintigraphy for evaluating the efficacy of yttrium-90 (Y-90) silicate therapy in rheumatoid knee synovitis. MATERIALS AND METHODS: Fifteen patients (13 women, 2 men; mean age, 53.5 +/- 8.4 years) with rheumatoid arthritis had radionuclide synovectomy using 185 MBq (5 mCi) Y-90 silicate to evaluate 24 knee joints with chronic persistent synovitis. Radiologic and clinical evaluations and Tc-99m HIG scans were performed in each patient before radionuclide synovectomy. Each patient was reassessed 3, 6, 9, and 12 months after therapy using clinical examination and Tc-99m HIG scintigraphy. RESULTS: In 14 of 24 knee joints (4 Larsen stage I, 10 Larsen stage II) that had excellent or good clinical responses to Y-90 silicate therapy, the Tc-99m HIG index values 3 months after treatment were significantly lower than the pretreatment index values (P < 0.001). In 13 of these 14 joints, these low index values and clinical results remained constant throughout the 1 year of follow-up. One patient (1 of the 14 knee joints) experienced severe pain and swelling as a result of recurrent arthritis at 9 months, and the Tc-99m HIG index value increased at 9 months and remained high 12 months after therapy. In 10 of 24 knee joints (4 Larsen stage II, 6 Larsen stage III) that had a fair or poor clinical response, Tc-99m HIG index values were statistically similar before and after radionuclide therapy. CONCLUSIONS: Quantitative Tc-99m HIG scintigraphy is a valuable method for assessing the efficacy of Y-90 silicate therapy in rheumatoid knee synovitis.