Amyloid Arthropathy

Over the past eight years there has been a better recognition of amyloid arthropathy and its association with underlying plasma cell dyscrasias. The radiological changes found in amyloid arthropathy are sufficiently characteristic at times to suggest the diagnosis. The radiological features of a patient with amyloid arthropathy, associated with kappa light chain myeloma, are presented and compared with previously reported cases. The features include: loss of soft tissue planes.: periarticular loss of bone density. : well defined cystic, subchondral and periarticular lesions, having a soap bubble appearance. preservation of joint spaces. Clinically, the usually symmetrical polyarth-ropathy is frequently confused with rheumatoid arthritis. Rheumatoid factor is not found howzver, and complete laboratory studies of serum and urine are required to demonstrate the associated dysproteinaemia. Biopsy will confirm joint amyloidosis.     

Unilateral lumbosacral facet joint dislocation without associated fracture

In the lumbosacral spine, unilateral facet joint dislocation is an infrequent injury, which is often associated with fractures at the involved or other lumbar levels. The rare occurrence of unilateral lumbosacral facet joint dislocation without any associated fractures is presented with CT and MRI, and surgical correlation. To our knowledge, cross‐sectional imaging of this injury has not previously been described in the published literature.     

Gout‐mimicking sarcoma recurrence at a prosthesis bone interface remote from any joint

Gout is known to occur in a variety of organs but most commonly presents as an inflammatory arthropathy. A few reported cases have documented its occurrence in prosthetic neo‐joints or juxta‐articular to this. We present the first reported case at a bone prosthesis interface remote from any joint and mimicking sarcoma recurrence because of its unusual location.     

氨基葡萄糖治疗腰椎小关节骨性关节炎的临床体会

目的探讨使用氨基葡萄糖治疗腰椎小关节骨性关节炎的效果。方法采用随机分组方法将120例患者分为口服氨基葡萄糖与非甾体类药物2组进行评分以及对患者关节压痛、平地行走痛、静息痛、晨起关节僵硬进行疗效评定。结果氨基葡萄糖组患者均在服药后1周至3个月开始疼痛减轻,并于治疗1个疗程后疼痛消失,开始参加日常活动,疗效优于对照组（P〈0.05）。结论氨基葡萄糖治疗腰椎小关节骨性关节炎副作用少,可以减轻腰椎小关节增生肥大,并减少腰椎的僵硬。     

经皮侧后路腰椎间孔成形与经椎间孔完全内镜下腰椎间盘摘除术

一、背景 1992年,报道经侧后路内窥镜下进行腰椎间盘摘除术以来,许多学者报告了经椎间孔内窥镜下腰椎间盘摘除术的技术及疗效。完全内镜下腰椎间盘摘除术是指使用带工作通道的硬杆状内镜在持续生理盐水灌洗下进行的微创腰椎间盘摘除手术,分为经椎间孔入路和经椎板间入路两类技术。Yeung等发明的YESS（yeungendoscopicspinesystem）系统是最早的完全内镜手术系统,最早的完全内镜下腰椎间盘摘除术是使用YESS系统经后外侧椎间孔入路进行的由盘内至盘外的操作技术,适用于椎间孔型及极外侧型椎间盘突出,对椎管内包含型突出及韧带下型椎间盘脱出也可以有效处理,但对椎管内脱出及游离髓核无法有效切除。     

Imaging of the absent cervical pedicle syndrome

Three cases of congenital absence of a cervical spine pedicle are described. This anomaly comprises a radiological triad of (i) the absent pedicle producing an apparently ‘giant’neural foramen; (ii) a dorsally displaced ipsilateral articular mass and lamina with a dysplastic and reversed facet joint; and (iii) deficiency or absence of the ipsilateral transverse process. Recognition of this anomaly is particularly important in the context of acute injury to avoid misdiagnosis as a traumatic facet joint fracture-dislocation. The giant foramen must also be differentiated from expansion due to a neurofibroma. A correct plain radiographic diagnosis is usually possible, but in doubtful cases appearances on computed tomography are pathognomonic. Magnetic resonance imaging, performed in two of the cases, was helpful in elucidating the contents of the giant foramen, but should rarely be necessary in clinical practice.     

限制背伸支具治疗近指间关节背侧骨折脱位

目的：评价限制背伸支具治疗近指间（ proximal interphalangeal,PIP ）关节背侧骨折脱位的效果。方法2009年9月至2013年9月,对48例PIP关节背侧骨折脱位患者采用阶段性限制背伸支具治疗,随访其远期功能情况,记录关节活动范围。采用TAM 评分进行手指客观运动功能评价,采用 VAS 评分进行主观满意度评价。结果48例均获4～48个月随访,平均18个月。骨折全部愈合;关节复位满意;PIP关节屈曲110°,伸直0°;TAM评分：优48例,优良率100%;VAS主观满意度9.9分。侧方不稳定且开口征＜30°的4例,支具治疗后无明显侧方不稳定,开口征＜15＆#176;,除侧方梭形膨胀外,无其它并发症。结论限制背伸支具治疗PIP关节背侧骨折脱位方法简单,效果可靠。     

严格掌握原发性脊柱肿瘤全脊椎整块切除的适应证

原发性脊柱肿瘤相对少见,约占所有脊柱肿瘤的20%,全身骨肿瘤的6. 6%～8. 8%[1]。尽管原发性脊柱肿瘤的诊治原则与四肢骨肿瘤基本相同,但由于脊柱解剖复杂,毗邻脊髓神经、大血管及重要脏器结构,其外科切除难度较大、风险较高,既往多采用次全切除方式,局部复发率居高不下,治疗效果远不如四肢骨肿瘤。近20年来,随着脊柱外科技术的不断进步、脊柱内固定与重建器械的飞速发展及肿瘤学认识的逐步融入,脊柱肿瘤的治疗由过去的简单椎板切除、减压到现在的全脊椎切除,由过去的分块切除到现在的整块切除,使得脊柱肿瘤的临床疗效明显提高。     

手术治疗骨巨细胞瘤44例分析

目的 分析比较不同手术方法治疗四肢长骨骨巨细胞瘤的临床效果。方法 回顾分析1991年11月-2005年9月手术治疗的44例骨巨细胞瘤。结果 44例患者均获得随访,随访时间10个月至14年1个月,平均10年2个月。病灶刮除植骨11例,肿瘤复发3例;病灶刮除骨水泥填充16例,肿瘤复发2例;瘤段切除灭活再植7例,肿瘤复发1例;瘤段切除关节融合3例,肿瘤复发0例;瘤段切除人工假体置换7例,肿瘤复发0例。病灶刮除组总复发率19％,瘤段切除总复发率为6％。结论 病灶刮除骨水泥填充术和肿瘤瘤段切除术均是治疗骨巨细胞瘤的可靠方法。     

血友病的临床治疗：第55届美国血液学会年会报道

血友病患者的预后在过去50年中有了显著提高.随着目前越来越多安全的凝血因子浓缩物的出现,血友病临床治疗的主要焦点成为预防长期并发症,尤其是在重型血友病患者中应预防可致残的关节病.对于有少量出血史、重型血友病A的幼年患者,早期预防性凝血因子输注治疗可取得确切的临床疗效.对于已存在关节病的青少年和成年血友病患者,可从预防性治疗中获益.凝血Ⅷ因子抑制物的产生是凝血因子替代治疗最棘手的并发症,临床上可采用抑制物免疫耐受诱导疗法来克服抑制物的作用.文章介绍了2013年第55届美国血液学会（ASH）年会关于临床治疗儿童及成年人血友病的研究进展.     

C1-C2 block vertebra with fusion of anterior arch of atlas and the odontoid

A rare case of atlanto-axial block vertebra and fusion of anterior arch with the dens, with instability at the atlanto-occipital joint, is reported. The literature is briefly reviewed.     

整脊手法配合脊柱诊断治疗仪治疗寰枢椎外侧关节骨关节炎的初步临床体会

目的探讨整脊手法配合脊柱诊断治疗仪治疗寰枢椎外侧关节骨关节炎的疗效。方法2004年至2008年收治10例患者,男5例,女5例。平均年龄47岁（32～70岁）。6例创伤性关节骨炎患者年纪较轻,其中5例有头部外伤史;4例（54～70岁）退行性骨关节炎患者无外伤史。所有患者治疗前均行张口位X线片检查,可见一侧寰枢椎外侧关节间隙闭锁或狭窄。依据病情不同而行整脊手法配合使用脊柱诊断治疗仪治疗。手法治疗的同时配合服用非甾体消炎药或佩带围领。结果改良Robinson标准评价本组疗效：优7例,良2例,可1例,差0例。治疗前VAS平均8．6分,治疗后平均2．6分,差异显著（P〈0．05）。所有患者治疗后短期内头颈部疼痛症状明显缓解,但疗程与疗效却相差甚远。年轻的创伤性骨关节炎患者疗程较短,影像学改变较易恢复;高龄的退行性骨关节炎患者疗程长,影像学变化不易改善。结论整脊手法配合脊柱诊断治疗仪是治疗寰枢椎外侧关节骨关节炎的有效保守治疗方法之一。     

膝关节周围骨巨细胞瘤的外科治疗

目的 比较不同手术方法治疗膝关节周围骨巨细胞瘤的疗效.方法 2000年5月-2008年5月收治骨巨细胞瘤37例,男22例,女15例,年龄19～56岁,平均32岁.股骨远端19例,胫骨近端18例.Campanacci分级：Ⅰ级4例,Ⅱ级23例,Ⅲ级10例.根据肿瘤部位、Campanacci分级及患者年龄,采取不同的手术方法.其中,单纯刮除植骨或骨水泥填充10例,刮除植骨内固定16例,瘤段切除＋人工关节置换11例.结果 随访时间1-9年,平均5年,刮除植骨组有3例复发,复发率为11.5%,瘤段切除＋关节置换组无复发,术后患者Enneking功能评定：优19例,良8例,可5例,差5例,总满意率为86.5%.结论 病灶刮除植骨是骨巨细胞瘤基本的外科治疗方法,局部辅助处理措施可降低病灶刮除术后的复发率.瘤段切除适用于Campanacci Ⅲ级骨巨细胞瘤,虽复发率较低,但重建后的并发症相对较多.     

基于H．264标准的双目立体视频压缩编码与实现

本文提出了基于H．264标准的立体视频编码器方案，主要由预测（包括运动补偿预测和视差补偿预测）、变换和熵编码器三个部分组成。以左通道为主序列，右通道为辅序列。左通道采用简单的H．264编码，右通道以块为单位，进行运动补偿和视差补偿。通过实验证明了混合编码框架（运动补偿预测和视差补偿预测）具有更好的压缩效果，通过对不同图像复杂度的序列仿真实验，得到良好的重建图像质量，证明了本算法的有效性。     

Imaging of the haemorrhagic complications of the haemophilias

Haemorrhage is the main manifestation of the haemophilias. Although acute haemorrhages can be life threatening, especially if involving the central nervous system, repeated haemorrhages involving the musculoskeletal system lead to two conditions unique to patients with haemophilias. This pictorial essay reviews the typical imaging appearances of haemorrhages and consequences in those with haemophilias, with particular emphasis on haemophilic arthropathy and pseudotumours.     

Congress of Neurological Surgeons systematic review and evidence-based guidelines for the treatment of adults with progressive glioblastoma update: introduction and methods

Journal of Neuro-Oncology - The management of glioblastoma at the time of progression is an important facet of all physicians involved in neuro-oncology. This is an update of the evidence-based...     

胸腰椎转移瘤98例的手术治疗

目的 探讨胸腰椎转移瘤手术治疗的适应证、手术方法及疗效。方法 从1994年1月-2003年1月收治的169例胸腰椎转移瘤巾，选择瘤椎仅限于1-2节段，行瘤椎切除并内固定116例，获得随访结果者98例．男性58例，女性40例，年龄21～78岁，平均56．5岁。胸椎63例，腰椎35例。椎体84例，椎弓14例。单节段92例，双节段6例。原发瘤包括转移性腺癌17例，转移性鳞癌16例，肺癌11例，乳腺癌11例，低分化转移癌8例，肾癌6例，胃肠癌6例．前列腺癌5例，食道癌4例，肝癌4例，甲状腺癌3例，胆道癌3例，子宫癌2例，鼻咽癌与卵巢癌各1例。重度疼痛69例，中度疼痛23例，合并截瘫39例。肿瘤椎体切除Luque棒加骨水泥椎体成形43例，肿瘤椎体切除钢板螺钉固定加骨水泥成形41例，椎弓肿瘤切除Luque环与椎板下节段钢丝固定14例。结果 随访8个月-4年，平均2．5年，疼痛缓解80／92例。39例截瘫中完全恢复10例，部分恢复23例，不恢复6例，截瘫改善率84．6％（33／39例）。生存期内胸腰椎稳定性良好，内固定无松动移位和折断。最短生存5个月，最长生存3．5年，生存期超过2年者17．3％（17／98例）。结论 手术能切除顽固的瘤灶，脊髓减压和稳定脊柱，从而缓解疼痛，维护或改善神经功能，提高生存质量。     

Prenatal Diagnosis of Iniencephaly: Report of 2 cases

Two rare cases of iniencephaly are presented, in which a prenatal diagnosis was made and subsequently confirmed on parturition.     

Silicon Interpositional Arthroplasty for Temporo-mandibular Joint Ankylosis

Temporo-mandibular joint (TMJ) ankylosis is characterized by a decreased mouth opening which affects mastication, speech, and facial aesthetic. Interpositional arthroplasty using autologous tissue is accepted treatment for TMJ Ankylosis; however, harvesting autologous tissue is associated with additional morbidity. In this article we report our results of silicon interpositional arthroplasty for TMJ ankylosis. 20 patients with TMJ ankylosis were included in the study. All patients underwent standard operative procedure using preauricular incision for release of TMJ ankylosis by excision of at least 1 cm of bony block and insertion of 2 cm thick silicon block in the joint space. Postoperatively early mobilization of TMJ was advised from 3rd day onwards. Post operative result was evaluated by assessing the mouth opening as inter incisor distance (IID). 20 patients (27 joints) of TMJ ankylosis were included in the study. There were 8 male and 12 female patients with age ranged from 3–35 years. According to Sawhney classification bony ankylosis was present as Type-IV (n = 13 joints), Type-III (n = 12 joints) and Type-II (2 joints). Preoperative mean IID was 7.15 mm and post operative mean IID was 43.5. There was no facial nerve paresis, malocclusion or recurrence but infection and extrusion of implant occurred in 1 case each. Silicon interpositional arthroplasty is an effective procedure for the treatment of TMJ Ankylosis; as it restores mouth opening and function, maintains the vertical ramus height, and prevents re-ankylosis without any donor site morbidity.     

全脊柱MRI成像在转移瘤中的诊断价值

目的 探讨全脊柱MRI成像在转移瘤中的诊断价值.方法 对2007年10月至2010年4月经临床证实的19例脊柱转移瘤患者行MRI成像,序列包括矢状位T1WI、T2WI扫描,在病变部位做横断位T2WI扫描.结果 19例脊柱转移瘤中累及单个椎体2例,多个椎体受累17例;受累椎体部位颈段1例,胸段13例,腰段7例,骶段1例;转移瘤骨质异常表现包括溶骨性破坏、成骨性改变、混合型改变等.结论 全脊柱MRI成像是脊柱转移瘤重要检查方法.