关节软骨缺损修复研究进展

关节软骨是滑膜关节重要的结构和功能单位，一旦关节软骨发生损伤，由于软骨组织本身缺乏血管，缺乏修复损伤和缺损的未分化细胞，软骨细胞包埋于致密的胶原一蛋白多糖基质中，限制了细胞的增殖和迁移能力，所以自身修复能力非常有限，若治疗不及时或不恰当，难以形成正常的关节软骨，因而无法满足正常关节的功能需求，将会导致严重的关节功能障碍。     

儿童多关节滑膜结核7例

目的：探讨儿童多关节滑膜结核的发病机制、临床特点和治疗原则。方法：回顾7例儿童多关节滑膜结核，其原发及继发病变均发生在下肢大关节。关节液结核PCR检查5例，病理检查2例，关节液PCR及病理检查2例。药物保守治疗5例，滑膜切除手术治疗2例，常规抗痨等对症治疗12～18个月。结果：随访2年以上其中关节功能优3例，良3例，中1例。结论：多关节滑膜结核临床较少见，其临床表现及X线检查无典型特征，误诊、漏诊率高，可疑病例早期行关节液结核PCR检查或病理学检查。治疗上主张保守抗痨治疗为主，对合并有骨质破坏或混合性关节感染应尽早实施手术治疗。     

腰椎关节突关节滑膜囊肿的诊断和治疗

目的探讨腰椎关节突关节滑膜囊肿的诊断及治疗方法。方法对2001-2005年收治的4例腰椎关节突关节滑膜囊肿患者的诊断及治疗进行回顾性分析。术前均行CT检查,其中2例行MRI检查。治疗均采用椎板减压囊肿切除术,术后随访时间为3-6个月。结果CT及MRI检查可明确诊断腰椎关节突关节滑膜囊肿。4例病人中,3例疼痛症状消失,1例缓解。结论CT及MRI检查对腰椎关节突关节滑膜囊肿有定性及定位诊断价值,手术治疗效果良好。     

关节滑膜软骨瘤病

本文叙述12例滑膜软骨瘤病的病因、病理,临床表现,诊断与鉴别诊断及治疗方法,经随访,疗效满意。滑膜软骨瘤病是一种滑膜疾病,主要表现为关节滑膜化生形成多数软骨小体,偶见于滑囊或腱鞘内,软骨小体不断生长,或脱落入关节腔,逐渐长大,部分发生钙化或骨化,故亦称滑膜骨软骨瘤病。本病应尽早诊断,手术为本病唯一有效的的治疗方法,效果良好,取出游离体及切除病变滑膜,避免了游离体长期存在于关节内引起的继发性病变,给病人造成难以弥补的伤害。     

滑膜软骨瘤病三例四个关节报告

滑膜软骨瘤病是一种少见的关节滑膜良性病,以滑膜增生、化生形成软骨结节为主要特征。我院从1986年1月至1995年7月10年中,诊、治3例4关节,平均随访5. 5年,疗效满意,现报告如下。 临床资料 一、一般情况:女2例,男1例。年龄37～54岁,平均45.5岁。病程4～12个月,平均8个月;部位包括膝关节2例3关节,肩关节1例;3例均无明显外伤史。 二、症状与体征:受累关节与一般慢性关节炎表现相似,有间隙性肿胀,2例有弹响、绞锁,1例有关节功能受限,2例局部可扪及质硬活动性包块。     

腰椎关节突关节滑膜囊肿的诊断和治疗

目的：探讨腰椎关节突关节滑膜囊肿的诊断及治疗方法。方法：对2001～2005年收治的4例腰椎关节突关节滑膜囊肿患者的诊断及治疗进行回顾性分析。术前均行CT检查，其中2例行MRI检查。治疗均采用椎板减压囊肿切除术，术后随访时间为3～6个月。结果：CT及MRI检查可明确诊断腰椎关节突关节滑膜囊肿。4例病人中，3例疼痛症状消失，1例缓解。结论：CT及MRI检查对腰椎关节突关节滑膜囊肿有定性及定位诊断价值，手术治疗效果良好。     

海水浸泡爆炸伤关节滑膜修复的研究

目的观察海水浸泡爆炸伤关节滑膜组织学变化,了解关节液对哌啶醇氮氧自由基(TEMPO)的作用。方法制作爆炸伤模型。随机分组,关节内注入TEMPO溶液0.5ml(浓度10-4mol/L),电子自旋共振仪(ESR)检测TEMPO,同时取滑膜作组织观察。结果1个月时滑膜组织仍肿胀,漏出的红细胞未完全吸收,关节液清除TEMPO能力低;2个月时滑膜组织形态改善,细胞数尚少,关节液清除TEMPO能力有提高;3个月时滑膜组织修复已近于正常,关节液清除TEMPO能力与正常关节液相比,5min和1h时差异不明显,2h和3h时差异明显。结论海水浸泡的兔关节爆炸伤经3个月修复,滑膜组织组织学观察已近于正常;关节液对外源性氮氧自由基清除能力短期正常,2h和3h时仍低于正常,且差异显著。     

肩锁关节损伤

肩锁关节位于皮下,为滑膜关节和平面微动关节,由肩胛骨的肩峰关节面和锁骨外侧端的肩峰关节面构成。临床上肩锁关节损伤远较胸锁关节损伤多见,在治疗方案的选择上尚存在一定的争议。1　肩锁关节的稳定结构和功能肩锁关节本身就存在不稳定,只是依靠韧带的限制而保持完整。起稳定     

下尺桡关节滑膜软骨瘤病1例

关节滑膜软骨瘤病(synovial condromatosis)是一种少见的滑膜疾病,多认为是由关节滑膜的结缔组织化生、纤维软骨性或骨软骨性小体所致.该病好发于膝、髋、肘、肩等大关节,常单关节发病,偶见多关节发病.下尺桡关节滑膜软骨瘤病国外文献偶有报道,国内尚未见报道.     

肢体延长对关节组织形态及功能的影响

肢体延长技术是目前治疗肢体不等长畸形的主要手段。早期的肢体延长为一次性截骨延长,在临床应用中因固定方法的限制而具有较大局限性。７０年代后,由于骨外固定技术的改进、引用及骨痂牵伸技术（ｃａｌｌｏｔａｓｉｓｔｅｃｈｎｉｑｕｅ）的形成［１］使肢体延长技术得以飞速发展,如延长幅度大为提高,而骨不愈合、神经损伤等并发症明显减少。但是,延长引起关节功能减退、关节软骨退变及关节强直等问题并未有效解决［２］。近年来,这一问题已逐渐引起人们的重视。一、关节的形态学特征及关节软骨的生化组成四肢关节为滑膜关节,由骨端…     

Osteoarthritis:toward a comprehensive understanding of pathological mechanism

Osteoarthritis(OA) is the most common degenerative joint disease and a major cause of pain and disability in adult individuals. The etiology of OA includes joint injury, obesity, aging, and heredity. However, the detailed molecular mechanisms of OA initiation and progression remain poorly understood and, currently,there are no interventions available to restore degraded cartilage or decelerate disease progression. The diathrodial joint is a complicated organ and its function is to bear weight, perform physical activity and exhibit a joint-specific range of motion during movement. During OA development, the entire joint organ is affected, including articular cartilage, subchondral bone, synovial tissue and meniscus. A full understanding of the pathological mechanism of OA development relies on the discovery of the interplaying mechanisms among different OA symptoms, including articular cartilage degradation, osteophyte formation, subchondral sclerosis and synovial hyperplasia, and the signaling pathway(s) controlling these pathological processes.     

肘关节粘连松解术中减少射频消融的使用对术后疗效的影响

目的对比在肘关节镜下粘连松解术使用射频消融或刨刀进行关节囊松解、炎性滑膜切除对术后关节引流量的影响。 方法将上海交通大学医学院附属仁济医院收治的骨关节炎性肘关节粘连患者24例随机分为2组，每组12例。射频消融组：使用射频消融进行滑膜切除和关节松解；刨刀组：使用刨刀进行滑膜切除和关节松解。对比术后关节引流量、关节屈伸活动度、关节功能评分等。 结果刨刀组术后引流量为（32.9±12.3）ml显著少于射频消融组（110.0±31.4）ml（P=0.00）。术后引流管留置时间射频消融组为（3.1±1.3）d，显著多于刨刀组的（1.3±0.5）d（P=0.00），但两组间关节活动度、功能评分恢复情况差异无统计学意义。 结论进行肘关节镜下粘连松解术时，射频消融的过多使用会增加术后引流量，使用刨刀进行滑膜切除和松解优于射频消融。     

Cell receptors to sulphated polysaccharides in the acute and chronically inflamed synovial joint

Receptors to sulphated polysaccharides have recently been discovered on "free" joint fluid cells and synovial membrane cells in the normal joint. A search for these receptors on cells was made in rabbits with acute and chronic adjuvant inflammatory arthritis in an attempt to further elucidate their role in joint homeostasis. These experiments demonstrated a significant increase in cell numbers within the joint. Receptor activity was most marked on macrophages found free within the synovial fluid. It is postulated that exogenous cells may be important in the process of joint destruction and are outside the control of the normal joint regulatory mechanisms. The endogenous cell population, which exhibits receptor activity, may be responding to the process of joint destruction by proliferation as a secondary phenomenon.     

滑膜病变在骨关节炎中的表现

骨性关节炎是一种退化性关节疾病,以关节软骨的降解、关节边缘骨赘的形成和滑膜病变为特征,以往的研究和治疗重点在关节软骨病变,而最新研究显示滑膜的炎症在骨关节炎中起重要作用,滑膜炎症和滑膜相关的致炎因子诱导的关节软骨的降解和破坏,促进了骨关节炎的发展。滑膜病变在骨关节炎中的表现日益突出,而针对滑膜病变的治疗将成为一个新的靶点。     

The role of synovitis in osteoarthritis pathogenesis

Research into the pathophysiology of osteoarthritis (OA) has focused on cartilage and peri-articular bone, but there is increasing recognition that OA affects all of the joint tissues, including the synovium (SM). Under normal physiological conditions the synovial lining consists of a thin layer of cells with phenotypic features of macrophages and fibroblasts. These cells and the underlying vascularized connective tissue stroma form a complex structure that is an important source of synovial fluid (SF) components that are essential for normal cartilage and joint function. The histological changes observed in the SM in OA generally include features indicative of an inflammatory "synovitis"; specifically they encompass a range of abnormalities, such as synovial lining hyperplasia, infiltration of macrophages and lymphocytes, neoangiogenesis and fibrosis. The pattern of synovial reaction varies with disease duration and associated metabolic and structural changes in other joint tissues. Imaging modalities including magnetic resonance (MRI) and ultrasound (US) have proved useful in detecting and quantifying synovial abnormalities, but individual studies have varied in their methods of evaluation. Despite these differences, most studies have concluded that the presence of synovitis in OA is associated with more severe pain and joint dysfunction. In addition, synovitis may be predictive of faster rates of cartilage loss in certain patient populations. Recent studies have provided insights into the pathogenic mechanisms underlying the development of synovitis in OA. Available evidence suggests that the inflammatory process involves engagement of Toll-like receptors and activation of the complement cascade by degradation products of extracellular matrices of cartilage and other joint tissues. The ensuing synovial reaction can lead to synthesis and release of a wide variety of cytokines and chemokines. Some of these inflammatory mediators are detected in joint tissues and SF in OA and have catabolic effects on chondrocytes. These inflammatory mediators represent potential targets for therapeutic interventions designed to reduce both symptoms and structural joint damage in OA. This article is part of a Special Issue entitled "Osteoarthritis".     

膝关节牵伸术修复膝关节软骨的研究进展

膝关节牵伸术是近年来治疗膝骨关节炎的新技术,它能减轻膝关节疼痛和改善膝关节功能,这与其修复软骨的作用密不可分。膝关节牵伸术修复软骨的作用机制和影响因素作为当前研究的热点,本文通过回顾文献发现,膝关节牵伸术能减轻膝关节负荷为软骨修复提供适宜的力学环境,引起的膝关节流体静水压波动不仅能帮助软骨吸收营养,还能促进软骨形成基因和抑制软骨基质降解酶基因表达。此外,膝关节牵伸术为滑液间充质干细胞募集到软骨损伤处创造了条件,并提升了滑液间充质干细胞增殖、分化为成软骨谱系的能力。膝关节牵伸术还能通过减少膝关节内部炎性因子含量和抑制炎性基因表达,减轻膝关节炎症反应和软骨损伤。目前已知的影响膝关节牵伸术修复软骨的因素包括适当增加膝关节负重活动、牵伸高度和牵伸时间有助于软骨修复,男性患者、膝关节炎严重程度更高的患者膝关节牵伸术后软骨修复效果更好。而膝关节牵伸术后第1年软骨修复疗效越好,预示着膝关节牵伸术保留膝关节的远期生存率越高。但目前对上述热点的研究只停留在初期阶段,仍需进行更深入的探索,才能对膝关节牵伸术的临床应用起到更好的指导。     

Therapie des posttraumatischen Ellengelenkempyems

Empyemas of the elbow joint following trauma or surgery jeopardize the treatment carried out and the function of the joint. Therefore, the joint infection has to be recognized early and treated consistently as an emergency. Clinical course, laboratory signs of inflammation, sonography, and joint aspiration are sufficient for diagnosis in most cases. Scintigraphy, MRT and/or CT are only necessary for chronic infections. For planning therapy, a classification that takes into account the preceding therapy, the extent of the infection, and also the grade of damage to the joint has proven useful. Stage-adapted therapy is carried out. Damage grades I (synovial hyperemia), II (synovial hypertrophy), and possibly III (synovial sponge) should be treated by repeated arthroscopies; grade IV (synovial "malignancy") is better treated by open surgery. If internal fixation at or near the joint has preceded, open revision of the joint presents itself even with low-grade joint damage. It is also the procedure of choice in cases with simultaneous extensive soft tissue or bone infection. It can be attempted to save internal fixation at or near the joint if the fixation is stable and positioned correctly. Recurrent infection has to be prevented by local and systemic antibiotic treatment; it should always be attempted to preserve function. The differential treatment strategies are discussed in detail.     

Synovial hemangioma of the interphalangeal joint: a case report

Among the differential diagnosis for lesions of the hand, synovial hemangioma of the articular surface and tendon sheath is often overlooked due to its rare nature. In comparison to more abundant reports describing their involvement of the knee joint, our literature review found only six cases involving the hand or wrist. We present our recent experience in treating a 17-year-old female diagnosed with synovial hemangioma of the long finger proximal interphalangeal joint. In addition, we have submitted pertinent imaging and pathological findings for review with the intent to increase awareness of synovial hemangioma during evaluation of hand lesions.     

Ganglion cyst of a lumbar facet joint in an adolescent—a case report

‘Lumbar facet joint synovial cyst’ is the recent terminology used to describe cysts within and outside the lumbar spinal canal. These include ganglion cysts, synovial cysts and cysts arising from the ligamentum flavum. Ganglion or synovial cysts typically arise from the joints and tendon sheaths of the appendicular skeleton but are uncommon in the spinal facet joints and rare in an adolescent. This case report illustrates a 14-year-old female patient of the senior author (JHP) with lumbar facet joint cyst who presented with lower back pain. Excisional biopsy was performed and the histology confirmed the diagnosis of a ganglion cyst.     

Imaging methods of examining the hip joint

The hip joint is a synovial joint of the appendicular skeleton which constituents of articular cartilage, subchondral bone plate, articular capsule synovial membrane which produces synovial fluid. Ankylosing spondylitis is chronic inflammatory disorder of unknown cause that affects the axial and appendicular skeleton. Alterations occur in synovial and cartilaginous joints and sites of tendon and ligament attachment to bone.