壤塘县藏族成人大骨节病膝关节单次注射玻璃酸钠的疗效观察

目的 研究壤塘县藏族成人大骨节病膝关节损害患者单次注射玻璃酸钠的疗效和副作用.方法 壤塘县藏族成人大骨节病膝关节损害28例,单侧膝关节注射一次玻璃酸钠2.0 ml,注射前及注射后第1、3和8周分别采用VAS疼痛评分、关节活动度和藏区大骨节病日常生活和劳动能力量表评价治疗效果.结果 VAS评分注射前,注射后1、3和8周分...     

WOMAC用于阿坝州成年大骨节病患者关节病损评价的研究

目的检验西安大略和曼彻斯特大学关节炎指数（Western Ontario and McMasterUniversities Osteoarthritis Index, WOMAC ）能否真实反映阿坝州成年大骨节病（Kashin—BeckDisease,KBD）患者的多关节病损情况。方法2010年9月-12月对阿坝州壤塘县成年KBD患者进行调查。记录患者各个大关节的疼痛、畸形和活动受限情况,并用WOMAC对患者进行评分。用Spearman秩相关分析WOMAC得分与患者各受累关节病损程度的相关性。结果调查成年KBD患者426例,完成调查表414份,应答率为97．2％,完成率为100％。有92．7％的患者都存在上下肢多个关节受累。受累关节的频繁程度依次是：膝、腕、肘、踝、肩、髋;而受累关节的严重程度依次是：膝、肘、踝、腕、肩、髋。WOMAC得分主要与膝关节疼痛和活动度的相关性较好（R=0．515,P〈0．001;R=0．478,P〈0．001）;而与其他关节尤其是上肢关节的相关性较弱或无相关性。结论阿坝州成年KBD患者具有上下肢多个关节受累的病损特点,而WOMAC只能反应患者膝关节的功能情况,不适合用其来评价患者的上下肢多关节病损程度和整体的功能状况。     

大骨节病流行区成人大骨节病和骨关节炎患者血清细胞介素-6检测分析

背景：成人大骨节病（Kashin-Beck Disease,KBD）的临床表现和病理改变类似于骨关节炎（osteoarthritis,OA）,其血清TNF-α和IL-1β的异常表达已被多次发现。然而,关于KBD患者血清白细胞介素-6（IL-6）的检测以及与KBD病情的相关性报道较少。目的：分析成人KBD和OA患者血清IL-6的表达水平有无差异,探讨IL-6水平与KBD分度及其他临床因素的相关性。方法：采集四川阿坝壤塘大骨节病区KBD患者血清标本64例,OA患者血清标本47例,非大骨节病区健康血清39例作为对照组。采用酶联免疫分析技术分别检测上述150例血清标本中的IL-6的表达水平。统计学分析组间有无差异,同时分析IL-6的表达水平与KBD分度、VAS评分及大关节受累数目的相关性。结果：KBD组和OA组患者血清IL-6表达水平均明显高于健康对照组（P〈0.001）。KBD组患者血清IL-6表达水平与OA组相比无统计学意义（P〉0.05）。KBD组各分度间IL-6的表达水平无统计学差异（P〉0.05）。IL-6的水平与KBD的分度、VAS评分及大关节受累数目均无相关性（P〉0.05）。结论：在阿坝壤塘KBD病区,IL-6在KBD和OA的发病机制中的作用相似,IL-6的表达水平与KBD的病情发展无相关性。     

成人大骨节病X线分级下手术治疗

目的 观察X线分级下选择手术方案治疗成人大骨节病的疗效。方法对287例成人大骨节病患者依据骨端X线分级区分病情活跃程度及严重程度,选择关节镜下有限清理加钻孔减压术、关节镜下有限清理加截骨、切开关节清理或合斤截骨、人丁关节置换、关节融合术,同时行大骨节病相关疾病的桡骨小头切除、髌骨复位、肱骨内上髁切除和肘、踝、腕尺管切开神经外膜切开减压术。结果本组287例术后随访1．5～5年,术后均无严重疼痛、功能障碍及假体松动、下沉、倾斜、脱位,无下肢深静脉血栓形成,无肺栓塞、坐骨神经牵拉伤、腓总神经压迫损伤及关节不稳等并发症。有3例关节血肿,经关节抽液后消失,2例浅表感染,经关节冲洗后痊愈。采用Harris关节评分法评价髋关节的运动功能（优良率66．7％）,采用HSS关节评分法评价膝关节的运动功能（优良率78．8％）,采用HSS关节评分法评价肘关节的运动功能（优良率76．5％）,采用McGuire评分法评价踝关节的运动功能（优良率68．6％）,采用Macnicol标准判定肘、腕、踝管综合症术后效果（优良率75．0％）。结论骨端x线分级下手术治疗成人大骨节病,有利于根据病情活跃程度和严重程度,选择手术方案,做到治疗的合理化、客观化、个体化,提高疗效。     

地塞米松和吗啡关节内注射用于膝关节镜术后镇痛

目的观察和比较地塞米松和小剂量吗啡配伍关节内注射用于膝关节镜手术后的镇痛效果。方法选择ASAⅠ～Ⅱ级择期腰麻下行单侧膝关节镜手术的病人90例,随机分为三组,每组30例。Ⅰ组手术后在关节内注射地塞米松5 mg＋盐酸吗啡1 mg;Ⅱ组手术后在关节内注射盐酸吗啡1 mg;Ⅲ组手术后在关节内注射生理盐水5 mL。给药后8、24、36、48 h在病人双足站立、膝关节伸展状态下进行视觉模拟评分（visual analogue scales,VAS）,观察三组膝关节手术后的镇痛效果以及不良反应,如呼吸抑制、恶心呕吐、尿潴留及搔痒等症状的发生率。结果给药后8、24、36、48 h,Ⅰ组VAS评分均显著低于Ⅱ组（P〈0.05或P〈0.01）和Ⅲ组（P〈0.01）;Ⅱ组给药后8、24 h VAS评分显著低于Ⅲ组（P〈0.05）,36、48 h VAS评分和Ⅲ组相比无显著性差异（P〉0.05）;Ⅱ组36、48 h VAS评分和8、24 h相比显著升高（P〈0.05）。三组患者术后均未发生呼吸抑制、恶心呕吐、尿潴留及搔痒等不良反应。结论地塞米松和小剂量吗啡关节内注射或单纯小剂量吗啡关节内注射均可有效缓解膝关节镜手术后的疼痛,而前者效果更好,更持久。     

Schatzker分型胫骨平台骨折术后膝关节功能评分与骨性关节炎发生的相关性分析

目的探讨不同Schatzker分型胫骨平台骨折患者术后膝关节功能评分与膝关节骨性关节炎形成的相关性。方法纳入自2012-01—2017-06胫骨平台骨折术后发生的81例膝关节骨性关节炎,符合美国风湿病学会关于膝关节骨性关节炎诊断标准及X线分级标准。胫骨平台骨折根据Schatzker分型:Ⅰ型6例,Ⅱ型8例,Ⅲ型12例,Ⅳ型14例,Ⅴ型19例,Ⅵ型22例。采用Pearson相关分析膝关节功能Rasmussen评分、HSS评分与疼痛VAS评分、WOMAC评分、骨性关节炎发生时间、骨性关节炎类型(累及单一关节或累及多个关节)的相关性。结果 Pearson相关分析结果显示,膝关节功能Rasmussen评分、HSS评分与WOMAC评分、疼痛VAS评分总分、骨性关节炎发生时间、累及多个关节发生呈负相关,与单一关节发生呈正相关。结论不同Schatzker分型胫骨平台骨折患者术后膝关节功能评价对于膝关节骨性关节炎形成时间、严重程度具有明显的指示作用,因此尽早对胫骨平台骨折患者术后膝关节功能进行评估有利于准确进行膝关节骨性关节炎预防和治疗,进而改善患者预后。     

关节镜下单隧道缝线套捆固定术治疗成人后交叉韧带胫骨止点骨折

目的 探讨关节镜下单隧道缝线套捆固定术治疗成人后交叉韧带（posterior cruciate ligament,PCL）胫骨止点骨折的疗效。方法 2019年10月—2021年10月，采用关节镜下单隧道缝线套捆固定术治疗16例PCL胫骨止点骨折患者。男11例，女5例；年龄26～58岁，平均41.1岁。致伤原因：交通事故伤12例，运动伤4例。受伤至手术时间2～10 d，平均6.0 d。骨折分型：Meyers-McKeeverⅡ型4例、Ⅲ型9例，ZaricznyiⅣ型3例。后抽屉试验Ⅰ度2例、Ⅱ度7例、Ⅲ度7例。合并外侧副韧带损伤3例，半月板损伤2例。手术前后采用疼痛视觉模拟评分（VAS）、Lysholm评分、国际膝关节文献委员会（IKDC）评分及膝关节活动度评价膝关节功能，采用后抽屉试验以及膝关节稳定度测试仪Kneelax 3检查评价膝关节稳定性，X线片复查评价骨折复位愈合情况。结果 术后切口均Ⅰ期愈合，无切口感染、腘窝神经血管损伤、下肢深静脉血栓形成等并发症发生。患者均获随访，随访时间6～12个月，平均10个月。术后6个月，X线片复查示骨折均达骨性愈合；后抽屉试验0度11例、Ⅰ度4例、...     

对侧膝关节疼痛对全膝关节置换手术患者的临床影响

目的:评估对侧膝关节疼痛程度对骨性关节炎患者全膝关节置换术(total knee arthroplasty,TKA)后1年手术侧关节功能障碍及治疗满意度的影响。方法:2019年3月至2021年1月行TKA的635例患者,男296例,女339例;年龄(69.33±9.38)岁,病程(1.15±0.44)年。根据术后对侧膝关节疼痛视觉模拟评分(visual analogue scale,VAS)分为轻度或无疼痛(VAS 0～3分)423例,中度疼痛(VAS 4～6分)105例,重度疼痛(VAS 7～10分)107例。分析比较对侧膝关节不同疼痛程度对术后12个月膝关节功能及满意度评分的影响。结果:对侧膝关节疼痛VAS在TKA术后明显降低,年龄大、身体质量指数高、术后手术侧膝关节WOMAC评分高、对侧膝关节中、重度疼痛是患者不满意的危险因素(P<0.05),OR分别为1.285、1.665、2.319、1.863。手术侧膝关节疼痛度高、居家环境为步梯房是患者出院1年后WOMAC评分高的危险因素(P<0.05);出院后坚持锻炼、功能性训练是患者出院1年后WOMAC评分高的保护因素(P...     

关节冲洗术联合透明质酸钠治疗K-L Ⅱ、Ⅲ期膝关节骨性关节炎疗效分析

目的观察关节冲洗术联合膝关节腔注射透明质酸钠治疗膝关节骨性关节炎的临床疗效。方法纳入自2018-12—2020-02诊治的77例Kellgren-LawrenceⅡ、Ⅲ期膝关节骨性关节炎,40例采用关节冲洗术联合透明质酸钠注射治疗(观察组),37例单纯于关节腔注射透明质酸钠治疗(对照组)。比较2组治疗后1周、2周、12周疼痛VAS评分、Lequesne指数评分及WOMAC评分。结果治疗中及治疗后所有患者均未出现关节感染、出血及下肢运动感觉障碍等并发症。治疗后疼痛VAS评分、Lequesne指数评分及WOMAC评分均较治疗前明显改善。观察组治疗后1周、2周、12周疼痛VAS评分、Lequesne指数评分及WOMAC评分均低于对照组,差异有统计学意义(P0.05)。结论关节冲洗术联合透明质酸钠治疗可有效改善膝关节骨性关节炎患者的疼痛症状及膝关节功能,其疗效优于单纯透明质酸钠注射。     

不同分期膝关节骨性关节炎治疗方案探讨

目的探讨关节镜下有限关节清理术联合系统康复训练对不同分期膝关节骨性关节炎(KOA)的疗效。方法选取2013年1月至2014年1月山东省阳谷县中医院收治的120例KOA患者作为研究对象,根据Kellgren-Lawrence X线分级标准分为4期,每期30例,再采用完全随机分组法将每期患者分为单一组(关节镜下有限清理术)和联合组(关节镜下有限清理术联合系统康复训练),每组各15例;治疗前和治疗6个月后采用Lysholm评分和美国特种外科医院(HSS)评分评价患者膝关节功能,采用视觉模拟量表(VAS)评分评价患者的自觉症状变化。结果治疗6个月后两组同期患者Lysholm评分、HSS评分均明显高于术前,VAS评分明显低于术前(P0.05)。治疗6个月后,联合组Ⅰ、Ⅱ、Ⅲ期患者Lysholm评分均优于同期单一组,Ⅰ、Ⅱ期VAS评分、HSS评分优于同期单一组(P0.05);但两组Ⅳ期Lysholm评分,Ⅲ、Ⅳ期VAS评分及HSS评分比较,差异无统计学意义(P0.05)。结论关节镜下有限清理术是治疗KOA的较好选择;术后辅以系统康复训练可确实增强Ⅰ、Ⅱ期患者的临床疗效,但对于Ⅲ、Ⅳ期患者而言,疗效改善有限。     

皮质类固醇与骨坏死关系的临床研究

目的探讨严重急性呼吸综合征(SARS)患者骨坏死发生的时间、发生率与皮质激素用量的关系。方法对551例SARS患者进行骨坏死普查,男131例,女420例,年龄21~59岁,平均(33±9)岁。其中12例未用激素,539例应用剂量不等的皮质激素(80~30000mg)。从停药至普查的时间为3~9个月。全部患者行双髋、双膝、双踝、双肩及双腕MRI检查及X线摄片,部分患者做CT扫描。股骨头坏死按ARCO分期,膝关节坏死按Lotka分期,肩关节坏死按Gruess分期。采用独立检验、秩和检验、多因素逐步Logistic回归分析行统计学处理。结果12例未用激素者,未检出骨坏死。539例应用激素者检出骨坏死176例(32·7%),其中累及股骨头为130例210髋、累及膝关节98例130膝、累及肱骨头21例36肩、累及踝关节16例26踝(距骨,跟骨)、累及腕关节11例17腕(月骨,舟状骨)、髌骨3例4膝、髂骨1例1处、长骨干(股骨,胫骨)梗死18例。股骨头坏死除11例15髋为Ⅱ期外,其余均为Ⅰ期。ⅠA为45髋、ⅠB为77髋、ⅠC为73髋。膝及肩关节坏死均为Ⅰ期。单关节受累34例,双关节受累45例,多关节受累93例,单纯骨干梗死4例。激素用量:发生骨坏死组为(5842±4988)mg,未发生骨坏死组为(2719±2571)mg(P<0·0001);用药时间:发生骨坏死组为(39±17)d,未发生骨坏死组为(27±15)d(P<0·01);激素冲击用量:发生骨坏死组为(340±207)mg/d,未发生骨坏死组为(211±160)mg/d(P<0·01);激素冲击治疗时间:发生骨坏死组为(28±13)d,未发生骨坏死组为(18±11)d(P<0·01)。检出骨坏死的时间均在用药后6个月以内。结论应用剂量不等皮质激素的SARS患者约1/3发生骨坏死,骨坏死常为多灶性,发生时间早;MRI为早期诊断骨坏死的金标准,对大剂量激素应用者宜尽早用MRI监测。     

Hemophilic arthropathy of the upper limb

Little has been written about the effects of hemophilic arthropathy on the function and radiography of the upper limb. Therefore, 14 moderate and 19 severe hemophiliacs between the ages of 10 and 57 years were examined clinically and radiographically. The extent of the arthropathic changes in the shoulders, elbows, wrists, and hands were classified according to the system proposed by the World Federation of Hemophilia. The severity of the arthropathy increased with the age of the patient and with the number of hemarthroses recorded, although the correlation between these parameters was variable. The elbow joints were the site of recognizable arthropathy in 87% of the cases, with a slight preponderance for the nondominant side. The glenohumeral and wrist joints were affected in a small proportion of patients, although symptoms were rarely experienced. Hemorrhages affecting the hands were uncommon and produced arthropathy infrequently.     

四川省壤塘县120例藏族成人大骨节病患者手部影像学特点

背景：大骨节病（Kashin-Beckdisease,KBD）是一种原因不明、以关节软骨和骺板软骨变性坏死为基本病变的地方性骨关节病。既往研究发现,几乎所有成人KBD患者均存在手部关节异常,手部关节的影像学改变特点是区分KBD和其他骨关节疾病的重要参考因素。目的：研究四川省阿坝州壤塘县藏族成人KBD患者手部X线片特征。方法：四川省阿坝州壤塘县120例藏族成人KBD患者为KBD组,选取年龄性别匹配的120位正常人作为对照组,均行双手前后位x线片检查,研究其影像学特点,测量KBD组及对照组右手近节和中节指骨指数。结果：KBD组120例,男42例,女78例;年龄为20-80岁,平均63．6岁。双手前后位X线片检查示方形骨端108例,喇叭状干骺端112例,腕骨拥挤113例,桡骨远端增粗及变短92例,指间关节半脱位57例,108例患者表现为关节间隙变窄、软骨下骨硬化及关节边缘骨赘增生等骨关节炎改变。KBD组男性患者及正常男性中指近节指骨指数分别为4．04及4．16（P=0．021）,女性患者及正常女性分别为4．21及4．37（P=0．013）。结论：四川省阿坝州壤塘县藏族成人KBD患者手部X线片示方形骨端、喇叭状干骺端、腕骨拥挤、桡骨远端增粗变短、指间关节半脱位及骨关节炎改变。男、女患者近节指骨指数小于正常人群。     

Führt intensiver Langstreckenlauf zur Arthrose der Hüft- oder Kniegelenke?

BACKGROUND: The aim of the study was to find what degenerative changes were present in the hip and knee joints of former elite marathon runners and how these subjects' joints differ from those of control persons.METHODS: Twenty former elite German marathon runners (active careers 1972-86) underwent clinical (FFbH-OA [hip joint] and AKSS [knee joint]) and radiographic (hip and knee joints, Kellgren and Lawrence classification) examination. X-Rays of the hip joints were compared with those of controls matched for age, gender and BMI who did not engage in much sport.RESULTS: In the group of former elite marathon runners, 3 of the 38 knee joints for which comparison with control joints was possible were found to be affected by grade 2 osteoarthritis. In the same group, severe osteoarthritis (Kellgren and Lawrence grade 3) was documented in 1 and moderate osteoarthritis (grade 2) in 6 of the 28 hips for which direct comparison against the controls was possible, as against 1 hip affected by grade 2 osteoarthritis in the entire control group. The clinical evaluation showed high scores in all athletes.CONCLUSIONS: Osteoarthritis of the knee joint is rare in former elite marathon runners. The risk of osteoarthritis of the hip joint seems to be higher than in control subjects who do not engage in much sport.     

Trends in arthroplasty in Japan by a complete survey, 2014–2017

BackgroundPrecise knowledge of the prevalence and trends of arthroplasty can facilitate the design of medical plans for efficient treatments. The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data Japan provides statistics about the annual number of arthroplasties (knee, hip, shoulder, finger, elbow, and foot/ankle) through health insurance claim numbers for these surgeries. The purpose of this study was to document the annual arthroplasty numbers between 2014 and 2017 in Japan and to analyze their four-year trends, gender differences, age distributions, and regional differences as revealed by the complete survey.MethodsNumbers of arthroplasty surgeries were extracted from the NDB Open Data Japan for 2014–2017. For “knee”, “hip”, “shoulder”, “finger”, “elbow”, and “foot/ankle” arthroplasties, we showed the annual arthroplasty numbers, annual arthroplasty numbers by age group, annual arthroplasty numbers in individual prefectures, and annual arthroplasty numbers per 100,000 population in individual prefectures.ResultsThe annual arthroplasty numbers in 2017 were 146,189 for all joints, 82,304 for knees, 59,029 for hips, 2454 for shoulders, 1551 for fingers, 536 for elbows, and 291 for feet/ankles. For the four years up to 2017, the rate of alteration in the number of arthroplasties was +14% for total arthroplasties, +9% for knees, +21% for hip joints, +97% for shoulders, + 8% for fingers, −10% for elbows, and +25% for feet/ankles. The proportion of females was 70–90% and the peak age was between the late 60s and late 70s for all joints. Variations in arthroplasty numbers per population by prefecture appeared to be small for knees and hips and large for other joints.ConclusionsWe revealed the annual total number of arthroplasties for each joint in Japan using the NDB Open Data Japan for the first time.     

Concordance between clinical and ultrasound findings in rheumatoid arthritis

BackgroundClinical joint examination is less time-consuming than ultrasound in rheumatoid arthritis. Knowledge of clinical and ultrasound concordance of joints groups could help in selecting joints for a best ultrasonographic assessment.ObjectiveTo evaluate concordance between clinical examination and ultrasound of joints in a heterogeneous group of patients with rheumatoid arthritis.MethodForty patients were included in a prospective, transversal, single-center study, whatever disease activity, duration or treatment. In each patient, 40 joints were evaluated for a total of 1600 joints. Synovitis was scored using clinical examination, B-mode, power Doppler and both B-mode and power Doppler. Concordance between swelling joint by clinical examination, synovitis thickening by B-mode (grade 1 or higher) and inflammation by power Doppler (grade 1 or higher) was assessed by computing the kappa coefficient.ResultsClinical joint examination and ultrasound concordance was very low at the shoulders and metatarsophalangeal joints (κ < 0.1) and was low at wrists (κ: 0.23 to 0.30). B-mode and power Doppler found 2.4 and 1.4 more synovitis than swollen joint count using clinical examination and up to 30 times more at metatarsophalangeal joints. Concordance was strong at tibio-talar joints (κ: 0.65 to 0.82) and moderate at others joints sites (κ: 0.4 to 0.6).ConclusionAssessment of a heterogeneous group showed that ultrasound adds information to clinical examination, most notably at the shoulders, wrists and metatarsophalangeal joints. Concordance was moderate to strong at other joint sites.     

Kashin Beck Disease: more than just osteoarthrosis

The purpose of this study was to investigate the influence of body function, activities and pain on the level of activity in adults with Kashin Beck Disease (KBD). Seventy-five KBD patients with a mean age of 54.8 years (SD 11.3) participated. Anthropometrics, range of joint motion (ROM) and muscle strength were measured as well as the time-up-and-go test and functional tests for the lower and upper extremities. Activity was assessed with the participation scale and the WHO DAS II. In the shoulder, elbow, hip and knee joints, a severe decrease in ROM and bilateral pain was noted. A decrease in muscle strength was observed in almost all muscles. The timed-up-and-go test scores decreased. No or mild restriction in activity was found in 35%, and 33% experienced a moderate restriction whereas 32% had severe to extreme restriction. Activities in the lower extremities were mildly to moderately correlated to ROM and muscle strength, whereas in the upper extremities activities were correlated to range of joint motion. Activity was significantly associated with ROM after correction for muscle strength, gender and age. Participation was borderline significantly associated with ROM after correction for muscle strength, gender, age and the activity time-up-and-go. In KBD adults, a severe decrease in activity is primarily caused by decrease in ROM. These findings have strong influence on rehabilitation and surgical intervention.     

Atraumatic osteonecrosis of the adult elbow

Osteonecrosis is a disease that leads to joint destruction and often involves large joints, such as the hips, knees, and shoulders. Nontraumatic osteonecrosis of the adult elbow, to the best of the authors' knowledge, has not been reported. Nine adult patients with atraumatic osteonecrosis of 11 elbows were identified. The mean age at presentation was 36 years (range, 26-63 years); five patients were women and four were men. Six elbows involved the capitellum, three involved the lateral epicondyles, one involved the trochlea and radial head, and one involved medial and lateral epicondylar disease. All patients were receiving corticosteroid therapy, and no relationship between the duration or the amount of corticosteroid use and the severity of the osteonecrosis was found. Seven patients with radiographic Stage I and Stage II disease responded well to nonoperative treatments consisting of activity modification, analgesics, and a brief period of immobilization. Nonoperative treatment failed in two patients with Stage III disease, and they had core decompressions for pain relief. One patient with late Stage III disease in both elbows underwent bilateral total elbow arthroplasties. In contrast to the pediatric population, osteonecrosis of the adult elbow potentially can lead to end stage arthritis. If the osteonecrosis is diagnosed early, nonoperative treatment may be effective in relieving pain, although the long-term results of these treatments remain unknown.