超声早期诊断无症状高尿酸血症患者关节病变

目的探讨高频超声对早期诊断无症状高尿酸血症患者关节病变的价值。方法采用高频超声随机检查75例无症状高尿酸血症患者(无症状组)和100名健康体检者(对照组)的双侧第一跖趾关节、踝关节、膝关节(共1050个关节)。声像图中出现以下征象之一为超声检查阳性:滑膜增厚、关节腔积液、晶体沉积、痛风石、骨侵蚀、滑膜内出现血流信号。结果无症状组关节病变的超声检出率为16.00%(12/75),远高于对照组(0)。无症状组有14个病变关节(14/450),均位于第一跖趾关节。病变关节的超声表现:滑膜增厚8个,关节腔积液3个,晶体沉积5个,骨侵蚀6个;20~60岁不同年龄段无症状高酸尿血症患者均可能出现关节病变。结论无症状高尿酸血症患者可能已出现关节病变。高频超声能早期诊断无症状高尿酸血症患者关节病变,可作为常规影像学筛查手段,应以第一跖趾关节作为检查的重点。     

超声早期诊断类风湿关节炎

类风湿关节炎是一种以慢性破坏性关节病变为特征的自身免疫性疾病,临床、实验室检查与放射学检查对早期诊断的作用有限。高频灰阶超声软组织分辨力较高,能够区分渗出性和增殖性滑膜病变;能量多普勒超声有助于区分活动性和非活动性关节病变;CEUS可提高检出滑膜增厚、滑膜血管增生等病变的敏感性。超声检出骨侵蚀的能力优于放射学检查,还可随访和监测治疗效果。     

膝关节骨性关节炎的手法治疗

膝关节骨性关节炎是多发于中老年人的慢性进行性疾病,以膝关节疼痛、活动受限、弹响、畸形,有时伴有关节肿胀积液为主要表现,病理上可出现软骨退变、磨损、丧失、软骨下骨硬化、囊性变、关节边缘骨赘及滑膜不同程度的炎症,是膝关节疼痛的主要原因.     

痛风性肩关节炎伴痛风石误诊一例并文献复习

痛风性关节炎是由于尿酸结晶沉积于关节腔或关节周围组织引起的炎症反应,累及肩关节少见。本文报告1例患者,男,49岁,主诉右肩疼痛9个月,加重伴活动受限2周。右肩外旋10°,背手达S5水平,MRI示右肩积液及关节内游离体。以右肩关节游离体、滑膜软骨瘤病可能收入院。关节镜探查见大量尿酸结晶沉积于滑膜、软骨及肩袖组织,行游离体取出及关节清理术。术后病理学检查提示滑膜炎性增生伴尿酸结晶沉积。通过文献回顾分析痛风性肩关节炎的临床特点、诊断及治疗方法。痛风性肩关节炎的临床表现主要为肩关节疼痛及活动受限。含钙盐沉积的痛风结石可以在X线和CT上显影;MRI可显示痛风结石,并能够评估关节内其他病变。痛风性肩关节炎临床表现不典型,影像学上无特异性征象,病理诊断是"金标准"。肩关节镜手术既能明确疾病诊断,又能完成治疗,是痛风性肩关节炎可靠的诊疗方法。     

手指骨密度变化在类风湿关节炎早期诊断及预后中的作用研究进展

类风湿关节炎（RA）是一种病因不明的自身免疫性疾病，多见于中年女性，我国患病率约为0．32％～0．36％；主要表现为对称性、慢性、进行性多关节炎，是一种慢性多关节的全身破坏性疾病；受累关节以近端指间关节、掌指关节、腕、肘、肩、膝和足趾关节最为多见；主要表现为关节滑膜的慢性炎症、增生，形成血管翳，侵犯关节软骨、软骨下骨、韧带和肌腱等，造成关节软骨、骨和关节囊破坏，最终导致关节畸形和功能丧失；早期诊断和治疗可以减少并发症出现，改善患者的生存质量。     

奇正青鹏膏治疗急性痛风关节炎的临床观察

急性痛风关节炎为尿酸盐结晶沉积于关节软骨、滑膜及关节周围组织而导致的急性炎症反应,临床表现为关节及其周围组织红、肿、热、痛,疼痛剧烈难忍。因此,尽快消除关节疼痛、肿胀是治疗急性痛风关节炎的主要目的。目前治疗急性痛风关节炎的药物包括秋水仙碱、非甾体抗炎镇痛药、     

滑膜巨噬细胞在骨性关节炎发病机制中的作用及其潜在性应用研究进展

骨性关节炎是一种全世界范围内发病率高的慢性退行性疾病,其病理特征为关节软骨退化和软骨下骨结构改变并伴有滑膜炎症和骨赘形成.虽然该病的研究取得了一些进展成果,但其确切的病因及发病机制仍不完全清楚.滑膜巨噬细胞作为关节滑膜中重要的炎症细胞,其不同的极化状态在骨性关节炎的发病中起着重要作用.巨噬细胞受其所处不同微环境的刺激时...     

富血小板血浆治疗膝关节骨性关节炎的现状

正骨性关节炎是一种慢性肌肉、骨骼退行性疾病,伴有关节肿胀、疼痛和僵硬等症状。膝关节骨性关节炎是临床最常见的骨性关节炎,涉及整个关节结构,包括关节软骨、滑膜、韧带、软骨下骨和关节周围的肌肉[1]。膝关节退行性改变、损伤、关节内应力失衡等原因导致关节软骨进行性破坏,其本质为关节软骨基质分解代谢与合成代谢失衡,这些可能与年龄、肥胖、关节创伤、绝经后女性、关节畸形和某些遗传特征等因素相关。因此,促进膝关节软骨受损组织的修复、延缓骨性关节炎的发展是减轻患者疼痛、改善功能状况的重要途径。     

颈椎类风湿关节炎的诊疗进展

类风湿关节炎（rheumatoid arthritis,RA）是一种以滑膜关节病变为主要表现的慢性自身免疫性疾病,构成关节的各种组织,如滑膜、软骨、韧带、肌腱以及骨骼均可受累。手足病变最为常见,多表现为对称性多关节炎;颈椎亦常受累,表现为各种颈椎不稳,可导致延髓、脊髓或神经根受压而表现相应的神经功能障碍。颈椎RA患者常合并周围关节的畸形、僵直或活动受限,体格检查不能准确评估神经功能状态,患者一旦出现明显的神经症状,颈椎不稳已进展较为严重。因此,应加深对颈椎RA的认识,有助于疾病的及时诊治。本文将就颈椎RA的诊断和手术治疗进展作一综述。     

骨关节炎

骨关节炎（osteoarthritis，OA）是一种最常见的关节病变，以中老年居多。1994年美国骨关节炎研讨会上，对骨关节炎作了较为简明的定义：骨关节炎是一组有不同病因但有相似的生物学、形态学和临床表现的疾病。该病不仅发生关节软骨损害，还累及整个关节．包括软骨下骨、韧带、关节囊、滑膜和关节月围肌肉，最终发生关节软骨退变，纤维化，断裂，溃疡及整个关节面的损害。骨性关节炎是一种退行性疾病，一般认为是由于衰老、创伤、炎症、肥胖、代谢障碍和遗传因素引起。主要为缓慢进展的关节疼痛、触痛、僵硬、肿大、活动时有骨擦音、关节积液以及活动障碍。骨关节炎的名称极多，如肥大性骨关节炎、退行性关节炎、     

Ultrasonography for diagnosing atypical gout. Two case reports

Gout is characterized by the deposition of monosodium urate crystals on the surface of the articular cartilage, within periarticular tissues, and within bone and skin. The diagnosis rests on identification of the crystals in joint fluid or a tophus. However, joint aspiration is not always feasible, and the presentation may be atypical. We describe two cases of chronic gouty arthritis misdiagnosed as psoriatic arthritis. Ultrasonography of the bone and joints disclosed two patterns recently described as highly suggestive of gout, namely, the double-contour appearance of the cartilage and the snowstorm appearance of the synovial membrane. In addition, ultrasonography was useful for guided aspiration of joint fluid or other material containing monosodium urate crystals. Thus, ultrasonography may contribute to improve the diagnosis and treatment of gout.     

痛风性膝关节炎的关节镜诊断和治疗

目的探讨关节镜对痛风性膝关节炎的诊断价值和近期疗效。方法对22例痛风性膝关节炎患者作膝关节镜检查观察其镜下表现,多点取病变组织做病理检查,将水肿增厚的滑膜和尿酸盐结晶尽可能清除,彻底冲洗。术后观察手术疗效,常规服用治疗痛风的药物。结果术前9例误诊为其他关节炎者术中确诊为痛风性关节炎,13例术前拟诊痛风性关节炎术中得到进一步的证实。22例均获随访,时间3～24个月,膝关节肿胀、疼痛明显减轻,功能改善明显,HHS评分由术前10～58（43±8.3）分到末次随访时提高到80～98（90±4.6）分,疗效评定：优9例,良13例。结论关节镜手术能较直观诊断痛风性关节炎,近期疗效满意。     

Ultrasonography of the hip, knee and ankle

Hip ultrasonography (US), besides visualization of anatomic structures, provides precise puncture and aspiration of the joint content. The most often US findings in inflammatory rheumatic diseases are intra-articular effusion (pathologic finding>2 mm), hypertrophy ofsynovial membrane, cartilage damage and bone erosions. US characteristics ofosteoarthritis (OA) are small amount of effusion, lost of cartilage, osteophytes on the articular edges and possible mild hypertrophy of synovial membrane. Recently, US has been used in diagnostics of many knee disorders, including lesions of articular cartilage, tendons, ligaments, menisci, synovial joint and surrounding blood vessels and muscles. US could be used for measuring thickness of hyaline cartilage and for assessment of its integrity at the area of femoral condyles and intercondylar notch, but only if patients are enable to bend their knees. Numerous arthropathies that affect the knee could be evaluated by US too, so it is possible to document the presence of effusion, hypertrophy ofsynovial membrane, formation ofpannus, popliteal cysts, loose bodies, cartilage thinness and synovial plica. New technologic development of US diagnostics provides high-quality presentation of some smaller structures like ankle joint, calcaneal insertion of Achilles tendon and surrounding soft tissues. The most important achievement is demonstration ofpathologic changes of Achilles tendon within inflammatory and degenerative diseases.     

下肢静脉超声检出肌肉骨骼系统病变的临床价值

目的探讨下肢静脉超声检出肌肉骨骼系统病变的临床价值。方法回顾性收集因临床疑诊或需除外下肢深静脉血栓接受下肢静脉超声检查的8 288例患者的资料,分析下肢静脉超声检查对于肌肉骨骼系统病变的检出率及合并深静脉血栓等超声表现。结果下肢静脉超声检出肌肉骨骼系统病变134例,以腘窝囊肿(90/134,67.16%)最常见,其后依次为血肿(31/134,23.13%)、肌肉撕裂(5/134,3.73%)、脓肿(2/134,1.49%)、肿瘤(2/134,1.49%)、肌层囊肿(2/134,1.49%)、腘窝术后积液(1/134,0.75%)及膝关节滑膜增生(1/134,0.75%)。不同肌肉骨骼系统病变超声表现各异。腘窝未破裂囊肿最大径大于破裂囊肿(F=5.266,P=0.024)。134例中20例合并下肢深静脉血栓,其中肌肉撕裂患者最易合并血栓(1/5,20.00%)。结论下肢静脉超声检查可在判别有无深静脉血栓的同时检出肌肉骨骼系统病变,有助于修正或补充临床诊断及治疗方案,具有较高临床价值。     

Ultrasonography in hip disease in children

Intra-articular synovial effusion was visualized in different juvenile hip diseases by ultrasonography; 166 hips from 149 children were examined. Joint aspiration of 97 hips confirmed that ultrasonography was more sensitive than conventional radiography in diagnosing effusion. The magnitude of the ultrasonic joint space correlated well with the clinical severity of the disease, the volume of synovial fluid, and the intra-articular pressure. Considerable widening of the ultrasonic joint space was seen in transient synovitis, septic arthritis, reactive arthritis and arthritis with urticaria; moderate widening was seen in some patients with Perthes disease, and symmetrical joint space in patients with nonspecific arthralgia. We conclude that ultrasonography is valuable in the diagnosis and follow-up of synovial effusion of the hip in children.     

高频超声在膝关节骨关节炎早期诊断中的临床应用

目的探讨高频超声在膝关节骨关节炎（OA）早期诊断中的临床应用价值。方法收集2008年至2011年在本组临床诊断为早期OA的38例76个膝关节,对其超声检查及x线检查结果进行回顾性分析。结果早期OA患者中,软骨改变为超声检查中显示率最高的声像特点,超声能较清晰、准确显示软骨内部回声改变、软骨厚度变化及半月板变性。同时行超声检查和X线检查的38例患者中,超声检查检出病变35例患者（92．1％）,76个膝关节中有70个（92．1％）检出病变;X线检查检出病变12例（31．5％）,21个膝关节（27．6％）检出病变。两者间病例检出率有统计学差异（x^2=22．0,P〈0．05）,以超声较高（92．1％vs34．3％）;超声关节病变检出率比X线检查高（90．7％w27．6％）,差别有统计学意义（x^2=45．3,P〈0．05）。结论早期OA患者有特征性的超声声像改变,高频超声上在膝关节早期OA的诊断中具有重要的临床价值。     

Ultrasonography in hip disease in children

Intra-articular synovial effusion was visualized in different juvenile hip diseases by ultrasonography; 166 hips from 149 children were examined. Joint aspiration of 97 hips confirmed that ultrasonography was more sensitive than conventional radiography in diagnosing effusion. The magnitude of the ultrasonic joint space correlated well with the clinical severity of the disease, the volume of synovial fluid, and the intra-articular pressure. Considerable widening of the ultrasonic joint space was seen in transient synovitis, septic arthritis, reactive arthritis and arthritis with urticaria; moderate widening was seen in some patients with Perthes disease, and symmetrical joint space in patients with nonspecific arthralgia. We conclude that ultrasonography is valuable in the diagnosis and follow-up of synovial effusion of the hip in children.     

Diagnostic ultrasound of the small joints of the hands and feet: current status and role of ultrasound in early arthritis

The small joints of the hands and feet play a central role in the diagnosis and classification of arthropathy. Ultrasound can be used to assess involvement in areas that are clinically occult. The aim of this article was to review the current status of ultrasound imaging of patients with rheumatological disorders of the hands and feet. There is increasing evidence that ultrasound detects synovitis that is silent to clinical examination. Detection and classification of synovitis and the early detection of bone erosions are important in clinical decision making. Ultrasound has many advantages over other imaging techniques with which it is compared, particularly magnetic resonance. The ability to carry out a rapid assessment of many widely spacedjoints, coupled with clinical correlation, the ability to move and stress musculoskeletal structures and the use of ultrasound to guide therapy accurately are principal amongst these. The use of colour flow Doppler studies provides a measure of neovascularisation within the synovial lining of joints and tendons, and within tendons themselves, that is not available with other imaging techniques. Disadvantages compared to MRI include small field of view, poor image presentation, and difficulty in demonstrating cartilage and deep joints in their entirety.