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、     

肩关节镜诊疗痛风性肩关节炎一例报道

痛风性关节炎是由于尿酸盐沉积在关节囊、滑囊、软骨、骨质和其他组织中而引起病损及炎性反应,以肩关节病变为首发症状的痛风性关节炎极为少见,既往未见采用肩关节镜诊治痛风性肩关节炎的病例报道。总结对本例痛风性肩关节炎的治疗体会,本研究组认为血尿酸阴性的肩关节病变不能排除痛风性肩关节炎的可能,肩关节镜是诊治痛风性肩关节炎的可靠技术。     

痛风性膝关节炎伴大量关节滑膜尿酸盐结晶1例报告

<正>痛风是嘌呤代谢紊乱和(或)血液尿酸浓度持续性增高引起的一组疾病症候群,临床特点为高尿酸血症及由此引起的关节旁或关节内痛风石沉积、痛风性关节炎反复急性发作和关节畸形,常并发肾脏慢性损害和肾结石形成。近年来,由于人民生活水平不断提高、饮食结构改变及对疾病认识的不断深入,本病在我国有逐年增多趋势。我院最近收治1例罕见的痛风性膝关节炎伴大量关节滑膜尿酸盐结晶病例,现报告如下。     

关节镜对痛风性膝关节炎诊治临床分析

目的探讨关节镜对痛风性膝关节炎的诊治价值。方法对19例痛风性膝关节炎患者进行关节镜检查并取滑膜病理送检,同时行关节腔内尿酸盐结晶及痛风石清理,大量生理盐水关节冲洗。术后常规服用治疗痛风的药物及功能锻炼,观察手术疗效。结果 5例术前诊断不明确者术后确诊为痛风性膝关节炎,14例术前初步诊断为痛风性膝关节炎患者术中确诊。术后切口均甲级愈合。随访6~15个月,术后膝关节疼痛VAS平均得分明显低于术前;手术后膝关节功能Lysholm平均得分显著高于术前。手术前后比较,差异均有统计学意义(P<0.05)。结论关节镜对痛风性膝关节炎可作出明确诊断,可明显缓解疼痛及改善膝关节功能障碍,具有临床诊治价值。     

关节镜有限清理术等综合性措施治疗痛风性关节炎

目的探讨膝关节痛风性关节炎综合治疗中关节镜的作用和疗效。方法自2000年2月至2009年2月,对45例反复急性发作的膝关节痛风性关节炎患者进行关节镜诊治,利用刮匙除去紧密附着在负重面关节软骨上的尿酸盐结晶,对充血、增生的滑膜及其附着的尿酸盐结晶不予特殊处理;修整剥脱的关节软骨及受侵蚀的半月板;用大量冲洗液冲洗关节腔,最后关节腔内注射复方倍他米松注射液（得宝松）及罗哌卡因等复合药物。术后抗炎镇痛,合理饮食调节及降尿酸治疗。结果 45例患者术后病情均得到不同程度的缓解,28例患者随访期内未发生痛风急性发作。17例患者有2～3次的急性发作,与饮食控制不良和未坚持降尿酸治疗或患有高三酰甘油血症、肥胖等代谢性疾病有关。结论关节镜下手术治疗膝关节痛风性关节炎是一种起效快、微创、效果显著的方法,关节内对软骨、滑膜尽量少的干预及复合镇痛药物的应用,有效地缓解了疼痛。但关节镜微创治疗仅是综合治疗的一部分,尚需要合理饮食调节、降酸等配合治疗。     

痛风的中医疗法浅析

痛风是由于嘌呤代谢紊乱,血尿酸增高,导致尿酸结晶沉积在关节及皮下组织而致的一种疾病.临床上以高尿酸血症、特征性急性关节炎反复发作、痛风结石形成为特点,严重者可致关节畸形及功能障碍、急性梗阻性肾病或痛风性肾病.中医药治疗本病取得了可喜进展,具有一定优势.     

急性痛风性膝关节炎关节镜的诊治体会

目的:探讨关节镜诊断与治疗急性痛风性膝关节炎的应用价值。方法:2011年10月至2013年10月应用关节镜微创技术为16例(17个膝关节)急性膝关节痛风性关节炎患者行滑膜刨削切除、半月板及关节软骨表面尿酸盐结晶体刮除,关节冲洗,合并的半月板、关节软骨等关节内结构损伤一并处理。术后常规服用降血尿酸药物、早期功能锻炼。对比患者术前、术后膝关节Lysholm评分。结果:患者术后关节肿痛及功能受限等临床症状均明显缓解或消失,随访6~36个月,效果满意。膝关节Lysholm功能评分平均(90.2±3.2)分。结论:关节镜下关节清理及滑膜切除术是治疗痛风性关节炎见效快、创伤小、效果确切的新型微创治疗方法。膝关节镜技术对急性痛风性膝关节炎的诊断与治疗具有确实可靠的临床效果与应用价值。     

髋关节滑膜软骨瘤病患者1863枚软骨游离体一例报告

髋关节滑膜软骨瘤病患者１８６３枚软骨游离体一例报告史明起，党晓谦，王坤正患者男性，１２岁。汉族，学生。１９９４年６月７日以右股前部疼痛伴右髋关节活动受限中年之主诉收住院。５年前因患髋关节化脓性关节炎在当地医院行右髋关节切开引流术，术后抗感染及关节冲洗...     

关节镜治疗肩关节滑膜软骨瘤病的临床疗效观察

背景:随着微创技术的发展,关节镜技术已成为治疗肩关节滑膜软骨瘤病的首选方法。目的:探讨关节镜手术治疗肩关节滑膜软骨瘤病的疗效。方法:2005年7月至2011年12月共收治肩关节滑膜软骨瘤患者10例,男7例,女3例;年龄25～75岁,平均45.6岁;均为单侧受累,左肩4例,右肩6例;病程6～36个月,平均15.4个月;其中4例并发退行性骨关节炎;主要临床症状为肩关节活动后疼痛、绞索及关节肿胀,均伴有明显的活动受限。所有患者均采用关节镜手术治疗,包括关节镜探查、切除病变滑膜、取出游离体和清理退行性病变。结果:术后疼痛、绞索及关节肿胀症状消失,关节功能恢复良好,关节活动度得到明显改善。全部获得随访,随访时间为6～24个月,平均12个月。1例效果不满意,其余均效果良好,无复发。结论:关节镜手术治疗肩关节滑膜软骨瘤病具有手术创伤小、患者术后恢复快、病变滑膜切除彻底等优点,疗效良好。     

滑膜软骨瘤病26例临床病理特点分析

目的：自１９７０年６月～１９９５年５月我科共收治滑膜软骨瘤病２６例，均经手术及病理证实。作者对该病的诊断依据及标准，从临床、Ｘ线表现及病理改变特点进行探讨。资料与方法：２６例中，膝关节１８例，其中双膝关节发病１例，肘关节４例，髋关节３例，肩关节１例，临床表现为不同程度的关节疼痛，功能受限及肌肉萎缩。因有的游离体未钙化或骨化，Ｘ线显示关节内游离体数目有时少于关节内游离体的实际数目。手术摘除游离体，切除病变滑膜，可收到满意疗效。关节镜手术创伤小，视野好，恢复快。游离体病理改变为肉眼下大块游离体有包膜，易裂解为许多小块。镜下软骨瘤体为分化较好的软骨小结节堆砌而成，其间有纤维组织分隔，软骨结节可钙化，游离体边缘有时可见滑膜细胞。结果：随访１６例，平均４年５个月，１２例功能恢复良好，２例无变化，２例术后功能稍差，劳累后仍疼痛。讨论：作者认为，临床、Ｘ线及病理相结合，主要依靠病理进行诊断比根据游离体数目多少诊断更为合理。Ｍｉｌｇｒａｍ根据病理将本病分为三个阶段有重要意义，特别对Ⅰ、Ⅲ期病例的诊断有临床价值。     

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.     

Diagnosis and Arthroscopic Treatment of Primary Synovial Chondromatosis of the Shoulder

Primary synovial chondromatosis of the shoulder is a rare condition. We present the case of a 24-year-old man with a 6-month history of right shoulder pain and decreased range of motion. Computed tomography and magnetic resonance imaging findings led us to the diagnosis of synovial chondromatosis of the shoulder. Arthroscopy revealed loose bodies in the glenohumeral joint, the biceps tendon sheath, and the subscapularis recess. Active intrasynovial proliferation of the axillary pouch was noted. All loose bodies were removed arthroscopically, and partial synovectomy was performed. Histologic examination confirmed the diagnosis of primary synovial chondromatosis. We recommend arthroscopic treatment for synovial chondromatosis of the shoulder because of low morbidity and early functional return.     

滑膜软骨瘤病13例临床分析

目的 探讨滑膜软骨瘤病外科诊断和治疗经验。方法 对１９８６－１９９７年期间经治的１３骨膜罗骨瘤病的诊断、治疗及其病理进行总结、分析。结果 滑膜软骨瘤病临床多表现为间歇性关节疼痛、肿长、功能受限,活动时关节有弹响声或磨擦感,少数有关节交锁有的可及活动性人;Ｘ线片显示关节内游离体数目往往秒于关节内游离体的实际数目;术中肉眼可见病变滑膜充血、增厚、表面粗糙;镜下风 管增生、淋巴细胞聚集、滑膜囊层细胞及纤     

Tophaceous gout in the bipartite patella with intra-osseous and intra-articular lesions: a case report

We report a case of a 34-year-old man who had an acute gouty attack with tophi around the accessory bone of the bipartite patella with intra-osseous lesions. As the symptoms did not respond to conservative treatments, the patient was treated surgically. Arthroscopy revealed urate crystals surrounded by inflammatory synovitis on the surface of the bipartite patella. Arthrotomy exposed the abundant crystals around the accessory bone and in the intra-osseous lesion. These findings made us speculate that some pre-existing inflammatory conditions around the accessory bone induced deposition of urate crystals, and the destruction of the barrier between the deposits and the joint led to an acute arthritis. Curettage of the tophi resulted in immediate improvement of knee function. There had been no recurrence of symptoms at the 2-year follow-up.     

Synovial chondromatosis of the shoulder: open synovectomy and insertion of osteoarticular allogaft with internal fixation to repair intraoperative glenohumeral joint instability

Synovial chondromatosis is a rare benign disorder characterized by chondroid metaplasia with multinodular proliferation of the synovial lining of a diarthroidal joint, bursa, or tendon sheath. These cartilaginous nodules may become embedded within the proliferating synovium and may extend into the surrounding soft tissues. They also can detach from the synovium, where they can calcify and may present as intra-articular loose bodies. Presence of these nodules leads to joint pain, dysfunction, and ultimately, destruction. Clinically, patients often present with a chronic monoarthropathy. In this article, we report a case of extensive synovial chondromatosis of the right shoulder and surrounding soft tissues with extensive erosion of the humeral head, discuss combined anterior and posterior surgical excision of the cartilaginous fragments, and describe insertion of an osteoarticular allograft to repair the humeral head defect and secondary anterior glenohumeral joint instability.     

Arthroscopic Retrieval of over 100 Loose Bodies in Shoulder Synovial Chondromatosis: A Case Report and Review of Literature

Synovial chondromatosis is a rare and benign condition of unknown cause. It is also known as synovial osteochondromatosis. It is characterized by involvement of the synovial tissue, which lines various joints of our body. Initial symptoms range from pain in the joint, locking of the joint at times, especially the knee, to arthritis of the joint that is a late feature of this condition. Although large joints such as the knee are commonly affected, involvement of the shoulder joint is a rare occurrence. Historically an open arthrotomy was preferred for removal of loose bodies coupled with a thorough synovectomy. However, arthroscopy for loose body retrieval has gained popularity over the past two decades. Arthroscopic surgery is an extremely skilled procedure and there is a learning curve for operating in certain anatomical areas such as the shoulder. However, not only does an arthroscopy provide the surgeon with an excellent view of the shoulder but the patient also has a faster recovery. We report a rare case of shoulder synovial chondromatosis in which more than 100 loose bodies were successfully retrieved by an arthroscopy in an individual who had an excellent outcome post‐surgery, reaffirming our faith in the procedure. A detailed literature review of arthroscopic procedures is also presented.     

Vorgehen bei Gelenkerguss

The fundamental components of the differential diagnostics of joint effusions are the patient history and clinical examination. In the case of unclear findings, arthrosonography can provide information for the distinction between intra-articular and extra-articular pathologies. In atraumatic joint effusions inflammatory parameters in blood are determined in order to differentiate between systemic inflammatory and local inflammatory joint effusions. In the case of normal values further diagnostics are carried out using imaging. With elevated inflammatory parameters the main differential diagnoses are gouty arthritis, autoimmune joint processes and septic arthritis. When in doubt, a joint aspiration and synovial fluid analysis should be performed to rule out septic arthritis or if necessary confirmation of gouty arthritis.     

Primary synovial osteochondromatosis of a subdeltoid bursa

Primary synovial osteochondromatosis (SOC) is known to be intra-articular and wherever it is observed outside a synovial joint, it is associated with the involvement of the nearby joint. Primary SOC has not been reported to involve a subdeltoid bursa. We present a case of a 52-year-old woman having a large number of loose bodies in a large tumor in the subdeltoid bursa. The swelling was first noticed by the patient 2 years back. Plain roentgenogram revealed soft tissue swelling only with no areas of calcification. On MRI, multiple nonosseous loose bodies were visualized in the bursa deep to the deltoid muscle. A surgical excision of subdeltoid bursa was done. A biopsy confirmed it to be cartilaginous loose bodies in synovial lining sugestive of metaplastic transformation of the synovial tissue.     

Rheumatologic aspects of painful conditions affecting the shoulder

Patients with shoulder arthritis present to the orthopedic surgeon due to joint pain and loss of shoulder motion. A differential diagnosis is established, based on the history and physical examination and selected laboratory tests and roentgenograms. Synovial fluid analysis is often very helpful in the diagnosis of shoulder arthritis and critical for differential diagnosis of inflammatory, degenerative, and septic arthritis. Shoulder involvement in primary osteoarthritis is uncommon. The shoulder is rarely the initial joint involved in rheumatoid arthritis. Several uncommon conditions, e.g., amyloid arthropathy and reflex sympathetic dystrophy syndrome, may present early and frequently in the form of shoulder pain. The results of treatment are determined by etiology of shoulder joint disease. Patients with shoulder involvement in rheumatoid arthritis generally respond to the basic management for rheumatoid arthritis. Physical therapy to improve the range of motion of the shoulder and anti-inflammatory medications, including intra-articular corticosteroids, are helpful in most cases.     

关节镜下诊断与治疗膝关节滑膜软骨瘤病

目的 报道膝关节滑膜软骨瘤病１５例,均用关节镜诊断及治疗,所有病例均经病理检查证实。作者对关节镜在术本病诊断中的优点,分型及治疗方法进行探讨,方法 所有１５例病例均为膝关节病变,左膝关节６例,右膝关节７例,双侧膝关节２例。主要临床症状为关节疼痛,交锁及反复肿胀,关节镜术野好,可全面检查关节腔,具有放大作用,可提高本病的诊断率并有助于分型,关节镜下可将本病分为三型,表浅型,深在型和游离体型,治疗采用