右膝关节囊内腱鞘巨细胞瘤一例

女,30岁,因右膝疼痛1年,加重5d入院.活动时疼痛加重,无夜间痛,无膝关节外伤史.查体:右膝髌韧带内下方可触及一肿物,局部无红肿、发热,质韧,大小约3cm×3cm×4cm,活动半径为1cm,轻压痛,浮髌试验(-),内侧挤压试验(+),McMurray 症(-),抽屉试验(-),膝关节活动度尚可,血常规检查无异常.     

左股骨下段软骨黏液样纤维瘤误诊为软骨肉瘤1例

1 病例资料 患者,女,77岁,因"发现左大腿下段包块3年余"于2010年4月16日入院.患者于16年前因左大腿一包块于我院行手术切除,术后恢复良好.近3年来左大腿再次出现包块,持续性疼痛,包块生长迅速.查体:左大腿中下段前内侧触及一约6cm×16 cm×18cm包块,局部皮肤青紫,边界不清,质地较硬,按压感疼痛.左膝关节屈伸活动未见异常,患肢末梢血运正常.     

Glubran 2胶栓塞治疗下肢高流速动静脉畸形1例

患者男,21岁,主因＂左大腿内侧搏动性肿物6个月、近期活动后疼痛＂入院。查体：左大腿内侧远段可触及6 cm×5 cm搏动性肿物,质软,轻压痛,局部皮温增高,可闻及轻度吹风样杂音。     

髌韧带下腱鞘巨细胞瘤1例报告

临床资料　患者女性 ,45岁。因左膝酸痛 ,屈膝受限 1年余 ,近半月加重入院。 1年前左膝内下方可及一肿物 ,随膝关节屈伸上下移动 ,活动时弹响 ,且有间歇性的“交锁”现象。无夜间痛、无膝关节外伤史。半月前左膝关节疼痛、肿胀积液。曾在外院诊断为“滑膜炎” ,行穿刺抽液、口服消炎痛无效后入院。查体 :左膝前下方肿胀 ,股四头肌无萎缩 ,无静脉怒张 ,局部皮温稍高 ,膝内侧间隙压痛。髌韧带内下方可触及一肿物 ,质韧 ,约 2cm× 3cm× 4cm ,活动半径为 1cm ,轻触痛。浮髌试验 ( + ) ,内侧挤压试验 ( + ) ,McMurray症 ( -) ,抽屉试验( -) ,膝…     

膝关节镜下前交叉韧带重建术后药物热一例

正1病例介绍患者男,34岁。因外伤致左膝关节疼痛伴活动障碍半月余于2016年7月入院。入院检查:体温36.5℃,左膝关节轻度肿胀,无畸形,髌骨内侧和外侧关节间隙后方压痛,浮髌试验(–),前、后抽屉试验(+),Mc Murray试验(+),轴移试验(–),Lachman试验(+),膝关节伸屈活动时无弹响,活动无明显受限。术前血常规、生化等实验室检查以及心电图、胸部X线片均未见明显异常,谷丙转氨酶126 U/L。入院诊断:左膝前交叉韧带损伤、左膝半月板损伤。     

腘窝囊肿压迫致腓总神经损伤一例

患者 女性,52岁,因左腘窝肿块4个月伴小腿麻木1个月入院.患者4个月前发现左侧腘窝内侧有一直径约5 mm肿块,主诉无疼痛及其他特殊不适.于当地医院就诊时行彩超检查示左腘窝囊肿,未行特殊处理.后肿块逐渐增大,入院前1个月以来感觉左小腿外侧及左足背皮肤麻木.入院后查体:左侧腘窝内侧扪及一约3 cm×2 cm肿块,质中、张力较大、活动可、边界清、无压痛.左侧小腿外侧、左足背皮肤感觉减退.左腓骨颈部Tinal征(+).我院肌电图检查示左侧腓总神经部分损伤.     

左大腿皮下尤文氏肉瘤1例报告

患者王×× ,男性 ,2 0岁 ,主因左大腿内侧肿物 4个月入院。入院前 4个月无意中发现左大腿内侧有一花生粒大小肿物 ,无红肿及疼痛 ,左下肢活动正常 ,未引起注意 ,未作任何治疗 ,肿物生长迅速 ,2个月即约鸡蛋大小 ,逐来我院就诊。查体 :周身浅表淋巴结未触及 ,心、肺、腹未见异常。左大腿中上 1/3内侧皮下可触及一肿块 ,约 5 cm× 4cm× 3 .7cm大小 ,椭圆形 ,质韧 ,与周围组织界限欠清楚 ,无压痛。B超示 :左大腿中上 1/3内侧可探及一 5 .6cm× 4.8cm× 3 .7cm大小实性肿物。X线示 :左股骨骨质未见异常。入院时诊断 :左大腿中上 1/3内侧肿物…     

髌骨动脉瘤样骨囊肿1例报告

动脉瘤样骨囊肿发生在髌骨者少见,我院收治1例,疗效满意,现报告如下。1病例报告患者,男,23岁,主因左膝疼痛、无力1年余入院。患者于1年前因走路不慎扭伤左膝,当时疼痛,活动受限,未经任何治疗,休息几日后缓解。以后自觉左下肢逐渐无力,走路不便,口服药治疗无效。于入院3d前体育活动时左膝轻微外伤,觉疼痛,故来我院就诊。主要体征有:左膝无明显肿胀,浮髌试验、抽屉试验、应力试验、麦氏征均为阴性,股四头肌萎缩。萎缩范围为髌上10cm周径左40cm,右41cm;髌下10cm周径左28cm,右29cm。髌骨侧位及轴位X线片示:左髌骨内低密度区(见图1)。MRI示:左…     

股骨下段非骨化性纤维瘤1例报道

<正>患者,女,17岁,因"右大腿内侧局部隐痛不适2个月"入院。患者入院2个月前感右大腿下段内侧隐痛,活动后疼痛明显,休息后好转,X线片检查发现右股骨下段异常信号影。专科检查:右大腿内侧局部无包块,无红肿,无感觉异常,压痛(-),右下肢纵向叩击痛(-),足趾感觉活动可,末梢血运良好。辅助检查:(1)     

Essex-lopresti损伤1例报告

1 病例简介 1.1 临床资料 女性患者,18岁,因左肘部跌伤后疼痛、活动受限1d人院.查体:头颅五官端正无畸形,心、肺、肝、脾未见异常.专科检查:左肘关节外侧略肿胀,内侧可见面积4.0 cm×5.0 cm的皮下瘀斑,左桡骨小头处压痛明显,左前臂旋转活动受限,左肘关节侧方应力试验阳性.     

Fractures of the distal humeral articular surface

Fractures of the distal humeral articular surface which do not involve the medial and lateral columns are often more extensive than is apparent from plain radiographs. This retrospective study describes the epidemiology of this injury using modern classification systems and compares pre-operative radiography with operative findings. The study group included 79 patients with a mean age of 47 years (13 to 91). The annual incidence was 1.5 per 100,000 population, and was highest in women over the age of 60. The majority of the fractures (59; 75%) were sustained in falls from standing height. Young males tended to sustain more high-energy injuries with more complex fracture patterns. In 24% of cases (19) there was a concomitant radial head fracture. Classification from plain radiographs often underestimates the true extent of the injury and computed tomography may be of benefit in pre-operative planning, especially in those over 60 years of age.     

Axillary view of the glenoid articular surface

The glenoid articular surface is best studied radiographically on a tangential projection with both true anteroposterior and axillary views. Forty-one dry scapulas were studied under fluoroscopy to define the axillary projection that would provide a true scapular lateral view. The superior and inferior articular margins were marked with radiopaque solder wires. A true axillary view was obtained when the projection of the wires superimposed. The projection of the cortical bone of the posterolateral surface of the coracoid was noted to be continuous with the projection of the subchondral cortical bone of the glenoid articular surface when the latter was viewed tangentially. An illustrative case is shown in which a screw was mistakenly seen violating the glenohumeral joint; however, with the defined true axillary view, the actual position of the screw was demonstrated. X-ray films taken of another 8 cadaver shoulders were used to study the position of screws inserted about the glenoid articular surface. The soft tissue shadow superimposition on the inferior glenoid margin can lead to a misinterpretation of the superior margin as the whole glenoid articular surface. Because soft tissue can interfere with the appreciation of the glenohumeral joint line on an axillary view, a projection that will show a continuous line of the coracoid and glenoid articular surface should be obtained, and it will indicate a tangential view of the joint.     

Arthroscopic exposure of the patellar articular surface

Patellofemoral cartilage degeneration is usually associated with a tight lateral retinaculum (lateral hyperpressure). The position of the patella on the femoral groove under hyperpressure makes reasonable access to the cartilage defects difficult for the arthroscopist. Frequently, the surgeon can barely see the cartilage, and the problem cannot be satisfactorily managed. By performing a lateral release and tilting the patella with a laterally drilled Kirschner wire, the articular surface of the patella can be completely exposed, allowing even perpendicular holes to be drilled whenever necessary.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp 98–100     

Contribution of articular surface geometry to ankle stabilization

BACKGROUND: Passive ankle stability under weight-bearing conditions has been found to depend substantially on the role of the articular surface geometry. In the present study, it was hypothesized that, in the ankle under axial loading, contact-stress changes in response to alterations of external load involve reproducible and specific patterns to maintain ankle stability. METHODS: Six cadaver ankles with the peri-ankle ligaments intact were tested. Each specimen, held at several predetermined ankle positions under a primary one-body-weight axial force, was subjected to an additional secondary load. The secondary load-specifically, anterior/posterior shear force, inversion/eversion torque, or internal/external rotation torque-was applied independently, while motion associated with the two other secondary loading directions was unconstrained. Contact stress in the tibiotalar articulation was monitored by a real-time contact-stress sensor. Site-specific stress changes solely due to secondary loading at each load/position were identified by subtraction of the corresponding axial-force-only baseline distribution. The role of these stress changes in ankle stabilization was studied for each specimen by analyzing the data with a computer model of ankle geometry. RESULTS: In the cadaver experiment, anterior and posterior shear forces caused reproducible positive changes in articular contact stresses on the anterior and posterior regions, respectively. Similar changes with version torques occurred on the medial and lateral regions. Positive changes with internal/external rotation torques occurred at two diagonal locations: anterolateral and posteromedial, or anteromedial and posterolateral. In the model analysis, these stress-change patterns were found to be effective in ankle stabilization, and the levels of contribution by the articular surface were calculated as accounting for approximately 70% of anterior/posterior stability, 50% of version stability, and 30% of internal/external rotation stability. CONCLUSIONS: The documented changes in contact stress illustrate the major role of articular geometry in passive ankle stabilization. The levels of contribution by the articular surface that we calculated are consistent with those reported in the literature. These findings support the conceptual mechanism of ankle stabilization by redistribution of articular contact stress.     

The glenoid-labral socket. A constrained articular surface

An anatomic study was designed to test the hypothesis that the articular surface of the glenoid fossa and labrum produces a composite socket of significant depth. Measurements were obtained from 25 anatomic specimen shoulders. The glenoid articular surface and labrum combine to create a socket that is approximately 9 mm deep in the superoinferior (SI) direction and 5 mm deep in the anteroposterior (AP) direction. The circular, pliable, fibrous labrum contributes approximately 50% of the total depth of the socket. Detachment of the labrum anteriorly, as in a Bankart lesion, may reduce the depth of the socket in the AP direction from approximately 5.0 to 2.4 mm. These anatomic observations provide some evidence that the socket may be an important factor in shoulder stability. Further in vivo kinematic studies of shoulders will be needed to better define the stabilizing role of the glenoid-labral socket.     

Assessment of distal radial articular surface by angled radiography

A common complication of surgical management of fractures of the lower radius involves hardware penetration of the articular surface. If neglected, this complication will lead to wrist joint degeneration. The authors of this study describe a plain roentgenographic angled view of the wrist that provides visualization of the distal radial articular surface to detect any hardware penetration. This view can also be used during surgery by means of an image intensifier.     

Different response of articular chondrocyte subpopulations to surface motion

OBJECTIVE: To investigate the effect of surface motion on the gene expression of proteoglycan 4 (PRG4), hyaluronan synthases (HAS1, HAS2) and on the hyaluronan (HA) and proteoglycan 4 (PRG4) release of chondrocytes from different zones of bovine articular cartilage. DESIGN: Superficial zone, deep zone, full thickness, and superficial/deep 1:1 mixed chondrocytes were seeded into 3D polyurethane scaffolds and stimulated using our bioreactor that approximates kinematics and surface motion characteristics of natural joints. One hour of surface motion superimposed on cyclic compression was applied twice a day over 3 consecutive days. Scaffolds were cut into top and bottom sections and analyzed for gene expression of PRG4, HAS1, and HAS2. RESULTS: Depending on the cell population, the gene expression levels increased within 8 days of culture in unloaded scaffolds, with a stronger increase in the top compared to the bottom sections. Mechanical loading further enhanced the messenger RNA (mRNA) levels in all cell types, with most pronounced up-regulations observed for the PRG4 expression in deep zone and the HAS2 expression in superficial zone cells. The effect of the biochemical and biomechanical environment appeared to be additive, resulting in highest mRNA levels in the top sections of loaded constructs. Bioreactor stimulation also enhanced the HA release in all cell populations. Full thickness chondrocytes experienced the greatest effect on HAS1 mRNA expression and HA release, indicating that the interaction between cell populations may promote HA synthesis compared to subpopulations alone. CONCLUSIONS: Reciprocating sliding can be an efficient tool for generating tissue-engineered constructs from various chondrocyte populations by providing a functional cartilage-synovial interface.