关节镜微创清理术治疗膝关节骨性关节炎

目的探讨关节镜下微创清理术对膝关节骨性关节炎（OA）的治疗效果。方法对54例膝关节骨性关节炎患者进行关节镜下选择性、有限化微创清理术。手术内容包括刨削或射频汽化增生的炎性滑膜组织和前交叉韧带（Anterior Cross Ligment）磨损、游离体取出、软骨打磨成形、增生髁间棘切除、部分骨赘切除、半月板部分切除、髁间窝成形。结果随诊45例。平均18个月（6-24月），大多数患者临床症状明显缓解，关节功能改善。结论关节镜微创清理术可有效缓解OA症状，改善关节功能，提高生活质量。     

透明玻璃酸钠在膝骨性关节炎关节镜术后的应用

膝骨性关节炎（OA）是临床常见的慢性活动性疾病，好发于中老年人．男女均可发病，其临床表现主要为膝关节疼痛肿胀，严重者出现关节畸形，影响行走与日常生活。治疗多以口服或外擦药物、理疗等方法，保守治疗无明显疗效者可采用关节镜技术治疗．我院自2006年5月-2009年5月，采用关节镜下清理术联合透明玻璃酸钠凝胶治疗骨性关节炎53例60膝，疗效较好，并与单纯采用关节镜下清理术治疗的45例48膝进行疗效对照观察．现报道如下。     

关节镜微创术治疗髋臼发育不良伴骨关节炎32例报道

目的:探讨关节镜微创术治疗中青年髋臼发育不良合并骨关节炎的方法与疗效。方法:对32例髋臼发育不良合并骨性关节炎患者患肢髋臼行关节镜下清理软骨磨损创面、增生肥厚的滑膜组织和盂唇组织处理。结果:术后随访28例(6个月～3.5年),依据Harris标准进行功能评分,得分为:优20例,良4例,尚可3例,差1例。结论:髋关节镜清理术可延缓髋臼发育不良伴骨性关节炎的病程,改善临床症状,提高生活质量。     

髋关节骨性关节炎磁共振信号改变与关节痛的相关性研究

骨性关节炎（OA）又名退行性关节病、增生性骨关节炎,是骨关节生理性退化的表现,其病理特点为关节软骨变性破坏,软骨下骨硬化或囊性改变,关节边缘骨质增生,滑膜增生,关节囊挛缩,韧带松弛或挛缩,肌肉萎缩无力等。以往的研究已经证实连续的机械应激会引起关节软骨的退化,继而导致骨的退化,进一步又引起OA［1］。     

关节镜下有限化清理术治疗膝骨性关节炎55例

膝骨性关节炎（OA）是中老年人常见病，严重者明显影响工作及生活。2005年6月～2006年6月，我们采用关节镜下有限化清理术治疗膝骨性关节炎55例，近期疗效较好。现报告如下。     

腓骨截骨治疗膝关节炎疗效分析

正膝关节骨性关节炎是一种以膝关节关节软骨变性和丢失及关节边缘和软骨下骨骨质再生为特征的慢性关节病,是老年人最常见的骨科疾病之一。膝关节炎早期可通过口服、外用药物及关节腔注射玻璃酸等治疗,病变较重者可通过关节镜清理、膝关节置换或截骨术等治疗。笔者2015年1月—2016年8月采用腓骨截骨术治疗共20例膝关节骨性关节炎,取得一定疗效。     

DTI监测膝关节早期骨性关节炎软骨退变的应用进展

膝关节骨性关节炎(OA),一般以关节镜作为关节软骨损伤的金标准;但是关节镜下所见关节软骨形态学的改变,已经是骨性关节炎较为晚期阶段,临床干预疗效不佳.怎样利用MRI对膝关节早期OA软骨退变进行检测一直是临床非常关心的问题.磁共振扩散张量成像(diffusion tensor imaging,DTI)测量能同时检测膝关节软骨组成及胶原结构细微变化,具有无创、可重复性好等优点.近年来,DTI在骨性关节炎早期检测方面已有初步的研究成果.本文对DTI的原理、DTI对正常软骨及早期OA的研究进展及存在问题进行综述.     

软骨下骨异常代谢和软骨退变的相互作用研究进展

正骨性关节炎(osteoarthritis,OA)是一种以关节软骨退行性变和继发性骨质增生为特征的慢性关节病。多发于负重比较大的膝关节髋关节脊柱以及远端指间关节等部位。病变几乎累及关节周围的所有组织,包括关节软骨、软骨下骨、关节囊、滑膜和周围的肌腱韧带等。对于该病的病因还没有完全明确。过去研究主要集中在软骨的退变方面。近年来的研究发现软骨下骨的改变在骨性关节炎的起病和进展中发挥重要作用[1]。鉴于软骨下骨异常代谢和软骨退变对骨关节炎的影响,现在此基础上就软骨下骨异常代谢和软骨退变二者之间的相互作用研究进展     

关节镜下诊断与治疗滑膜软骨瘤病

1996－2000年对24例26个关节（膝、肘、踝关节）的滑膜软骨瘤病人施行了关节镜手术，22例24个关节获得平衡24．5个月随访，效果满意。所有病人都施行了镜下软骨瘤摘除术和病变滑膜切除术，仅有两个病人遗漏了2个游离体，无其它并发症。关节镜下游离体摘除和滑膜切除术是治疗滑膜软骨瘤病的良好方法。     

综合疗法治疗膝骨关节炎189例

膝骨关节炎（OA）是一种以关节软骨的变性、破坏及骨质增生为特征的慢性关节病。X线表现关节间隙变窄,软骨下骨质致密,骨小梁断裂,有硬化和囊性变,关节边缘有唇样增生。2008年以来,我们采用综合疗法治疗OA189例,疗效满意。现分析报告如下。     

低场磁共振在膝关节骨关节炎中的诊断价值

目的讨论低场磁共振系统在膝关节骨关节炎中的影像表现及诊断价值。方法对86例临床确诊膝关节骨关节炎患者的低场磁共振影像表现进行回顾性分析。结果低场磁共振系统对膝关节骨关节炎患者膝关节的多种病理改变,包括软骨改变、软骨下骨改变、半月板变性、关节积液、滑膜增厚、骨髓水肿及软组织肿胀显示效果理想。结论低场磁共振能提供多种诊断膝关节骨关节炎的影像表现,可以达到临床明确诊断的作用。     

Imaging of the articular cartilage in osteoarthritis of the knee joint: 3D spatial-spectral spoiled gradient-echo vs. fat-suppressed 3D spoiled gradient-echo MR imaging

PURPOSE: To compare three-dimensional (3D) spatial-spectral (SS) spoiled gradient-recalled acquisition in the steady state (SPGR) imaging with fat-suppressed 3D SPGR sequences in MR imaging of articular cartilage of the knee joint in patients with osteoarthritis. MATERIALS AND METHODS: MR images of six patients with osteoarthritis of the knee were prospectively examined with a 1.5T MR scanner. For quantitative analyses, the signal-to-noise ratios, contrast-to-noise ratios, and contrast of cartilage and adjacent structures including meniscus, synovial fluid, muscle, fat tissue, and bone marrow were measured. RESULTS: In patients with osteoarthritis, 3DSS-SPGR images demonstrated higher spatial resolution and higher mean signal-to-noise (S/N) ratios (cartilage, 24.9; synovial fluid, 12.3; muscle, 20.7; meniscus, 21.6), with shorter acquisition times (7 minutes 20 seconds), when compared to fat-suppressed 3D SPGR images (cartilage, 22.3; synovial fluid, 10.8; muscle, 16.7; meniscus, 13.4). CONCLUSION: 3DSS-SPGR imaging is a promising method for evaluating cartilage pathology in patients with osteoarthritis of the knee and has the potential to replace fat-suppressed 3D SPGR imaging.     

射频汽化技术在关节镜手术的临床应用

介绍应用射频汽化技术在关节镜下手术的临床应用与疗效。自2000年5月－2001年12月，应用射频汽化技术进行关节镜手术134例，其中肩袖损伤6例，钙化性冈上肌腱炎5例，肱骨大结节骨折关节镜下经皮复位空心钉内固定3例，臀肌挛缩松解术7例，关节镜下股骨干钢板取出3例，髋关节感染病灶清创3例，股骨头无菌性坏死9例，骨性关节炎6例，髋滑膜软骨瘤病6例，膝关节骨性关节炎20例，半月板损伤21例，镜下ACL重建14例，ACL松弛行射频皱缩术4例，髌骨半脱位支持带松解6例，膝关节镜粘连松解6例，膝国窝囊肿关节镜下射频汽化4例，踝关节撞击征6例、滑膜炎5例。结果表明，关节镜下射频手术具有低温冷凝、绉缩、汽化、切割和止血等特点，创伤小、组织反应轻、渗出少，术后关节无肿胀，有利于早期功能恢复。     

Correlation between radiographic findings of osteoarthritis and arthroscopic findings of articular cartilage degeneration within the patellofemoral joint

Objectives To correlate radiographic findings of osteoarthritis on axial knee radiographs with arthroscopic findings of articular cartilage degeneration within the patellofemoral joint in patients with chronic knee pain.Subjects and methods The study group consisted of 104 patients with osteoarthritis of the patellofemoral joint and 30 patients of similar age with no osteoarthritis of the patellofemoral joint. All patients in the study group had an axial radiograph of the knee performed prior to arthroscopic knee surgery. At the time of arthroscopy, each articular surface of the patellofemoral joint was graded using the Noyes classification system. Two radiologists retrospectively reviewed the knee radiographs to determine the presence of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts. The sensitivity and specificity of the various radiographic features of osteoarthritis for the detection of articular cartilage degeneration within the patellofemoral joint were determined.Results The sensitivity of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration within the patellofemoral joint was 73%, 37%, 4%, and 0% respectively. The specificity of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration within the patellofemoral joint was 67%, 90%, 100%, and 100% respectively.Conclusion Marginal osteophytes were the most sensitive radiographic feature for the detection of articular cartilage degeneration within the patellofemoral joint. Joint-space narrowing, subchondral sclerosis, and subchondral cysts were insensitive radiographic features of osteoarthritis, and rarely occurred in the absence of associated osteophyte formation.     

关节软骨损伤病人滑膜液中抗胶原抗体的测定

间接测定滑膜液和血清中的抗Ⅱ型胶原抗体,结果示:15例关节软骨损伤病人有2/3滑膜液反应阳性,6例半月板和创伤性滑膜炎病人的滑膜液反应均阴性;滑膜液反应阳性者血清中抗体阴性。认为关节软骨损伤后滑膜炎的病理机制可能与Ⅱ型胶原的自身免疫有关,并且其自身免疫反应主要局限于损伤关节。     

Levels of biomarkers correlate with magnetic resonance imaging progression of knee cartilage degeneration: a study on canine

To examine the association between levers of cartilage oligomeric matrix protein (COMP), matrix metalloproteinases-1 (MMP-1), matrix metalloproteinases-3 (MMP-3), tissue inhibitor of matrix metalloproteinases-1 (TIMP-1) in serum and synovial fluid, and MR imaging of cartilage degeneration in knee joint, and to understand the effects of movement training with different intensity on cartilage of knee joint. 20 adult canines were randomly divided into three groups (8 in the light training group; 8 in the intensive training group; 4 in the control group), and canines of the two training groups were trained daily at different intensity. The training lasted for 10 weeks in all. Magnetic resonance imaging (MRI) examinations were performed regularly (2, 4, 6, 8, 10 week) to investigate the changes of articular cartilage in the canine knee, while concentrations of COMP, MMP-1, MMP-3, TIMP-1 in serum and synovial fluid were measured by ELISA assays. We could find imaging changes of cartilage degeneration in both the training groups by MRI examination during training period, compared with the control group. However, there was no significant difference between these two training groups. Elevations of levels of COMP, MMP-1, MMP-3, TIMP-1, MMP-3/TIMP-1 were seen in serum and synovial fluid after training, and their levels had obvious association with knee MRI grades of cartilage lesion. Furthermore, there were statistically significant associations between biomarkers levels in serum and in synovial fluid. Long-time and high-intensity movement training induces cartilage degeneration in knee joint. Within the intensity extent applied in this study, knee cartilage degeneration caused by light training or intensive training has no difference in MR imaging, but has a comparatively obvious difference in biomarkers level. To detect articular cartilage degeneration in early stage and monitor pathological process, the associated application of several biomarkers has a very good practical value, and can be used as a helpful supplement to MRI.     

Early changes in experimental osteoarthritis using the Pond-Nuki dog model: technical procedure and initial results of in vivo MR imaging

The purpose of this study was to prove the feasibility of combining in vivo MR imaging with the Pond-Nuki animal model for the evaluation of osteoarthritis. In an experimental study, 24 beagle dogs underwent transection of the anterior cruciate ligament of the left leg (modified Pond-Nuki model). The dogs were randomly assigned into four groups and examined by MRI after 6, 12, 24 and 48 weeks. MR imaging of both knees was performed under general anesthesia with the contralateral joint serving as control. In group 1 (6 weeks postoperatively), the first sign detected on MRI was subchondral bone marrow edema in the posteromedial tibia. After 12 weeks, erosion of the posteromedial tibial cartilage could be observed, followed by meniscus degeneration and osteophytosis after 24 and 48 weeks. The contralateral knee joint showed transient joint effusion, but no significant signs of internal derangement (P<0.001). By combining in vivo MR imaging with the Pond-Nuki model, it is possible to detect early signs of osteoarthritis. The first sign was posteromedial subchondral bone marrow edema in the tibia followed by progressive cartilage degeneration and joint derangement. The in vivo model therefore seems to be suitable for longitudinal studies or monitoring the therapeutic effects of osteoarthritis.An erratum to this article can be found at     

The effect of a meniscal prosthesis on knee biomechanics and cartilage. An experimental study in rabbits.

A meniscal prosthesis made of Dacron with polyurethane coating was tested as a substitute for the medial meniscus in a rabbit experimental model concentrating on biomechanical behavior of the knee joint and gross and histologic evaluation 3 months after surgery. The results were compared to sham-operated knees, knees with a peripheral incision of the medial meniscus, and knees with a total meniscectomy. Knees with prosthesis implantation had the same stiffness as knees with sham-operation or meniscal incision, but knees with meniscectomy were stiffer (P less than 0.05). Knees with prosthesis showed lower energy storage during relaxation than knees with sham-operation or meniscal incision (P less than 0.05). Energy storage in the prosthesis group was similar to the meniscectomy group. Partial or total ingrowth of synovial tissue into the prosthesis was present in 93%, and 63% of the incised menisci had healed. Cartilage changes were present in 70% of the prosthesis group, in 25% of the knees with meniscal incision, and in all knees with meniscectomy. The sham-operated knees were free from cartilage degeneration. Knees with prosthesis had the same frequency of cartilage changes on the femur, but had less changes on the tibia compared to knees with meniscectomy. A high rate of osteophyte formation was observed after prosthesis implantation as well as following meniscectomy, but the osteophytes were larger in the prosthesis group (P less than 0.01). The most frequent and severe effect on the synovium was found in the prosthesis group (92%), but no foreign body reaction or loose Dacron particles were found.(ABSTRACT TRUNCATED AT 250 WORDS)