Tuberculosis of the upper limb joints

Summary Seventy-four cases of tuberculosis of the upper limb joints (sterno-clavicular 1; shoulder 12; elbow 42; wrist 10 and fingers 9), treated by two of the authors, were reviewed. Eighty-seven percent presented at an advanced stage of destruction. The diagnosis was proved in 71 out of 74 cases. In most, the treatment was 6–12 months of chemotherapy, plaster immobilization (in order to prevent or correct deformity) and functional rehabilitation whenever possible. The sterno-clavicular and finger joints were not immobilized. Response to chemotherapy was favourable in 66 of the patients followed up. One relapse occurred at the 18th month.The affected shoulder joints healed with loss of movement, but were not painful. At the elbow, ten patients developed spontaneous bony fusion in the right-angle position, 27 had a useful range of motion and 19 had more than 70° of flexion-extension movement. One patient had an arthrodesis. At the wrist, two patients healed with painful stiffness and an arthrodesis was performed. All the finger lesions healed with painless stiffness which did not interfere much with function because rehabilitation had been started early. The authors believe that conservative management usually gives better results than arthrodesis or excision of the joint.

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Résumé Les auteurs rapportent les résultats de leur expérience dans 74 cas d'ostéo-arthrite tuberculeuse du membre supérieur: 1 sterno-claviculaire, 12 scapulo-humérales, 42 coudes, 10 poignets et 9 articulations des doigts, toutes traitées personnellement par les deux auteurs principaux. Sur le plan diagnostique, 87% des patients se présentaient à un stade de destruction avancée. Le diagnostic de certitude fut obtenu dans 71 cas sur 74. Dans la majorité des cas, le traitement a été standardisé: chimiothérapie de 6 à 12 mois, immobilisation plâtrée pour prévenir ou corriger les déformations, suivie de reéducation chaque fois que possible. Les lésions de la sterno-claviculaire et des doigts ne furent pas immobilisées. Les résultats ont été bons en ce qui concerne la chimiothérapie: 66 réponses favorables chez 66 patients suivis. Il y a eu une rechute au 18éme mois. Du point de vue orthopédique, les lésions scapulo-humérales ont guéri avec une raideur de l'épaule toujours importante mais indolore. Au niveau du coude, 10 patients évoluèrent vers la fusion osseuse précoce spontanée, qui se fit à 90° de flexion grâce à l'immobilisation plâtrée; 27 guérirent avec une conservation variable des mouvements du coude dans un secteur fonctionnel et 19 d'entre eux présentaient plus de 70° d'étendue de flexion; 1 patient fut arthrodésé. Au niveau du poignet, 2 patients guérirent avec une raideur douloureuse qui nécessita une arthrodèse. Les lésions des doigts guérirent avec une raideur plus ou moins marquée, bien compensée par la mobilité des autres articulations, conservée intacte par la reéducation. Les auteurs concluent à la meilleure qualité des résultats du traitement conservateur que des classiques interventions d'arthrodèse ou de résection articulaire.

     

再植指晚期骨与关节畸形

目的　探讨断指再植后晚期骨与关节畸形的发生原因和矫治方法 ,并提出相应的预防措施。方法　 1990年 1月至 2 0 0 0年 5月 ,对 3 2 8个再植指进行长期随访 ,发现 85指晚期并发骨与关节畸形 ,对畸形发生的原因进行回顾性分析 ,并对其中 5 4指进行了各类修复和重建手术。结果　再植指晚期骨与关节畸形的发生原因包括 :内固定使用不当、骨与关节处理欠妥、肌腱粘连或修复不牢固、瘢痕挛缩、受伤机制的影响和小儿骨骺损伤等。 5 4指经功能重建术后 ,其功能评分较术前显著提高 (P <0 0 5 )。结论　断指再植后晚期并发骨与关节畸形的几率较高 ,在再植术中应用各种预防手段 ,可有效降低畸形的发生 ,从而提高再植指的功能。     

Normal morphology of sacroiliac joints in children: magnetic resonance studies related to age and sex

Objective. To determine in a prospective study the normal MRI morphology of the sacroiliac joints (SIJs) in relation to age and sex during adolescence. Design and patients. A total of 98 children (63 boys, mean age 12.7±2.8 years; 35 girls, mean age 13.7±2.3 years), ranging in age from 8 to 17 years, with juvenile chronic arthritis (JCA) but without signs of sacroiliitis fulfilled the study prerequisites (no back pain and no pathologic changes of the SIJs on physical examination before MRI in a 1.5-year follow-up). An additional eight HLA-B27-negative boys and eight HLA-B27-negative girls without arthritis served as controls. The MRI protocol comprised a T1-weighted SE sequence, an opposed-phase T2*-weighted GE sequence, and a dynamic contrast-enhanced study in single-section technique. Results. Noncontrast MRI permitted differentiation of “open” from ossified segmental and lateral apophyses of the sacral wings, with a significant difference in age (P <0.05) between children with open and ossified apophyses. Ossification of the apophyses of the sacral wings was seen significantly earlier (P <0.05) in girls than in boys. Girls also had a significantly higher incidence of transitional lumbosacral vertebrae, pelvic asymmetries, and accessory joints. In the contrast-enhanced opposed-phase MRI study, normal cartilage of the SIJs showed no contrast enhancement whereas the joint capsule showed a moderate enhancement. Conclusion. There are significant age- and sex-related differences in the normal MRI morphology of juvenile SIJs. Our findings might serve as a standard of comparison for the evaluation of pathologic changes – in particular for the early identification of juvenile sacroiliitis.     

Cartilage destruction in small joints by rheumatoid arthritis: assessment of fat-suppressed three-dimensional gradient-echo MR pulse sequences in vitro

Purpose. To assess the accuracy of different MR sequences for the detection of articular cartilage abnormalities in rheumatoid arthritis. Design and patients. Ten metacarpophalangeal joints and 10 metatarsophalangeal joints (specimens from arthritis patients undergoing ablative joint surgery) were examined with a fat-suppressed (FS) 3D FLASH, a FS 3D FISP, a FS 2D fast spin-echo T2-weighted, and a 2D FS spin-echo T1-weighted sequence. Each cartilage lesion and each cortical lesion was graded from 0 to 4 (modified Outerbridge staging system). Subsequently, the results of each sequence were compared with the macroscopic findings and statistically tested against each other. Results. The study shows that 3D gradient-echo sequences with fat suppression were best for imaging and grading of cartilage lesions in arthritis of the small joints of the hands and feet. Using 3D techniques, all grade 2, grade 3, and grade 4 lesions of cartilage or cortical bone were detected. Conclusion. FS 3D gradient-echo techniques were best for the detection and grading of hyaline cartilage and subchondral bone lesions in rheumatoid arthritis. MRI has a great potential as an objective method of evaluating cartilage damage and bone erosions in rheumatoid arthritis.     

维丁胶性钙预防关节腔内注射皮质类固醇引起骨关节的损害

目的：采用维丁胶性钙预防关节内注射皮质类固醇对骨关节的损害。方法：４５只健康新西兰白兔，随机分为三组，每组１５只。Ａ组：右膝关节内注射醋酸强的松龙７．５ｍｇ／ｋｇ。Ｂ组：用药同Ａ组，同时每周肌注维丁胶性钙三次，每次１ｍｌ。Ｃ组：右膝关节内注射生理盐水０．３７５ｍｌ／ｋｇ，作为对照。于实验的第３、５、７、９、１１周的第１天，每组取３只动物作髋关节和膝关节Ｘ光照片，并取膝关节及股骨头标本作病理组织学和超微结构检查。结果：Ａ组。用药２次后，Ｘ线照片、病理组织学检查和超微结构观察均有骨关节损害的表现，并随给药次数的增加而加重。Ｂ组。用药６次后才出现轻度病理组织学和超微结构改变。Ｃ组。各项指标均正常。从而证实维丁胶性钙有预防或减轻皮质类固醇所致骨关节损害的作用。结论：在疼痛治疗中，关节内注射皮质类固醇应尽量减少注射次数和延长间隔时间，并同时应用维丁胶性钙肌注有一定预防骨质损害作用。     

尺桡骨中段旋转截骨术治疗先天性上尺桡关节融合及并发症探讨

目的探讨尺桡骨中段旋转截骨术治疗先天性上尺桡关节融合的优越性及并发症。方法对7例先天性上尺桡关节融合的患儿，行尺桡骨中段旋转截骨术，Ⅰ期旋转至所需位置。结果7例患儿随访2个月～3年，平均1年，7例中1例1侧术后发生缺血性肌挛缩，1例1侧发生钢板断裂，其余病例均于3个月内截骨处达骨性愈合，患肢功能满意。结论此术式是治疗先天性上尺桡关节融合的较理想的方法。     

Musculoskeletal involvement in sarcoidosis,

Sarcoidosis is a multisystem inflammatory disorder of unknown cause. It most commonly affects the pulmonary system but can also affect the musculoskeletal system, albeit less frequently. In patients with sarcoidosis, rheumatic involvement is polymorphic. It can be the presenting symptom of the disease or can appear during its progression. Articular involvement is dominated by nonspecific arthralgia, polyarthritis, and Löfgren''s syndrome, which is defined as the presence of lung adenopathy, arthralgia (or arthritis), and erythema nodosum. Skeletal manifestations, especially dactylitis, appear mainly as complications of chronic, multiorgan sarcoidosis. Muscle involvement in sarcoidosis is rare and usually asymptomatic. The diagnosis of rheumatic sarcoidosis is based on X-ray findings and magnetic resonance imaging findings, although the definitive diagnosis is made by anatomopathological study of biopsy samples. Musculoskeletal involvement in sarcoidosis is generally relieved with nonsteroidal anti-inflammatory drugs or corticosteroids. In corticosteroid-resistant or -dependent forms of the disease, immunosuppressive therapy, such as treatment with methotrexate or anti-TNF-α, is employed. The aim of this review was to present an overview of the various types of osteoarticular and muscle involvement in sarcoidosis, focusing on their diagnosis and management.     

Transient Exposure of Fibroblast Growth Factor-2 Induced Proliferative but Not Destructive Changes in Mouse Knee Joints

Fibroblast growth factor-2 (FGF-2) has the potential to regenerate damaged articular cartilage tissue due to its exerting anabolic effects on chondrocytes. However, FGF-2 is involved in pathogenesis of rheumatoid arthritis, where the joint is destructed. The study aims at clarifying the effects of FGF-2 on joints. When radiolabeled FGF-2 was injected into knee joints of C57Bl/10 mice, a transient binding was observed in the superficial and intermediate zones of the articular cartilage as well as in the synovium and perichondrium. An FGF-2 injection (5 μg) caused synovial hyperplasia adjacent to the articular cartilage on day 7, cartilage formation adjacent to the articular cartilage on day 14, and osteophyte on day 21. The intensity of safranin-O staining of the articular cartilage increased on day 14. These changes were dose-dependent. No destructive changes in the joints were observed. In a joint, transient exposure of FGF-2 caused proliferative changes, but not destructive changes.     

三维运动捕捉技术在颈椎整复手法中肢体运动轨迹的在体研究

目的:通过三维运动捕捉与分析系统,采集与分析手法运动数据,归纳肩、肘、膝和踝关节运动特点。方法:由1位施术者在头部、躯干、左右肩峰、肘关节内外侧、腕关节内外侧、前臂外侧、上臂外侧、髂前上棘、髂后上棘、股骨大转子、胫骨结节、内外侧膝、腓骨小头、内外侧踝、足跟、双侧大腿、小腿胫骨外侧以及第1、2、5跖骨头、粘贴光标,对1位受试者完成1次颈椎“骨错缝、筋出槽”治疗的右手手法操作周期,重复5次,对施术者右侧肩、肘、膝和踝关节运动轨迹进行捕捉、记录、计算和分析。结果:手法操作过程中4个关节运动轨迹的趋势一致,其中肘关节的离散度最为明显。肩关节和肘关节的三维活动度明显,而膝关节和踝关节相对较小,然而膝关节的屈伸活动明显大于旋转和侧弯活动。结论:石氏伤科颈椎整复手法的上肢关节灵活性较高,而下肢关节的稳定性是重要保证,其中同侧膝关节通过屈伸活动来辅助上肢发力;红外线三维运动捕捉与分析系统建立的手法模型可以为教学和基础研究提供新的研究思路。     

半肩假体置换治疗肱骨近端复杂性骨折的应用研究

目的探讨半肩假体置换治疗肱骨近端NeerⅢ和NeerⅣ骨折的临床疗效及手术要点。方法从2005年9月～2010年10月,本组收治了33例肱骨近端复杂骨折的患者,男14例,女19例;年龄62～80岁,平均73.7岁;左侧11例,右侧22例,NeerⅢ13例,NeerⅣ20例,行LINK半肩假体置换治疗。术后应用改良的半肩关节置换评分系统（scoring system-modification for hemiarthroplasty,SSMH）评分和美国肩肘医师评分（American Shoulder and Elbow Surgeon Score,ASES）评价治疗效果。结果 33例患者中均得到随访,随访时间6～55个月,平均28个月。SSMH评分术后1周平均评分14.5分,末次随访（所有患者随访时间均〉6个月）平均评分25.6分,ASES评分术后1周平均评分45分,末次随访平均为84分。结论半肩关节置换是一种治疗肱骨近端复杂性骨折的有效方法,肩袖重建方式、假体与关节盂吻合度、术后功能锻炼是影响疗效的主要因素。