关节镜结合放射治疗膝关节色素沉着绒毛结节性滑膜炎

[目的]探讨采用关节镜结合放射治疗膝关节色素沉着绒毛结节性滑膜炎的方法及其临床应用价值。[方法]2000年1月～2003年7月,共收治14例膝关节色素沉着绒毛结节性滑膜炎患者,采用关节镜下常规器械加双极射频进行关节内病变切除,术后弥漫性色素沉着绒毛结节性滑膜炎辅以放疗,13例通过10～45个月的随访,了解患膝活动度、疼痛、肿胀情况。[结果]13例随访患者,术前国际膝关节评分委员会(IKDC)膝关节功能主观评分为(58.7±6.4)分,最后随访时,IKDC膝关节功能主观评分为(86.5±5.7)分。[结论]通过关节镜能完成膝关节色素沉着绒毛结节性滑膜炎滑膜较彻底切除,对弥漫性膝关节色素沉着绒毛结节性滑膜炎辅以术后放疗是一种有效方法。     

32P colloid radiosynovectomy in treatment of chronic haemophilic synovitis: Iran experience

Repeated intra-articular bleeding with subsequent development of chronic synovitis and cartilage changes, leading to haemophilic arthropathy, is one the most debilitating problems in haemophilic patients. Radiosynovectomy is a familiar therapeutic choice in management of chronic synovitis in haemophilia. We report the treatments results of synoviorthesis with (32)P chromic phosphate with emphasis on clinical aspects. Between 2002 and 2006 we performed 66 procedures in 53 patients. Seven patients were excluded. The remaining 46 patients were followed for an average of 31 months. The mean age of patients at the time of injection was 15.9 years (range: 6-28). There were three repeat injections. According to Fernandez-pallazi and Cavilgia clinical classification (Table 1) [23], nine joints were Stage II and 46 were Stage III. In latest follow-up, 77% of patients reported at least a 50% decrease in bleeding frequency after treatment (P < 0.0001). The need for antihaemophilic factor consumption dropped by about 74% postradiosynovectomy (P < 0.0001). In most of the injected joints, the range of motion remained stable or improved. A trend was found for the number of haemarthrosis to increase after a period of considerable improvement. Synoviorthesis using (32)P effectively reduces the intra-articular bleeding rate and factor concentrate use. Durability of the response seems to be unpredictable, perhaps attributable to the late intervention. An early radiosynovectomy might be more helpful in terms of stability of response to treatment.     

The Usefulness of Magnetic Resonance Imaging in the Diagnosis of Anterolateral Impingement of the Ankle

The purpose of this study is to assess the sensitivity and specificity of magnetic resonance imaging (MRI) in the diagnosis of anterolateral impingement of the ankle and to assess the most helpful sequence in making the diagnosis. Twenty-four patients who had undergone ankle arthroscopy were chosen. Twelve patients had arthroscopically documented anterolateral impingement, and 12 patients with no impingement on arthroscopy served as controls. Two musculoskeletal radiologists and an orthopedic surgeon, blinded to the operative diagnosis, retrospectively reviewed selective MRI images in the sagittal, axial, and coronal planes. The sensitivities and specificities were calculated for all 3 reviewers. The Kendall coefficient of concordance was calculated for overall agreement among reviewers. Sensitivities varied from 0.75 to 0.83, whereas specificities varied from 0.75 to 1.00. Using the Fisher exact test of contingency, the sensitivities and specificities showed that all reviewers' interpretations were statistically significant with P = .039, .001, and .012, respectively. The axial images were felt to be most helpful in making the diagnosis. The physicians felt that the sagittal images were helpful in 67%, 83%, and 100%, respectively. MRI is a useful tool that can aid the clinician in the diagnosis of anterolateral impingement of the ankle. T1 sagittal images demonstrating displacement of the normal fat signal anterior to the fibula by scar can be useful and help to confirm the diagnosis.     

TDP局部照射用于治疗儿童髋关节一过性滑膜炎的疗效观察

目的:探讨加速儿童髋关节一过性滑膜炎疾病的愈合.方法:随机性分析2005年1月～2006年4月共100例髋关节一过性滑膜炎患儿的治疗效果,把病人随机分为治疗组及对照组.治疗组按常规方法治疗加TDP灯局部照射,对照组仅按常规方法治疗.结果:治疗1周后,治疗组B超检查增厚滑膜厚度变化差值、关节腔间隙宽度变化值、关节腔积液好转率、"4"字试验阴性率均明显优于对照组(P＜0.05).结论:TDP灯用于治疗儿童髋关节一过性滑膜炎能加速疾病愈合,提高治疗效果.     

面部色素痣的外科治疗

面部色素痣较常见于鼻、颊、额、颧区，部分病变累及一侧面部的多个区域。这些病变手术切除后的缺损主要采用全厚皮片移植、直接拉拢缝合或邻近皮瓣整复。     

原发性色素性结节状肾上腺皮质病(附4例报告)

目的：探讨原发性色素性结节状肾上腺皮质病(PPNAD)的临床表现和诊断治疗方法。方法：总结4例PPNAD的临床资料，4例均有库欣综合征的临床表现，内分泌检查结果提示为功能自主性肾上腺皮质肿瘤，但影像学检查并未发现肾上腺肿瘤。结果：4例患者均行单侧肾上腺全切除术，手术标本均表现为肾上腺大小正常或轻度增大，外表和切面上见黑色或深褐色小结节，结节间皮质萎缩，光镜下见组成结节的细胞体积大，脑质嗜伊红染色、颗粒状，部分细胞脑质中的颗粒状色素颗粒具脂褐质染色特征。结论：PPNAD在青少年中是一种引起库欣综合征的罕见病因，双侧肾上腺切除术是治愈本病的方法。     

Relative frequency of solitary melanocytic lesions of the oral mucosa

Background: Solitary pigmented lesions of melanocytic origin are uncommon in the oral mucosa. These lesions include the oral and labial melanotic macule, oral melanocytic nevus, oral melanoacanthoma, oral melanoma and atypical melanocytic proliferation. The purpose of the study was twofold: to report a large series of solitary melanocytic lesions from one source, and to determine the relative frequency of these lesions. Methods: The study was based on a systematic search of the files of the Pacific Oral and Maxillofacial Pathology Laboratory, University of the Pacific, San Francisco for solitary pigmented melanocytic lesions (benign and malignant) accessed during the years 1984–2002. Results: Of the 89 430 biopsies accessed during the 19‐year period, 773 (0.83%) cases of solitary pigmented melanocytic lesions in the oral mucosa were identified. Oral and labial melanotic macules were the most common melanocytic lesions comprising 86.1% of the entire group and 0.7% of the total number of accessed biopsies. The vermilion border and gingiva were the most common sites (31.1% and 31.0% respectively). Oral melanocytic nevi comprised 11.8% of the entire melanocytic group and 0.1% of the total number of biopsies. The most common site was the palate (44%). Intramucosal nevi were the most common (64%), followed by compound nevi (16.5%) and common blue nevi (16.5%). Junctional nevi were uncommon (3.0%). Oral melanoacanthoma comprised only 0.9% of the entire melanocytic group and 0.008% of the total number of biopsies. Oral melanoma and atypical melanocytic proliferation were the least common lesions each comprising 0.6% of the entire melanocytic group and 0.006% of the total number of biopsies. The most common site for oral melanoma was the palate (60%). Conclusion: The palate was the most common location for both melanocytic nevi and oral melanoma. Thus, all melanocytic lesions in the palate should be viewed with caution and biopsy is recommended to rule out melanoma. Further studies are required to elucidate the entity of oral atypical melanocytic proliferation.     

膝关节弥漫性色素沉着绒毛结节性滑膜炎的关节镜治疗

目的探讨采用关节镜技术治疗膝关节弥漫性色素沉着绒毛结节性滑膜炎的方法及其临床效果。方法1999年1月～2001年12月,对32例膝关节弥漫性色素沉着绒毛结节性滑膜炎,在常规关节镜入路的基础上,结合膝关节后内侧、后外侧和跨后纵隔入路,进行滑膜全切。手术时强调对膝关节后内侧室和后外侧室病变滑膜的彻底切除,同时通过辅助切口切除关节外病变组织。术后进行系统的康复训练。通过13～47个月的随访,了解患膝疼痛、肿胀、活动度以及患肢整体功能康复情况。结果术后1年,2例有轻微疼痛,1例有轻度肿胀,均无关节积液;膝关节活动度平均为143°±5.1°。最后随访时,23例行MR检查,1例在内侧半月板后角底面与胫骨平台之间的憩室内发现复发,影像学复发率为4.35%(1/23),但患者无主观症状;其余患者在MRI上无复发现象。术前国际膝关节评分委员会(IKDC)膝关节功能主观评分为(63.4±5.1)分,Lysholm膝关节功能评分为(35.6±4.7)分。最后随访时,IKDC膝关节功能主观评分为(87.9±4.9)分,Lysholm膝关节功能评分为(86.3±5.6)分。3例患者因前十字韧带功能不全,于滑膜切除术后3～5个月进行了前十字韧带重建术。结论通过关节镜能够完成膝关节弥漫性色素沉着绒毛结节性滑膜炎的滑膜彻底切除,有助于滑膜炎的治疗。关节镜手术创伤小,