经皮椎体后凸成形术治疗疼痛性椎体血管瘤

目的 探讨经皮椎体后凸成形术(percutaneous kyphoplasty,PKP)治疗疼痛性椎体血管瘤的临床疗效。方法 搜集2008年01月-2017年04月苏州大学附属第一医院骨科行PKP治疗的疼痛性椎体血管瘤(vertebral hemangioma, VH)患者资料。本组32例中男7例、女25例,年龄平均61.3±12.8岁(32-92岁)；血管瘤位于胸椎20例、腰椎9例、胸椎合并腰椎多发者3例,共累计36个椎体,其中2个椎体血管瘤合并椎体压缩骨折。应用视觉模拟评分(visual analogs scales, VAS)评估患者疼痛情况,用Oswestry功能障碍指数(ODI)量表评估患者生活质量,并记录术后并发症。结果 32例患者共计36个血管瘤椎体均顺利完成手术,其中双侧穿刺30个椎体,单侧穿刺6个椎体。所有患者完成随访,平均14.69±4.91月(7-26个月)。VAS评分术前5.63±1.52,术后24h为1.31±1.06,与术前相比有显著统计学差异(p<0.05),术后1月0.88±0.82,末次随访0.69±0.58；ODI评分术前(61.09±18.95)%,术后24h(21.72±10.57)%,与术前相比有显著统计学差异(p<0.05),术后1月(12.66±9.10)%,末次随访(9.31±5.60)%。VAS评分与ODI评分均较术前明显下降,且在术后随访中呈递减趋势。术后X线片4例椎体出现椎旁骨水泥漏,无临床症状,无椎管内渗漏。1例患者术后8月因骨质疏松出现临近椎体骨折再次行PKP术,1例92岁患者术后1年自然死亡。术后影像学资料未显示有血管瘤复发。结论：对于无神经压迫、以疼痛为主要症状的椎体血管瘤,椎体后凸成形术具有良好的安全性和治疗效果；合并椎体压缩骨折的血管瘤患者PKP同样有效。     

Articular Ultrasound in Asymptomatic Volunteers: Identification of the Worst Measures of Synovial Hypertrophy,Synovial Blood Flow and Joint Damage Among Small-, Medium- and Large-Sized Joints

Articular ultrasound of 6500 joint recesses was performed for the purpose of identifying which joint had the highest measurements among small-sized (SSJ), medium-sized (MSJ) and large-sized (LSJ) joints. Quantitative measurements of synovial hypertrophy (QSR) and semiquantitative measurements of synovial hypertrophy (SSH), power Doppler (SPD) and bone erosion (SBE) (score: 0–3) were made. Higher measurements (p < 0.01) of QSR were obtained in the second metatarsophalangeal joint (MTP), talonavicular joint, and hip. The highest SSH scores (2/3) were obtained in the second MTP, talonavicular joint, hip and knee; the highest SPD scores (1/2/3) in the first MTP, second MTP, dorsal second metacarpophalangeal (MCP) and radiocarpal recesses; and the highest SBE scores (2/3) in the radiocarpal, ulnocarpal and posterior recesses of the glenohumeral joint. In conclusion, higher measurements of synovial hypertrophy were found in the first and second MTPs (SSJ), talonavicular recess (MSJ) and hip (LSJ). Synovial blood flow was frequent in the first MTP and radiocarpal recess. Bone erosion stood out only in the glenohumeral joint.     

Diagnosis and treatment of vertebral hemangiomas with neurologic deficit: a report of 29 cases and literature review

Background contextVertebral hemangiomas (VHs) are called benign tumors but are actually just vascular malformations. The diagnosis and treatment for aggressive VHs is still controversial, due to their rarity.PurposeTo evaluate the safety and efficiency of the present diagnostic methods and treatment choices.Study designA retrospective study of aggressive VHs with neurologic deficit.Patients sampleA total of 29 consecutive aggressive VH cases were diagnosed and treated in our department since 2001.Outcome measuresWe routinely took anteroposterior and lateral spinal roentgenograms, computed tomography, and magnetic resonance images.MethodsTrocar biopsy is indicated in suspected malignant cases. Radiotherapy was usually our first choice if the neurologic deficit was mild or developed slowly. Surgery was indicated if the neurologic deficit was severe or developed quickly or if the radiotherapy was not effective.ResultsThis series included 12 males and 17 females, and the mean age at diagnosis was 44.0 years (range, 21–72 years). Ten patients had radiculopathy, 1 had cauda equina syndrome, and 18 cases had myelopathy. Twenty-one cases had lesions in the thoracic spine, 5 in the lumbar, and 3 in the cervical region. Eleven cases had untypical image findings, including five cases with pathologic vertebral fracture. The neurologic compression came from only epidural soft tumor mass in 18 cases, whereas it came from both bony compression and soft lesion in the other 11 cases. Ten cases had radiotherapy alone, but two failed and had surgery later. Twenty-one cases had surgery. In the 12 cases having surgical decompression without vertebroplasty, the average estimated blood loss was 1900 mL, and it was 1093 mL for the eight cases having decompression with vertebroplasty. The average follow-up was 51.1 months (range, 24–133 months). There was no recurrence in those cases with radiotherapy, whereas three had local recurrence in those six cases treated by surgical decompression alone without radiotherapy.ConclusionsIn aggressive VHs, epidural soft-tissue compression was usually the main reason for neurologic deficit. In cases with rapid progressive and/or severe myelopathy, posterior decompression and stabilization could be combined with intraoperative vertebroplasty to reduce blood loss.     

Power Doppler sonography for detection of intraarticular vascularization in knee joints of patients with rheumatoid arthritis

Abstract

A series of 47 knee joints in 24 patients with rheumatoid arthritis were examined for intraarticular vascularization by power Doppler sonography. The intensity of vascularization was compared with the synovial effusion and proliferation evaluated by gray-scale sonography and the clinical findings in the patients. Vascularization was graded from 0 to 3 by counting the number of color-flow signals: grade 0, no signals; grade one, 1–4 signals; grade two, 5–8 signals; grade three, 9 or more signals. The grade of vascularization correlated with the grade of synovial effusion (P ? 0.01), the grade of synovial proliferation (P ? 0.05), and the serum levels of C-reactive protein (P ? 0.05). It correlated inversely with disease duration (P ? 0.01). Consistent with improvement of articular inflammation, a decrease in the number of color-flow signals was observed in two patients. Power Doppler sonography is suitable for evaluating the intensity of synovitis and for monitoring the clinical activity of rheumatoid patients.     

Synovial osteochondromatosis in bilateral subacromial bursae

Abstract

We report a rare case of synovial osteochondromatosis in bilateral subacromial bursae. A 73-year-old man presented with sudden shoulder pain. Roentgenograms showed a large number of calcifications between the acromial processes, and a greater tuberosity on both sides. Surgery was performed to remove loose bodies from both sides. There were 11 in the right subacromial bursa, and 9 in the left. According to Milgram’s staging system, this case was diagnosed as stage III. A follow-up examination 10 months after the operation found no recurrence, pain, or limitation of the range of motion on either side.