Atypical <Emphasis Type="Italic">Mycobacterium</Emphasis> infections of the upper extremity

Background: We encountered five patients with atypical Mycobacterium infections in the upper extremity, and examined their outcomes. Patients and methods: Two patients were male and three were female. The average patient age was 67 (range, 63–75) years. A wide synovectomy was performed to diagnose all cases followed by a therapeutic regimen of Rifampicin, Isoniazid, and Ethambutol. Results: The causative atypical organism was Mycobacterium marinum in three cases and Mycobacterium intracellulare in two cases. In one patient, inflammation recurred or did not disappear, and, therefore, three debridements were necessary. The average duration of antimicrobial therapy was 12 (range, 5–24) months. The average follow-up period was 26 (range, 5–66) months, and resolution had been achieved in all cases at the time of follow-up evaluation. Conclusion: Surgical debridement and appropriate mycobacterial culture or PCR method are critical to enable diagnosis and appropriate management.     

Assessment of both articular synovitis and tenosynovitis by ultrasound is useful for evaluations of hand dysfunction in early rheumatoid arthritis patients

Objectives: We investigated the association between hand dysfunction and ultrasound (US)-detected articular synovitis and tenosynovitis in patients with rheumatoid arthritis (RA).

Methods: Thirty RA patients were examined. In both hands of all subjects, articular synovitis and tenosynovitis were assessed by US at 22 joints and 12 tendons. Each joint and tendon was scored by gray-scale (GS) and power Doppler (PD) on a scale from 0 to 3. The sums of the GS or PD scores were used as the articular synovitis score and the tenosynovitis score. The sum of the articular synovitis and tenosynovitis scores was used as the combined US score. Hand dysfunction was evaluated by a grip-Health Assessment Questionnaire (HAQ) and visual analog scale of morning stiffness (MS-VAS). We used Spearman’s correlation coefficient to determine the relationships among the US scores, the two hand dysfunction indices, and the DAS28-ESR.

Results: The articular synovitis scores were significantly correlated with grip-HAQ (GS: r_s?=?0.47, p?=?0.009, PD: r_s?=?0.48, p?=?0.006), but not with MS-VAS. The tenosynovitis scores were correlated with MS-VAS (GS: r_s?=?0.38, p?=?0.039, PD: r_s?=?0.36, p?=?0.053), but not with grip-HAQ. Both grip-HAQ (GS: r_s?=?0.53, p?=?0.002, PD: r_s?=?0.55, p?=?0.001) and the MS-VAS (GS: r_s?=?0.39, p?=?0.031, PD: r_s?=?0.47, p?=?0.008) were correlated with the combined US scores.

Conclusions: The US scores combined with articular synovitis and tenosynovitis scores well reflect the severity of hand dysfunction in early-stage RA patients.     

Antigen-induced tenosynovitis in hypersensitized rabbits: a model for rheumatoid tenosynovitis

Summary Rabbits were first immunized and later challenged with the same antigen (bovine serum albumin, or ferritin) by injection into the tibialis anterior tendon. Inflammatory changes of the tenosynovium and epitenon included infiltration by neutrophils (early) and mononuclear cells (later) over a 6-week course of tenosynovitis. A pattern of antigen entrapment in the tendon together with immunoglobulin was shown by use of radiolabelled antigen and immunochemical staining. Half-life of antigen in the tissues averaged 5 days over the 6-week period. Changes in the epitenon included cellular necrosis, appearance of phagocytic cells, and disruption of the collagen matrix. Tissues of control animals (challenged without prior immunization) showed minimal changes and significantly less retention of antigen (P>0.005). The model is relevant to the mechanism of tendon damage associated with antigen-driven chronic inflammation, as may be the case in rheumatoid arthritis.     

针刀治疗指屈肌腱腱鞘炎的临床疗效

目的观察针刀治疗指屈肌腱腱鞘炎的临床疗效。方法把指屈肌腱腱鞘炎中后期的患者125例随机分为治疗组64例和对照组61例。对照组采用局部药物封闭治疗,治疗组用针刀松解狭窄的腱鞘。结果治疗21 d后治疗组治愈率(92.18%)、总有效率(96.87%)明显高于对照组(治愈率42.62%、治愈率90.16%)(P0.05)。180 d后再次随访,治疗组的治愈率(95.13%)与总有效率(98.44%)仍明显高于对照组(治愈率34.42%、总有效率72.13%)(P0.05)。结论针刀治疗中后期指屈肌腱腱鞘炎具有较好的临床疗效。     

早期类风湿性关节炎手功能障碍与关节内炎症的相关性分析

目的探讨早期类风湿性关节炎(RA)手功能障碍与关节内炎症之间的相关性。方法回顾性分析63例早期RA伴手功能障碍患者的临床及超声检查资料,分析手功能障碍评分、晨僵视觉评分(MS-VAS)与关节内滑膜增生、滑膜炎、腱鞘炎、关节腔积液及炎症总评分之间的相关性。结果①关节内炎症与手功能障碍的相关性:滑膜增生、滑膜炎与手功能障碍均呈正相关(rs=0.46、0.51,P=0.010、0.003);腱鞘炎、关节腔积液与手功能障碍均无相关(r_s=0.29、0.12,P=0.120、0.160);关节内炎症总评分与手功能障碍呈正相关(r_s=0.53,P=0.002)。②关节内炎症与MS-VAS的相关性:滑膜增生、滑膜炎与MS-VAS均无相关(r_s=0.28、0.35,P=0.140、0.060);腱鞘炎与MS-VAS呈正相关(r_s=0.39,P=0.030);关节腔积液与MS-VAS无相关(r_s=0.16,P=0.320);关节内炎症总评分与MS-VAS呈正相关(r_s=0.47,P=0.008)。结论早期RA患者手功能障碍与关节内滑膜炎症相关,晨僵则与腱鞘炎相关,超声提示滑膜炎、腱鞘炎能更加全面地反映早期RA手腕部关节功能。     

早期类风湿性关节炎手功能障碍与关节内炎症相关性分析

目的 探讨早期类风湿性关节炎(RA)手功能障碍(SOFI)与关节内炎症之间相关性。 方法 分析63例早期RA伴手功能障碍患者临床及超声资料,分析SOFI评分、晨僵视觉评分(MS-VAS)与关节内滑膜炎、腱鞘炎、关节腔积液及炎症总评分之间相关性。 结果 滑膜炎与SOFI之间有显著相关性(GSUS:rs=0.46,P=0.01,PDUS：rs=0.51,P=0.003),而与MS-VAS之间没有显著相关性(GSUS:rs=0.28,P=0.14,PDUS：rs=0.35,P=0.06);腱鞘炎与MS-VAS之间有显著相关性(rs=0.39,P=0.03),而与SOFI之间没有显著相关性(rs=0.29,P=0.12);关节腔积液与SOFI(rs=0.12,P=0.36)及MS-VAS(rs=0.16,P=0.32)之间均无显著相关性;关节内炎症总评分则与SOFI(rs=0.53,P=0.002)及MS-VAS(rs=0.47,P=0.008)之间均有显著相关性。 结论 早期RA患者手功能障碍(SOFI)与关节内滑膜炎相关,晨僵则与腱鞘炎相关,超声提示的滑膜炎、腱鞘炎能更加全面地反应早期RA手腕部关节功能。     

推割刀治疗狭窄性腱鞘炎的解剖学观察

狭窄性腱鞘炎为一多发于中老年女性的骨科常见病多发病,可严重影响病人的日常工作和生活.近年来各地相继报道了运用传统小针刀或一些自创刀具经皮切割、松解治疗狭窄性腱鞘炎的成功经验[1-6].然而同时这类松解治疗手术中也出现了一些诸如屈指肌腱断裂、血管神经损伤等并发症[7].我院骨科从1990开始,在借鉴传统小针刀经皮切割疗法的基础上,研制了推割刀,治疗屈指肌腱狭窄性腱鞘炎400余例,未发生一例由于推割刀松解术所引起的屈指肌腱及周围组织副损伤的理想疗效.为了能全面、准确地阐述推割刀治疗屈指肌腱狭窄性腱鞘炎的作用机理,我们进行了模拟推割刀松解术后对屈指肌腱鞘及其腱鞘滑车的解剖学研究. ……     

Post-traumatic stenosing flexor tenosynovitis

Two cases of post-traumatic stenosing flexor tenosynovitis (flexor tendon entrapment or trigger digit) are presented. The medical literature contains few reports of this uncommon etiology for a problem that afflicts at least 2% of the adult population.     

Treatment of Stenosing Tenosynovitis of Finger Flexor Tendon by Lateral Puncture Method： A Report of Termyu-one Cases

在掌指关节附近找出最痛点,皮肤常规消毒后,快速进针,得气后,嘱患者活动患指,然后变换针刺方向,应用本法治疗21例屈指肌腱狭窄性腱鞘炎,结果治愈7例,好转12例,未愈2例,总有效率90.5%.     

狭窄性腱鞘炎的分期治疗

狭窄性腱鞘炎(俗称扳机指,Triggering finger)是手外科的常见病,保守疗法仍是治疗该病的常用措施。本文对1999年3月-2004年6月就诊的125例患者根据病情程度将其分为3期,施以不同的治疗方法,取得了较好的疗效。现总结报告如下。1临床资料1·1一般资料本组共125例(146指),男24例,女101例;年龄27~75岁,平均51岁。其中,拇指61指,食指19指,中指28指,环指33指,小指5指。发病至本次治疗间隔时间平均27周。1·2分期标准根据孙康等[1]对狭窄性腱鞘炎的分期:Ⅰ期,掌指关节掌侧局限性疼痛,并有压痛,但不出现弹响,主动伸屈活动正常;Ⅱ期,患指伸屈时产生…