关节镜下滑膜切除术治疗局限型膝关节色素沉着绒毛结节性滑膜炎的临床分析

【摘要】 目的 探讨关节镜下治疗局限型膝关节色素沉着绒毛结节性滑膜炎(PVNS)的方法及疗效。方法 回顾性分析2008年9月~2014年5月在我院术前行MRI检查、术后经病理证实的10例色素着绒毛结节性滑膜炎患者的临床资料及治疗方法,并对患者进行跟踪随访9~68个月,采用Lysholm膝关节功能评分了解患者术后患膝疼痛、肿胀及活动度等功能恢复情况。结果 10例患者在术后随访期均无并发症发生,复发2例,Lysholm 膝关节功能评分为91.80±5.28分,明显高于术前(P<0.01)。结论〓关节镜下对局限型色素沉着绒毛结节性滑膜炎的患者实施滑膜切除术,手术创伤小,术后膝关节功能恢复好,是一种安全有效的治疗膝关节局限型色素沉着绒毛结节性滑膜炎的方法。     

Arthroscopic management of intra-articular pigmented villonodular synovitis of temporomandibular joint

This retrospective study reports on four patients with intra-articular pigmented villonodular synovitis (PVNS) of the temporomandibular joint (TMJ) who were managed with arthroscopy between 2002 and 2009. There were three females and one male, with a mean age of 46 years at diagnosis. The common symptoms were trismus and pain. No pre-auricular swelling or mass was detected. Magnetic resonance imaging (MRI) and arthrography showed an anteriorly displaced disc, disc perforation, osteophyte of the condyle, or increased joint effusion. No neoplasm was suspected radiologically. Under arthroscopy, a yellow nodule and loose bodies were found in one patient, and a yellow or brown hyperplasia of the synovial membrane was noted in the other three patients. Degeneration of the articular cartilage was detected in two patients. The arthroscopic procedures used for every patient were partial synovectomy and debridement of articular surfaces with electric shaving and coblation. Arthroscopic disc repositioning was performed for the two young patients. Postoperative histological examination verified the diagnosis of PVNS of the TMJ. The average follow-up period was 57.4 months, and no recurrence was found. Arthroscopy has proved to be a useful method for the management of intra-articular PVNS of the TMJ.     

中医微创针刀镜联合常规西药治疗早期类风湿关节炎膝关节滑膜炎100例临床观察

目的:观察中医微创针刀镜联合常规西药治疗早期类风湿关节炎膝关节滑膜炎的临床疗效。方法:将200例类风湿关节炎早期患者随机分为治疗组和对照组,每组100例。治疗组行膝关节中医微创针刀镜滑膜切除术后,口服美洛昔康、甲氨蝶呤治疗;对照组仅口服美洛昔康、甲氨蝶呤治疗。2组疗程均为24周。治疗前后对2组患者进行临床评估和影像评估。结果:治疗组显效49例,有效38例,无效13例,总有效率为87.00%;对照组显效24例,有效20例,无效56例,总有效率为44.00%。2组比较,差异有统计学意义(P<0.05)。治疗后,2组MRI检测情况比较,治疗组较对照组明显好转(P<0.05)。结论:中医微创针刀镜切除早期类风湿关节炎膝关节病变滑膜,后续配合美洛昔康、甲氨蝶呤治疗可有效减轻患者的临床症状,值得临床推广。     

Mechanistic immunological based classification of rheumatoid arthritis

The classical autoimmunity paradigm in rheumatoid arthritis (RA) is strongly supported by immunogenetics suggesting follicular helper T-cell responses driving high titre specific autoantibodies that pre-dates disease onset. Using the immunological disease continuum model of inflammation against self with “pure” adaptive and innate immune disease at opposite boundaries, we propose a novel immune mechanistic classification describing the heterogeneity within RA. Mutations or SNPs in autoinflammatory genes including MEFV and NOD2 are linked to seronegative RA phenotypes including some so called palindromic RA cases. However, just as innate and adaptive immunity are closely functionally integrated, some ACPA+ RA cases have superimposed “autoinflammatory” features including abrupt onset attacks, severe attacks, self-limiting attacks, relevant autoinflammatory mutations or SNPs and therapeutic responses to autoinflammatory pathway therapies including colchicine and IL-1 pathway blockade. An emergent feature from this classification that non-destructive RA phenotypes, both innate and adaptive, have disease epicentres situated in the extracapsular tissues. This mixed innate and adaptive immunopathogenesis may be the key to understanding severe disease flares, resistant disease subsets that are unresponsive to standard therapy and for therapies that target the autoinflammatory component of disease that are not currently considered by expert therapeutic recommendations.     

色素沉着绒毛结节性滑膜炎的MRI表现

目的：探讨色素沉着绒毛结节性滑膜炎的MRI表现特点。方法：分析38例病人行MRI检查并经术后病理证实病例的临床资料。结果：弥漫性32例，其中28例表现为关节内滑膜弥漫性增厚，在T1WI上23例呈中等信号，5例呈多发的结节状低信号，在T2WI上12例呈中等信号，11例呈低信号，5例呈多发的结节状低信号；其余4例表现为关节内局限性肿块形成，在T1WI上均呈中等信号，在T2WI上2例呈中等信号，2例呈低信号。局灶性6例，表现为软组织内的肿块形成，在T1WI、T2WI上5例呈中等信号，1例呈低信号。结论：色素沉着绒毛结节性滑膜炎病人的MRI可表现为滑膜的弥漫性增厚和局限性肿块形成2种，其典型的表现是在T1WI和T2WI上均为低信号。     

透明质酸钠治疗踝关节创伤性滑膜炎的随机平行对照临床研究

目的 观察透明质酸钠（sodium hyahtrormte，SH）关节腔内注射治疗踝关节创伤性滑膜炎的临床效果。方法 采用随机平行对照的方法，比较44患者治疗前后的Baird-Jackson踝关节评分值，判断透明质酸钠的疗效。按时间顺序将44患者随机分到两组（透明质酸钠治疗组和对照组），每组各22名患者，透明质酸钠治疗组的患者关节内每周注射透明质酸钠20mg一次，共5次，对照组的患者只单纯给与超短波理疗，每日一次作用强度100w于患踝作用0分钟，治疗5周。然后定期随访，根据Baird-Jackson踝关节评分值，比较治疗前后两组关节症状和功能的改善情况。治疗中对照组有两名患者脱落。结果 与治疗前相比，透明质酸钠治疗组的疗效非常显著。透明质酸钠治疗组疗效明显优于超短波治疗组。对于轻度患者，透明质酸钠注射液治疗见效早，疗效好。结论透明质酸钠注射液能够有效的治疗踝关节的创伤性滑膜炎。在踝关节创伤性滑膜炎的早期对病人应用透明质酸钠注射液，会更有效的阻止病情的发展。