针刀治疗髌下脂肪垫损伤的临床疗效观察

目的 观察针刀治疗髌下脂肪垫损伤的临床疗效.方法 将70例髌下脂肪垫损伤者随机均分为治疗组(针刀组)和对照组(电针组)两组.在治疗前后以VAS评分和膝关节活动度为观察指标,对两组的复发率和有效率进行统计学分析.结果 两组治疗后VAS评分明显降低(P＜0.01),两组间比较无统计学差异(P＞0.05);两组治疗后膝关节活动度明显增加(P＜0.01),治疗组明显高于对照组(P＜0.01);治疗组复发率(12.00%)明显低于对照组(40.74%)(P＜0.01);治疗组的有效率(93.94%)明显优于对照组(63.64%)(P＜0.05).结论 针刀可缓解脂肪垫损伤者疼痛症状,尤其是在改善膝关节活动度方面具有较好优势,且具有复发率低的特点,是治疗髌下脂肪垫损伤的良好手段,值得进一步推广.     

超声造影在膝骨关节炎患者髌下脂肪垫血流灌注中的临床应用探讨

目的 探讨超声造影技术在膝骨关节炎(KOA)患者髌下脂肪垫血流灌注情况的临床应用优势与价值。方法选取因膝骨关节炎就诊的患者46例，同时选取12例自愿行肌骨超声及超声造影的健康者为对照组。膝骨关节炎组根据Kellgren-Lawrence分级分为3个亚组。参与者均行常规膝关节超声检查及髌下脂肪垫超声造影检查。观察髌下脂肪垫血流信号显示情况，分析超声造影下时间-强度曲线的最大强度及曲线下面积。结果 膝骨关节炎组髌下脂肪垫彩色多普勒显示率100%,对照组显示率83.33%,两组彩色多普勒显示率差异有统计学意义(P<0.05)。超声造影在两组均可见增强。膝骨关节炎K-L分级2级、3级组最大强度均高于对照组(P<0.01)。不同分级之间最大强度依次递增，除K-L1级、3级组之间有统计学意义外，其余组间差异无统计学意义(P>0.05)。膝骨关节炎各K-L分级组曲线下面积均高于对照组，且差异有统计学意义(P<0.05),KOA组不同分级之间曲线下面积依次递增，但组间差异无统计学意义(P>0.05)。结论 超声造影能够显示髌下脂肪垫的血流灌注情况。膝骨关节炎患者髌下脂肪垫...     

基于能谱CT物质分离成像的膝骨关节炎中医证型的相关参数研究

目的：探讨不同中医证型膝骨关节炎（KOA）能谱CT成像的髌下脂肪垫（IPFP）脂基物质含量、关节间隙面积和骨赘评级的差异。方法：回顾性分析发作期KOA患者118例,其中寒湿痹阻证51例（A组）,气滞血瘀证40例（B组）,肝肾亏虚证16例和气血虚弱证11例（C组）,使用能谱CT检查后行基物质分离图像后处理及分析,探讨不同中医证型KOA能谱CT成像IPFP脂基物质含量、关节间隙面积及骨赘评级的差异。结果：各证型间脂肪/肌肉物质分离图像IPFP最大面积和CT值差异均无统计学意义（均P>0.05）。A组IPFP脂基物质含量最低,C组IPFP脂基物质含量最高（P<0.05）,B组膝关节内侧间隙面积小（P<0.05）。各证型间膝关节外侧间隙面积和骨赘评级差异均无统计学意义（均P>0.05）。结论：IPFP脂基物质含量和关节间隙面积均与发作期KOA中医证型间存在一定相关性,能谱CT基物质分离成像在中医辨证施治KOA中具有一定的临床应用价值。     

银质针透热疗法结合超声波治疗髌下脂肪垫劳损的临床研究

目的观察银质针结合超声波治疗髌下脂肪垫劳损的疗效,探讨该病的治疗方法。方法将74例髌下脂肪垫损害患者,随机分为治疗组和对照组各37例,治疗组采用银质针透热结合超短波治疗,对照组只采用超短波治疗,治疗前后采用活动痛(VAS)、症状改善率作为观测指标,比较两组疗效并进行统计学处理。结果治疗组与对照组的总有效率比较差异有统计学意义(P<0.05),两组治疗前后VAS评分比较差异有统计学意义(P<0.01),治疗组效果更好。结论银质针透热结合超短波对髌下脂肪垫劳损有很好的疗效。     

全膝关节置换术中保留髌下脂肪垫对髌腱短缩的影响

目的探讨保留髌下脂肪垫在全膝关节置换术中对髌腱短缩的影响。方法将邯郸市第一医院骨科86例(86膝)行全膝关节置换术的骨性关节炎患者按手术方式分为保留组(保留大部分髌下脂肪垫及滑膜)与切除组(切除髌下脂肪垫,选择假体进行置换)各43例。保留组男性13例,女性30例,平均年龄(60.95±5.34)岁。切除组男性15例,女性28例,平均年龄(61.27±5.51)岁。对比两组术前、术后1年HSS膝关节功能评分(疼痛、功能、活动度、肌力、屈膝畸形、稳定性),膝关节活动度(屈膝度、屈曲挛缩),并记录髌腱短缩的发生率、膝前痛发生率及术后并发症发生率。结果保留组髌腱短缩的发生率低于切除组(25.58%vs.46.51%),差异有统计学意义(P=0.043)。两组术后1年疼痛、功能、活动度、肌力、屈膝畸形、稳定性评分均高于术前,差异有统计学意义(P0.05);组间各项目评分比较差异均无统计学意义(P0.05)。两组术后1年屈膝度、屈曲挛缩均低于术前,差异有统计学意义(P0.05);但组间比较差异无统计学意义(P0.05)。所有患者术后均未发生髌腱损伤。保留组术后1年膝前痛发生率低于切除组(2.33%vs.20.93%),差异有统计学意义(P=0.007)。结论保留与切除髌下脂肪垫用于全膝关节置换术在改善膝关节功能、膝关节活动度方面疗效相当,但前者可明显降低髌腱短缩及膝前痛发生率,且并未增加髌腱损伤风险,临床应用价值较高。     

髌下脂肪垫的MRI定量检测及其在膝关节骨关节炎中的应用进展

髌下脂肪垫（IPFP）是参与膝关节骨关节炎（KOA）发生、发展的重要关节组织。MRI可以直接观察和量化IPFP的变化,包括其形态学表现、信号强度变化及血流灌注变化等,有助于推测IPFP在KOA发病及进展中的作用。就基于MRI对IPFP的定量检测方法及其在KOA中的研究现状和进展予以综述。     

髌下脂肪垫损伤的诊治

髌下脂肪垫(以下称脂肪垫)损伤在门诊中较为常见。今就本人几年来治疗本病的一些体会谈谈看法。病因(一)直接外伤:多见于撞击、扭挫。在膝关节外伤时,脂肪垫亦可受累,造成脂肪垫     

股四头肌脂肪垫和股前脂肪垫形态和信号特征与膝关节骨性关节炎的相关性研究

目的:探讨股四头肌脂肪垫(QFP)和股前脂肪垫(PFP)的形态和信号特征与膝关节放射学骨性关节炎(ROA)结构改变的关系.方法:回顾性分析纳入的60个临床资料齐全的膝关节X线和MRI检查图像资料,于矢状面PDW-SPAIR序列图像上定量测量QFP最大前后径、最大头尾径、最大斜径和最大面积及PFP的最大厚度.半定量评估Q...     

股骨外侧髁与髌韧带撞击是导致外上侧髌下脂肪垫水肿的原因吗?

正摘要目的评估膝伸肌机制是否与MRI显示外上侧髌下脂肪垫水肿相关。材料与方法本研究由学院伦理审查委员会批准,并获得全部病人知情同意书。采用MRI前瞻性评价外上侧髌下脂肪垫水肿病人(n=30)和无髌下脂肪垫水肿的对照组病人(n=60)。对照两组病人的人口数据与伸肌机制特征,包括滑车沟深度     

综合康复治疗膝关节骨性关节炎的临床分析

目的：探讨综合康复治疗膝关节骨性关节炎（ KOA）的治疗效果。方法将84例KOA患者随机分为两组。治疗组44例,采用针灸、超短波,中频离子导入、运动疗法、ADL指导的多种治疗。对照组40例,采用中频离子导入治疗,以上治疗均10次为一疗程,每日一次。结果治疗组的疗效优于对照组差异有显著性。结论综合康复治疗是治疗KOA的有效方法。     

Biomechanical and kinematic influences of a total infrapatellar fat pad resection on the knee

BACKGROUND: This biomechanical study was performed to evaluate the consequences of total infrapatellar fat pad resection on knee kinematics and patellar contact pressure. HYPOTHESIS: Resection of the infrapatellar fat pad produces significant changes in knee kinematics and patellar contact pressure. STUDY DESIGN: Biomechanical cadaveric study. METHODS: Isokinetic knee extension was simulated on 10 human knee cadaveric specimens (6 men, 4 women; mean age at death, 44 years). Joint kinematics were evaluated by an ultrasound-based 3D motion analysis system, and retro-patellar contact pressure was measured using an electronic pressure-sensitive film. All data were taken before and after resection of the infrapatellar fat pad and statistically analyzed. RESULTS: A total resection of the infrapatellar fat pad resulted in a significant decrease of the tibial external rotation relative to the femur between 63 degrees of flexion and full knee extension (maximum: 3 degrees rotation difference at 0 degrees knee flexion, P = .011), combined with a significant medial translation of the patella between 29 degrees and 69 degrees of knee flexion (range, 0.9-1.3 mm, P = .017-.028). Retro-patellar contact pressure was significantly reduced (from 20% to 25%, P = .008-.021) at all flexion angles. CONCLUSION: A resection of the infrapatellar fat influences patellar biomechanics and knee kinematics. CLINICAL RELEVANCE: The infrapatellar fat pad may have a biomechanical function and may play a role in anterior knee pain syndrome.     

Infrapatellar fat pad pressure and volume changes of the anterior compartment during knee motion: possible clinical consequences to the anterior knee pain syndrome

This biomechanical study was performed to measure tissue pressure in the infrapatellar fat pad and the volume changes of the anterior knee compartment during knee flexion–extension motion. Knee motion from 120° of flexion to full extension was simulated on ten fresh frozen human knee specimens (six from males, four from females, average age 44 years) using a hydraulic kinematic simulator (30, 40, and 50 Nm extension moment). Infrapatellar tissue pressure was measured using a closed cell sensor. Infrapatellar volume change in the anterior knee compartment was evaluated subsequent to removal of the fat pad using a water-filled bladder. We found a significant increase of the infrapatellar tissue pressure during knee flexion, at flexion angles of <20° and >100°. The average tissue pressure ranged from 343 (±223) mbar at 0° to 60 (±64) mbar at 60° of flexion. The smallest volume in the anterior knee compartment was measured at full extension and 120° of flexion, whereas the maximum volume was observed at 50° of flexion. In conclusion, the data suggest a biomechanical function of the infrapatellar fat pad at flexion angles of <20° and >100°, which suggests a role of the infrapatellar fat pad in stabilizing the patella in the extremes of knee motion.     

复元胶囊对膝骨关节炎患者血清MMP-3和TIMP-1表达变化的影响

目的观察复元胶囊治疗膝骨关节炎（KOA）患者血清基质金属蛋白酶-3（matrix metalloproteinase-3,MMP-3）和基质金属蛋白酶抑制因子-1（tissue inhibitor of metalloproteinase - 1, TIMP - 1）的表达变化。方法将60例辨证为肝。肾不足、筋脉瘀滞证的KOA患者随机分为两组,治疗组口服复元胶囊,对照组口服仙灵骨葆胶囊,4W为1疗程,共服用3疗程。另将30例健康查体者纳入健康组。治疗前后收集血清,采用酶联免疫吸附试验检测MMP-3和TIMP-1的表达,观察药物不良反应。结果治疗前治疗组、对照组血清MMP-3、TIMP-1水平较健康组明显增高（P〈0．05）;治疗后治疗组和对照组血清MMP-3、TIMP-1水平较治疗前明显降低（P〈0．05）,未见明显的毒副作用。结论复元胶囊通过调节MMP-3和TIMP—1表达变化发挥治疗KOA的作用。     

Therapeutic ablation of the infrapatellar fat pad under ultrasound guidance: a pilot study

AIM: To describe the technique of ablation of the infrapatellar fat pad using alcohol injection under ultrasound guidance and to assess the efficacy of the procedure in the relief of pain arising from fat pad impingement. MATERIAL AND METHODS: Consecutive patients with anterior knee pain and pathology in the infrapatellar fat pad, confirmed on magnetic resonance imaging (MRI), were enrolled in the study. A mixture of alcohol and local anaesthetic was injected under ultrasound guidance, with repeat injections at three-weekly intervals. Twelve patients (seven men, five women), mean age 30.8 years, underwent the procedure. Visual analogue scale pain scores were recorded before treatment and at the end of the treatment course. RESULTS: Before treatment, the mean (+/-SD) pain score was 7.75 (+/-1.14). Patients underwent a mean of four injections (range 2-6). After treatment, the mean pain score was 2.92 (+/-2.61), representing a decrease of 62% (p<0.001). Follow-up data were complete for all 12 patients. Other than short-lived pain at the time of injection, no serious side-effects were encountered. CONCLUSION: In patients with pain due to inflammation of the infrapatellar fat pad, ultrasound-guided alcohol ablation of the fat pad can provide effective symptom relief. The results of this pilot study indicate that a larger study is warranted to assess the long-term benefits of this well-tolerated procedure.     

Hoffa's recess: incidence, morphology and differential diagnosis of the globular-shaped cleft in the infrapatellar fat pad of the knee on MRI and cadaver dissections

We frequently observed a fluid-like indentation at the inferior posterior margin of Hoffa's fat pad of the knee and sought to establish the incidence and differential diagnostic criteria of this cleft. In total, 133 MRI studies and 35 cadaver specimens were analyzed for the location, size, and shape of clefts at the inferior posterior margin of Hoffa's fat pad. The incidence of a fluid-like ovoid cleft on MR images was 13.5% and in cadavers 14.3%. The cleft was located just below the insertion of the infrapatellar synovial fold (plica synovialis infrapatellaris, ligamentum mucosum). More linear-shaped indentations at the posterior margin were visible in all patients and cadavers due to the horizontal course of the alar folds. A fluid-filled indentation within the inferior posterior margin of Hoffa's fat pad has to be expected in more than 10% of knee studies and should not be confused with tumors like ganglion cysts. We term this cleft the infrahoffatic recess. One hypothesis of its origin concerns the embryological regression process of the infrapatellar membrane into the infrapatellar synovial fold. It should not be confused with linear clefts due to the alar folds.     

Fibrous scar in the infrapatellar fat pad after arthroscopy: MR imaging

PURPOSE: We describe the MR appearance of fibrous scars in the infrapatellar fat pad after arthroscopy. MATERIALS AND METHODS: The subjects were 96 patients who underwent arthroscope-assisted anterior cruciate ligament (ACL) reconstruction and were examined by oblique sagittal MR imaging at different follow-up intervals. Two observers evaluated the characteristics of the fibrous scars in the infrapatellar fat pad. RESULTS: All fibrous scars with low signal intensity were accentuated at the portal and coursed horizontally through the infrapatellar fat pad. The fibrous scar within the fat pad occurred and peaked within 6 months after arthroscopy. It then subsided gradually and had disappeared by one year later in nearly half of the patients. CONCLUSION: Identifying MR imaging characteristics of fibrous scars in the fat pad after arthroscopy may be clinically helpful to differentiate these scars from other abnormalities that involve the infrapatellar fat pad.     

膝骨关节炎患者步态动力学相关参数分析

目的:分析膝关节骨性关节炎(KOA)患者下肢关节的动力学变化特点,为进一步研究其发病机制及临床治疗提供依据。方法:选取胫股关节OA患者60名,根据K/L影像分级分为轻型患病组(LKOA)和重型患病组(MKOA);另取年龄、性别、体重、身高与患病组相当的30名正常受试者作为健康对照组(CON)。利用VICON三维动作分析系统测试并比较实验对象下肢各关节动力学相关参数。结果:支撑早期,LKOA组膝关节最大外展力矩大于MKOA组和CON组(P<0.001);MKOA组支撑期中期膝关节内收力矩第1峰值显著大于LKOA组(P<0.05)和CON组(P<0.001);LKOA组支撑末期膝关节内收力矩第2峰值明显低于CON组(P<0.05);MKOA组髋关节内收力矩第1峰值显著低于CON组(P<0.05)。结论:胫股关节KOA病情越重,膝关节内侧面负荷越大;与健康人相比,OA患者髋关节外展力矩较大,重型患者髋关节内收力矩较小。     

Intra-articular ganglion cysts of the knee: clinical and MR imaging features

The purpose of this study was to present clinical and MR imaging features of intra-articular ganglion cysts of the knee. Retrospective review of 1685 consecutive medical records and MR examinations of the knee performed at three imaging centers allowed identification of 20 patients (13 men and 7 women; mean age 35 years), in whom evidence of intra-articular ganglion cyst was seen. Of the 20 ganglion cysts, 5 were found in the infrapatellar fat pad, 10 arose from the posterior cruciate ligament, and 5 from the anterior cruciate ligament. Three of five patients with ganglion cyst in the infrapatellar fat pad had a palpable mass. In 7 of 15 patients with ganglion cyst in the intercondylar notch, exacerbation of pain occurred in a squatting position. On four MR arthrographies, ganglion cysts were an intra-articular round, lobulated, low signal intensity lesion. Five cases of fat-suppressed contrast-enhanced T1-weighted SE images demonstrated peripheral thin rim enhancement. The clinical presentation of intra-articular ganglion cyst is varied according to its intra-articular location. The MR appearance of intra-articular ganglion cyst is characteristic and usually associated with the cruciate ligament or the infrapatellar fat pad. Magnetic resonance arthrography has no definite advantage over conventional MR in the evaluation of the lesion. For intra-articular ganglion cyst in the infrapatellar fat pad, fat-suppressed contrast-enhanced MR imaging could be useful, because a thin, rim-enhancing feature of intra-articular ganglion cyst allows it to be distinguished from synovial hemangioma and synovial sarcoma. Received: 29 June 2000 Revised: 13 September 2000 Accepted: 15 September 2000