Lisfranc损伤术后创伤性关节炎的临床研究

目的：评估Lisfranc损伤术后创伤性关节炎的临床研究。方法：选取本院19例伴有Lisfranc损伤的患者,其中男15例,女4例,年龄21~58岁,平均41岁。患者损伤后进行了切开复位内固定和闭合复位内固定术（采用空心螺钉和克氏针）。骨折情况：同侧7例,单独型7例,分离型5例。其中6例为开放性骨折,8例损害5个跖跗关节,6例仅有韧带损伤。采用MFS和AOFAS评分系统对结果进行评估,负重位X线片评估完全复位、半脱位、排列错乱和术后创伤性关节炎。结果：随访24~40个月,平均30个月。解剖复位组的AOFAS评分为（79.3±4.85）分,MFS评分为（80.4±4.11）分,均高于非解剖复位组的（67.5±5.13）分、（69.4±6.07）分,差异均有统计学意义（P=0.0007、P=0.0009）;非解剖组的术后创伤性关节炎发生率较解剖组更易发生（P=0.037）。4例患者发展成术后创伤性关节炎,其中1例在内固定取出后发展成横向半脱位,2例患者发展成平足。2例患者有严重的功能受限,其中1例患者进行了关节融合。复合骨折的2例患者出现伤口的表面感染。3例患者出现空心钉的断裂。结论：采用解剖复位治疗Lisfranc损伤的患者,疗效较好,很少发展成关节炎。     

Arthritis

Abstract

Horticultural therapy is a treatment modality that utilizes plants and gardening activities as vehicles in adjunctive therapy programs for all ages and for diverse diagnoses. This paper provides a brief background of horticultural therapy, and reviews Web sites and bibliographic databases to the literature on horticultural therapy.     

Arthritis psoriatica

The symptoms ofpsoriatic arthritis vary from arthralgia and enthesitis to chronic erosive and mutilating arthritis, and are seen in 6-39% of all psoriasis patients. Because of increasing awareness of the clinical signs of psoriatic arthritis among both dermatologists and rheumatologists, the diagnosis ofpsoriatic arthritis is made more often; this is important since earlier diagnosis and treatment can avoid irreversible joint destruction. The overlap between the immunological mechanisms in the pathogenesis ofpsoriasis and psoriatic arthritis has led to the identification of common therapeutic targets, of which tumour-necrosis factor (TNF) is the most important. The successful treatment of psoriasis patients with TNF-a-blocking agents has not only brought about a marked improvement in the quality of life of many patients but has also improved the insight into the pathogenesis, for example by demonstrating that the role of acquired immunity is much more important than was previously thought. The Dutch Society of Dermatology and Venereology and the Dutch Society of Rheumatology have drawn up guidelines for the treatment of patients with psoriasis and psoriatic arthritis using these so-called biologics.     

Rheumatoid Arthritis

Why self-perpetuating joint destruction is intermittent in some patients and unrelenting in others remains largely unknown, but progress has been made in identifying the different types of clinical course and tailoring specific treatment regimens for each.     

Rheumatoid Arthritis

Rheumatoid arthritis is a common inflammatory joint disorder, with a prevalence of about 1% in the general population. It shows high variability with respect to its course and prognosis. In typical cases an insidious onset of symmetrical synovitis of the small joints of the hands and feet occurs, accompanied by symptoms such as morning stiffness, weakness and fatigue. Besides clinical findings, laboratory tests and imaging techniques are other cornerstones for diagnosis of rheumatoid arthritis.Rheumatoid arthritis is anything but a benign disease, potentially leading to disability, chronic pain, morbidity and even early death. Recent studies provide strong evidence that early diagnosis and treatment are crucial for the prognosis of the disease. In recent years, great efforts have been made to detect and establish diagnostic, as well as prognostic, parameters for rheumatoid arthritis. Whereas the reliability of new diagnostic parameters has not been proven conclusively, reliable prognostic factors have been established that may help in identifying patients at high risk for progressive, disabling disease. These risk factors include: high number of joints involved at onset, marked disability, elevated acute phase reactants, a positive finding for rheumatoid factor, female gender, advanced age, presence of certain HLA class II antigens, early x-ray changes, low bone mineral density and job-related physical requirements.As the established classification criteria cover longstanding disease, but not the early stages, it appears necessary to establish a new set of diagnostic criteria for early rheumatoid arthritis. In the case of newly diagnosed rheumatoid arthritis, more attention should be paid to well-known risk factors. This allows a risk profile to be established for individual patients, which may facilitate decisions regarding therapy. A better outcome of rheumatoid arthritis would not only be advantageous for individual patients, but would also result in reduced costs for healthcare systems.     

类风湿关节炎患者动脉粥样硬化危险因素作用的研究进展

类风湿关节炎的病人具有较高的动脉粥样硬化的发病率，并具有高于普通患者的死亡率。控制动脉粥样硬化的发病，可以降低死亡率，改善生活质量。该文从传统的危险因素、炎症、血管内皮功能障碍、脂质代谢紊乱、胰岛素抵抗、高半胱氨酸血症几个方面作一综述。     

Juvenile Rheumatoid Arthritis

Abstract

Parents of a child with a chronic illness cope with a continual need for information. One of the least understood chronic childhood illnesses is Juvenile Rheumatoid Arthritis (JRA). Internet resources are examined that deal with aspects of the disease and its treatment. Support groups are an important benefit of the Internet for both parents and children dealing with the ups and downs of JRA. This article explores the topic from the personal point of view of the author, who has a daughter with JRA.     

Intractable Gouty Arthritis

Barriers between the male's immune system and his germ cells have been presumed. However, they turn out to be imperfect, which suggests that autoimmune attack may be prevented in part by chronic exposure of T lymphocytes to tolerogenic doses of “foreign” germ cell antigens. Breakdowns in such active immunoregulation may account for some cases of unexplained infertility.     

Arthritis in children

Chronic arthritis in children is uncommon. Careful clinical and laboratory studies over many years have defined subgroups of disease that have their characteristic pattern of joint development and disease course. The prognosis for children who have arthritis is generally excellent but it may take years of care by a variety of specialists to achieve optimum results.