复发性多软骨炎研究进展

复发性多软骨炎(relapsing polychondritis，RP)是一种罕见的以软骨组织发作性炎症为特征的病变，由于本病报道日益增多，对其临床特征、发病机制的认识及治疗也日益深入．现将有关本病的研究进展综述如下。     

跖骨头籽骨骨软骨炎1例报告

跖骨头籽骨骨软骨炎，临床少见。报告1例如下。 1临床资料 男，51岁，无任何诱因出现左足第一跖骨头处疼痛2年，伴间歇件跛行，负重行走时加重，休息、热敷缓解。否认外伤及感染史。经保守治疗无效后收入院。查体：左足无畸形，跖关节底稍肿胀，压痛明显，趾背伸感跖趾关节处疼痛加重。     

复发性多软骨炎误诊2例

1　病例报告例 1　男 ,5 2岁。主因反复发作喘憋、气促、呼吸困难 8个月 ,加重 2 d入院。 8个月前无明显诱因出现喘憋、气促、呼吸困难 ,就诊于当地医院 ,诊为重症哮喘 ,行气管插管及呼吸机辅助通气治疗 ,好转后出院。此后上述症状多次发作 ,当地医院均以哮喘急性发作予激素治疗后症状改善。 2 d前再次出现喘憋、气急、呼吸困难。病程中无发热、声嘶、关节肿痛及体重减轻。查体 :双耳廓无畸形 ,鼻无异常。喉及肺部可闻及吸气性哮鸣音 ,双肺未闻及湿罗音。心、腹及神经系统未见异常。辅助检查 :WBC7.8× 10 9/ L ,Hb145 g/ L ,ESR48mm/ h…     

复发性多软骨炎累及气管误诊1例分析

对复发性多软骨炎累及气管误诊1例分析如下。1病历摘要女,45岁。因反复咳嗽3 a余,伴喘憋1个月,加重10 d余入院,患者于3 a前开始无明显诱因反复咳嗽,咳白黏痰,未引起重视,在外抗感染治疗后时轻时重。入院前1个月出现喘憋渐进性加重,活动时气喘明显加重,曾在当地卫生院诊断为COPD,经抗炎、平喘治疗无明显好转,近10 d较严重,不能平卧,伴声嘶,无咽痛及双下肢浮肿。查体:喘息貌,营养良好,坐位呼吸,可见吸气性三凹征,皮肤黏膜无黄染,浅表淋巴结未触及肿大,鞍鼻,球结膜充血,咽稍红,双扁桃体不大,气管居中,甲状腺不大,颈静脉无怒张,双肺呼吸音粗,…     

剥脱性骨软骨炎MRI诊断价值

目的:探讨MRI在剥脱性骨软骨炎(OCD)诊断中的价值。方法:回顾性分析15例经膝关节镜及手术证实的剥脱性骨软骨炎MRI影像资料。评价剥脱性骨软骨炎的MRI特点。结果:15例OCD MRI表现为关节持重部位软骨下骨质缺损区。5例为T1低信号,T2低信号灶。8例为T1低信号、T2高信号。2例为T1低信号、T2等信号。病灶周缘呈低信号环绕。关节软骨变薄、粗糙,部分中断、缺如。与关节镜检查结果一致。结论:OCD在MRI有特征性表现,MRI对其可作出明确诊断。     

耻骨联合骨软骨炎1例

患者女,２７岁。足月顺产一胎后感会阴部疼痛一月余,下肢活动受限。骨盆正位片示：耻骨联合间隙增大,达１４ｃｍ,两侧耻骨轻度上下错位约０４ｃｍ,双侧耻骨联合面毛糙,骨质密度增高,左侧耻骨联合面呈弧形切迹样骨质破坏,破坏边缘呈鼠咬状（图１）。Ｘ线诊断：...     

直线偏振光联合辣椒碱软膏治疗骨软骨炎疗效分析

目的：观察直线偏振光联合辣椒碱软膏治疗胫骨结节软骨炎和足舟骨软骨炎的疗效。方法：对86例骨软骨炎患者,随机分为两组,每组43例。实验组用直线偏振光联合辣椒碱治疗;对照组单用辣椒碱软膏治疗。观察经过不同治疗后疼痛缓解情况。结果：治疗后直线偏振光联合辣椒碱软膏治疗疼痛减轻率为93.1%,单用辣椒碱软膏治疗疼痛减轻率为86.1%（P〈0.01）。结论：直线偏振光联合辣椒碱软膏治疗骨软骨炎疗效优于单用辣椒碱软膏治疗。     

剥脱性骨软骨炎MRI诊断分析

目的探讨MRI在剥脱性骨软骨炎诊断中的应用价值。方法回顾性分析经手术组织病理证实的30例剥脱性骨软骨炎患者的MRI影像资料。结果病变位于膝关节股骨内侧髁及外侧髁26例,距骨滑车关节面内侧及外侧4例;MRI表现为软骨不光滑、粗糙、变薄甚至坏死,软骨碎片与宿骨脱落形成关节内游离体;关节不同程度积液21例;并关节退行性改变4例中3例为膝关节,1例为踝关节。结论MRI检查可作为诊断剥脱性骨软骨炎首选检查方法。     

封闭小针刀治疗胫骨结节骨软骨炎

目的依据胫骨结节骨软骨炎发病机制，探讨寻求胫骨结节骨软骨炎更为有效的治疗方法。方法对48例胫骨结节骨软骨炎患者应用封闭小针刀临床治疗观察。结果应用此方法治疗总有效率达到100％。结论此方法简单，操作方便，易于掌握，值得临床推行。     

坐骨耻骨骨软骨病的临床影像学诊断(附23例报道)

目的:探讨坐骨耻骨骨软骨病的临床影像学表现。材料与方法:对23例坐骨耻骨骨软骨病的临床影像学表现和随机抽取100例因其他原因摄骨盆正位片进行分析。结果:病变组23例中,16例为单侧,7例为双侧。X线表现为坐骨耻骨结合处局限性骨膨隆,8例有层状改变,病变区内密度不均,有类圆形低密度透光影,骨皮质完整,8例周围骨质轻度增生,未见骨膜反应和软组织改变。8例CT表现为坐骨耻骨结合处局部膨大,其内有低密度透光区,有碎裂,骨皮质连续性中断,断端边缘欠整齐,邻近的髓腔轻度硬化,无明显的死骨和骨膜反应,邻近的软组织正常;正常组中14例出现上述X线改变,其中3例为双侧性。结论:坐骨耻骨骨软骨病的影像学表现较典型,结合临床表现,即可作出诊断及鉴别诊断。     

腰椎间盘退变伴终板骨软骨炎的低场MRI诊断

目的探讨低场MRI对腰椎间盘退变伴终板骨软骨炎的诊断价值。方法总结90例(196例次)腰椎间盘退变同时合并终板骨软骨炎的MRI表现。结果按Modic分型,I型112例(57．1％);Ⅱ型25例(12．8％):III型59 例(30．1％)。病变好发下腰段,累及椎间盘双侧面多见,伴椎间盘变性突出167 例(85．2％),骨质增生173例(88．3％),椎管狭窄170例(86．7％)。结论低场MRI能清楚的显示腰椎间盘退变及终板骨软骨炎的病变部位、范围及形态特点,较具一定特征性,准确诊断有助临床治疗方案的选择。     

Repair of large osteochondritis dissecans lesions using a novel multilayered tissue engineered construct in an equine athlete

Osteochondral lesions resulting from osteochondritis dissecans are problematic to treat and present a significant challenge for clinicians. The aims of this study were to investigate the use of a scaffold‐assisted microfracture approach, employing a novel, multilayered, collagen‐based, osteochondral graft substitute in the treatment of severe osteochondritis dissecans of both lateral femoral trochlear ridges in an equine athlete, and to assess the potential of this novel scaffold to enhance repair of the osteochondral unit. A 15 month‐old female filly presented with large osteochondritis dissecans lesions involving both femoral lateral trochlear ridges. After routine arthroscopic debridement and microfracture of the subchondral bone, multilayered osteochondral defect repair scaffolds were implanted into the fragmentation beds in both left and right femoropatellar joints via mini‐arthrotomies. Exploratory arthroscopy 5 months postimplantation revealed smooth cartilaginous repair tissue, contiguous with the adjacent cartilage, covering the defect. At 22‐month follow up, the filly had no signs of lameness and was exercising at her intended level. Radiographically, although still slightly flattened, the femoral trochlear ridges were smooth, with no evidence of osteoarthritis. Ultrasonographically, the defects were filled with bone and covered with an overlying cartilaginous layer, with the trochlear ridge contour almost entirely restored. This report demonstrates the effective clinical use of this novel, multilayered, osteochondral defect repair scaffold in the treatment of osteochondritis dissecans of an equine athlete. The successful repair achieved here using this novel scaffold in an equine patient with large bilateral lesions shows the potential for clinical translation in the treatment of human patients presenting with osteochondral defects. Copyright © 2016 John Wiley & Sons, Ltd.     

Subchondral bone as a novel target for regenerative therapy of osteochondritis dissecans: A case report

BACKGROUNDOsteochondritis dissecans (OCD) is a rare disease of unclear cause characterized by subchondral bone damage and overlying cartilage defects. The current report presents the results of subchondral bone as a novel target for implantation of peripheral blood stem cells (PBSCs) in the treatment of OCD.CASE SUMMARYA 16-year-old patient diagnosed with OCD underwent subchondral bone implantation of PBSCs. Four months later, the patient''s visual analog scale scores, Western Ontario and McMaster University osteoarthritis index, and whole-organ magnetic resonance imaging score improved significantly, and regeneration of cartilage and subchondral bone was observed on magnetic resonance imaging.CONCLUSIONThis is the first case of OCD treated with subchondral bone as an implantation target of PBSCs, which highlights the importance of subchondral bone for cartilage repair. This treatment could be a potential option for articular cartilage and subchondral bone recovery in OCD.     

脊髓纵裂1例

患者女,24岁,车祸致腰背部疼痛伴下肢麻木3h入院。查体:胸腰段棘突压触及扣击痛,双下肢运动可,躯干无明确感觉障碍平面,足背动脉搏动好,双侧股四头肌、胫前肌、拇长伸肌、小腿三头肌肌力为Ⅴ级,肌张力不高,双膝、跟腱对称,巴氏征及克氏征未引出。X线片示:胸11、12椎体呈楔行改变,建议进一步检查除外骨折。CT示:胸10~12椎体形态异常,前后径小,椎体及附件未见骨折,胸11椎体前缘见裂隙影,周围见骨质硬化(图1),椎管内见平行排列的两个圆形软组织密度影。MRI示:胸9、11、12椎体形态不规则,胸11椎体见异常信号影,T1WI、T2WI均呈低信号,FST2…     

石骨症1例

患者男,16岁,于2007年8月22日在做跳远动作时摔倒,致右侧上臂及右大腿肿痛畸形。查体:神志清楚,智力正常,全身淋巴结不大,肝肋下2.5cm,脾肋下1.5cm,身高156cm。化验:RBC3.86×1012/L、WBC9.87×109/L、N51%、L45%、嗜碱C1%、嗜酸2%、单核1%、ESR7mm/h。胸片两肺未见明显异常。患者8岁时曾在家中跌倒致右侧胫腓骨中段骨折,在外院行钢板内固定,8个月后行走正常。患者否认石骨症家族史。X线检查(图1、2):右侧肱骨干骺端及股骨近端干骺部可见多条横行浓密带;髂骨翼有晕轮样致密带;锁骨、肩胛骨及肋骨骨皮质增厚,髓腔模糊甚至消失;脊柱表…     

骨斑点症1例

患者男,23岁,5年前因右侧大腿下段皮肤结节状纤维组织增生(犹如瘢痕疙瘩)行手术治疗,现感其局部不适而来院检查.X线检查:右股骨远段干骺端松质骨小梁清晰粗大,骨皮质下可见散在的多个0.2～1.2 cm大小不等,呈圆形、卵圆形、索条形或不规则的斑点状致密阴影,其中少数斑点状病灶与骨皮质相连,少数零星斑点于松质骨内,长轴与骨小梁平行,未见骨质破坏(见图).     

纵隔血管周细胞瘤1例

患者女,48岁,胸痛、活动后气促明显半年.发病以来,体重减轻10余斤.CT表现(图1):后上纵隔脊柱左侧见一大小约76 mm×80 mm×74 mm类圆形肿块影,密度不均匀,其内可见多个低密度区,边缘似可见完整包膜,向左突入左肺野,与周围肺组织分界欠清,主动脉弓受压,脂肪间隙尚存在,增强扫描呈明显不均匀强化,其内见多个小囊性低密度区及间隔影,边界显示更清晰,左肺上叶支气管管腔受压、变窄,邻近肺组织受压征象.左侧胸腔弧形液性密度影,左叶间裂积液.