颈椎间盘突出症合并夏科氏关节病1例

患者,男,63岁。颈部及右上肢疼痛不适2年余,在外院以“颈椎病”对症治疗,症状时轻时重。近8个月来,右上肢无力和肩肌、上臂肌肌萎缩进行性加重,右肩关节渐进性活动不便,现已弹性固定。无外伤史。检查:颈椎向右侧弯畸形,压痛明显,活动受限,右肩肌及上臂肌肌萎缩明显,右肩关节弹性固定,肱骨头向前脱位,于锁骨下可触及肱骨头,无明显压痛。右肱二、三头肌腱反射未引出,霍夫曼氏征(一)。X线片示:右肩关节前脱位,关节边缘有骨赘增生。MRI片示:C3     

Chiari畸形Ⅰ型合并夏科氏关节病1例

Ｃｈｉａｒｉ畸形Ⅰ型合并夏科氏关节病１例宋若先张云昌刘晓平患者，女，５６岁。因左肘关节肿胀、活动受限１个月入院。１月前自觉左上肢酸软无力，左肘肿胀，伸屈不灵，且有摩擦感，渐加重。于当地县医院拍片诊断为“左肘滑膜软骨瘤病”，患者未接受手术而入我院。既往...     

足夏克氏关节病的诊疗研究进展

足夏克氏关节病是临床罕见病,其发病机制包括神经创伤理论、神经血管理论、综合理论、炎症因子理论等。该疾病以足踝进行性关节及骨质破坏为显著特征,常规X线片检查对该病早期诊断不敏感,CT及MRI的表现具有特征性,可以对疾病的骨质及软组织病变做出全面的评价,结合足踝部肿痛、皮肤温度升高等临床表现不难做出诊断。夏克氏足分类方法较多,包括解剖学、影像学和临床分型等,目前常用的改良Eichenholtz分期对于疾病的评估更全面,对治疗更具指导意义。根据疾病的分期,治疗上主要包括不负重支具保护、药物及手术治疗等,早期诊断、支具保护,可以保护关节,延缓畸形发展;药物治疗的疗效目前尚缺乏长期明确的结论;对于晚期患者,必须积极采取手术治疗,以获得一个稳定有功能的足踝关节,降低截肢率。     

Chiari畸形合并夏科关节病1例

1病例资料患者,男,60岁。因右上肢无力、感觉减退伴关节畸形10年入院。查体:颈椎无畸形,无压痛,活动良好。右胸背T2～3、右上肢触觉正常,痛、温觉消失。右上肢肌萎缩,肘关节畸形,外翻30°,无红肿、压痛。右肘屈曲65°～150°。右上肢肱二、三头肌反射未引出,Hoffman征阴性。MRI示:小脑扁桃体疝入枕骨大孔平面下7mm,颈髓、胸髓中央管扩张,呈长T1、长T2信号。见图1。X线片示:右肘关节间隙狭窄,关节畸形,周围有大量云絮状异位骨化及钙化影。见图2。肌电图:右小指展肌、右第1骨间背侧肌见失神经电位。神经电图:右尺神经前臂段运动传导速度减…     

脊柱夏科氏关节病的诊断与治疗

脊柱夏科氏关节病是一种罕见的具有进展性的严重的退行性脊柱疾病。其临床表现隐匿且不典型,容易导致漏诊、误诊,延误病情,影响预后。目前国内尚无系统性分析脊柱夏科氏关节病的文献。脊柱夏科氏关节病的病因主要分为脊髓损伤及非损伤性神经病变两类,其中脊髓损伤引发脊柱夏科氏关节病的危险因素包括长节段固定、脊柱侧凸、椎板切除、脊柱负荷过大的运动和肥胖。脊柱夏科氏关节病好发于下胸椎或腰椎,常见症状是脊柱畸形、坐姿不平衡和局部疼痛。根据潜在疾病引起本体感觉及痛温觉损害,影像学上大量的骨破坏和吸收以及大量新骨形成,组织学提示非特异性慢性炎症,并排除其他炎性和肿瘤性疾病,可以作出诊断。对稳定性好、未合并感染、神经功能平稳、未出现皮肤瘘口、坐姿不平衡或自主神经功能紊乱的脊柱夏科氏关节病患者,可以考虑保守治疗。对症状持续大于6个月、脊柱不稳定、皮肤出现瘘口或并发感染的患者建议优先选择手术。术前应评估髋关节的异位骨化或强直,术中重视病灶内坏死组织、炎症组织的充分清除以及足量的植骨,建议融合至骶骨或骨盆。术后并发症包括内固定失败、新的夏科氏关节形成、伤口愈合困难、感染等。对脊髓损伤合并截瘫的术后患者,建议定期、系统、长期随访,观察整体胸腰椎而非仅仅手术部位的影像。熟知脊柱夏科氏关节病的危险因素及典型症状,有助于早期发现和诊断,并选择适当的治疗方案。     

脊髓空洞症合并夏科氏关节病一例报告

脊髓空洞症合并夏科氏关节病一例报告李欣朱式仪马宝通患者男，３１岁。右上肢放射性刺痛、无力１０余年，右肘粗大２年。无明显诱因。近年来右上肢无力和肌萎缩进行性加重。在外院以“颈椎病”对症治疗无效。检查：颈椎无畸形，压痛（＋），活动良好。右上肢肌萎缩，尤以...     

Chiari畸形合并夏科氏关节1例

患者 ,男 ,40岁。因右肩部肿、疼 ,活动不适 3月 ,在当地乡镇卫生院行右肩平片检查 ,初步诊断 :右肩关节脱位 ,未治疗。来我院 ,门诊询问病史无牵拉及外伤 ,复拍片 :见右肱骨头及关节盂破坏 ,骨质密度不规则增高 (图 1) ,放射科考虑为骨肿瘤 ,收住院治疗。入院后查体 ,生命体征正常 ,浅表淋巴结无肿大 ,心肺腹 (一 ) ,颈项稍短 ,后发际低 ,右肩关节肿大 ,肩上抬外展无力 ,三角肌肌力Ⅳ级 ,右上肢右背部痛温觉减退 ,肱二、肱三头肌肌腱反射 ( ) ,右膝腱反射 ( ) ,右霍夫曼氏征 (一 )。进一步行右肩关节ＣＴ平扫 (图 2 ) ,诊断为“右肩…     

脊柱夏科特关节病1例报告

夏科特关节病又称神经性关节病,由于各种原发病,患者痛觉和位置觉丧失,不能本能地调整肢体位置,关节失去保护性反射,同时,关节区域的血管及破骨细胞异常增殖导致局部代谢紊乱,最终导致加速的严重关节退行性变,表现为骨与软骨的破坏、关节面崩解和关节脱位^[1-2]。不同的原发病有不同的好发部位,脊髓痨患者好发于脊柱关节,脊髓空洞患者好发于上肢的肩关节、肘关节和腕关节,糖尿病患者则好发于足、踝关节^[3]。脊柱夏科特关节病（CSA）目前国内相关报道较少。本院收治1例胸椎脊髓损伤后继发CSA及髋关节病变的患者,现将诊疗过程报告如下。     

全膝关节置换术治疗甲型血友病膝关节病变的疗效分析

目的 评价全膝关节置换术治疗甲型血友病膝关节病变的疗效、手术特点、假体选择及凝血因子替代治疗的有效性和安全性.方法 2003年6月至2009年4月,采用全膝关节置换术治疗甲型血友病膝关节病变患者19例(25膝);年龄18～54岁,平均33.4岁.Ⅷ因子替代治疗方案为手术当天补充至100%,术后3 d内80%以上,术后3 d至一周60%以上.术后进行以持续被动活动器(CPM)为主的功能锻炼,锻炼时机为Ⅷ因子输注后6 h内.观察比较手术前后膝关节HSS评分、疼痛、活动度及并发症.结果 18例(24膝)患者得到随访,随访时间7～54月,平均31个月.术前患者HSS评分为平均(51±14)分(31～64),术后HSS评分为平均(86±9.5)分(62～110).关节活动度由术前平均55°±26.3°(10°～100°),改善为术后平均82°±18.6°(60°～100°).屈曲畸形由术前平均19°±13°(0°～45°),改善为术后平均2.7°±3.2°(0°～10°).所有患者术后1～5 d时间内检测的平均Ⅶ因子浓度为74.07%.术后1例发生关节出血,1例发生腓总神经麻痹,1例患者术后17个月因假体感染行翻修术.结论 在合理补充凝血因子条件下,全膝关节置换术是治疗血友病膝关节病变的有效方法,可明显改善膝关节症状和活动度.     

The mid-term clinical outcomes of total knee arthroplasty in the management of end-stage hemophilic arthropathy

Objective:This study aimed to evaluate the mid-term clinical outcomes of total knee arthroplasty (TKA) in the management of end-stage hemophilic arthropathy.Methods:Eleven patients (15 knees) undergoing TKA with stiff knees were retrospectively evaluated. TKA was performed in all patients without additional surgical interventions such as posterior capsular release, hamstring release, synovectomy, VY quadricepsplasty, or tibial tubercle osteotomy. All patients were evaluated for clinical and radiological results at follow-ups. Functional evaluation and pain status were assessed using the Knee Society Score and Visual Analogue Scale.Results:The mean age at the time of operation was 40.8 ± 11.8 years (range = 30–64 years). The mean follow-up was 51.2 ± 20.6 months (range = 24–95). The mean flexion contracture significantly decreased from 17.6 ± 11.3 to 1.7 ± 2.8 degrees, and the mean maximum flexion increased dramatically from 55.6 ± 20.5 to 109.2 ± 16.2 degrees (P < 0.001). Statistical significant improvement in flexion and flexion contracture degrees continued up to the postoperatively 18 months. The mean Knee Society Score increased from 22.7 ± 2.4 points preoperatively to 87.8 ± 3.8 points at the last follow-up (P < 0.001). The mean cost of coagulation factor consumption and blood transfusion accounted for 78% of the total cost. Conclusion:This study has shown that TKA is an effective treatment for relieving pain and improving both ranges of motion and quality of life in managing end-stage hemophilic arthropathy of the knee joint.Level of Evidence: Level IV, Therapeutic Study     

全膝关节置换术治疗血友病膝关节炎

目的：评价全膝关节置换术治疗血友病膝关节病变的疗效、手术特点、假体选择及凝血因子替代治疗的有效性和安全性。方法：2008年1月至2010年6月,采用全膝关节置换术治疗男性血友病性膝关节炎患者10例（12膝）,年龄17～49岁,平均33.6岁,其中8例为甲型血友病,2例为乙型血友病。根据Arnold和Hilgartner影像学分级：7膝为Ⅳ级,5膝为V级。Ⅷ因子替代治疗方案为手术当天补充至80%以上,术后3d内60%以上,术后3d～2周40%以上。Ⅸ因子替代治疗方案为手术当天补充凝血酶原复合物制剂（PCC）使FⅨ活性水平〉40%,术后3d内FⅨ活性水平〉30%,术后3d～2周FⅨ因子活性水平〉20%。观察比较手术前后膝关节HSS评分及各单项评分（包括疼痛、功能、活动度、肌力、屈曲畸形及稳定性）。结果：10例（12膝）均获随访,时间6～24个月,平均11个月。术前HSS（44.9±12.5）分（29～62分）改善为术后（84.4±10.2）分（72～96分）;各单项评分包括疼痛、功能、活动度、肌力、屈曲畸形及稳定性均较术前明显提高。同时发现在疼痛方面由术前平均（8.5±4.1）分改善为术后（24.5±4.4）分,TKA缓解疼痛作用明显。结论：在严格围手术期凝血因子的替代治疗下,TKA已成为血友病性膝关节炎一种安全有效的治疗手段,可以有效减轻膝关节疼痛,改善膝关节功能。     

The treatment of dupuytren's contracture

It is evident from a review of the literature that conservative treatment, namely, stretching, heat and massage and the use of ointments and irradiation, has failed to prevent or cure Dupuytren's contracture. Following an experience of more than twenty years, during which time I have seen 315 patients who were afflicted with this condition and have operated on more than 100 of them, I have come to the conclusion that the operation of choice is surgical excision of the involved palmar fascia. The result has been satisfactory in about 90 per cent of the cases. Subcutaneous section of the constricting bands ot palmar fascia is a satisfactory method of treating certain patients. A carefully managed program of physical therapy is necessary. A combination of excision, splinting and physical therapy results in a useful functioning extremity.     

Total knee arthroplasty for the treatment of chronic hemophilic arthropathy

Total knee arthroplasty (TKA) for hemophilic (factor VIII deficiency) arthropathy is a complex and demanding procedure with a high complication rate. However, the long-term benefits have not previously been reported. This study reviews 19 TKAs performed for hemophilic arthropathy that were followed for a minimum of 5.5 years and an average of 9.5 years. At present, 13 knees have good or excellent results, and six knees rate as poor or failures. Those patients with excellent results have maintained good pain relief and function. Four of the six failures were among the first seven arthroplasties performed, when only 80% factor VIII coverage was used during the perioperative period. Since the use of 100% factor VIII coverage was instituted, the failure rate has declined. Ten of the 19 knees suffered complications, including one deep infection, six superficial skin necroses, three nerve palsies, seven postoperative bleedings, and one transfusion reaction. Six of the seven knees operated on under 80% factor VIII coverage had complications. Once 100% factor VIII coverage was instituted, the only complications included one skin necrosis and three postoperative bleedings. The roentgenographic failure rate has remained high with progressive roentgenographic lucencies in 13 of 19 tibial components, associated with component shift in three knees. While these roentgenographic findings have not necessarily correlated with clinical results, they are disturbing and may portend future failures. However, pain relief and improved function are maintained at longer follow-up times. The best results were obtained under 100% factor VIII coverage using a posterior stabilized prosthesis and patellar resurfacing.