基层医院高频超声及X线诊断婴儿发育性髋关节发育不良的应用价值

＿目的：探讨基层医院高频超声及X线诊断婴儿发育性髋关节发育不良（DD H ）的应用价值。方法：选择本院确诊为DDH 的患儿共35例（58髋）。对比分析患儿的超声与X线检查的一致性,统计分析独立使用α角、β角以及综合Graf法结果诊断 DDH 的敏感度、特异度、符合率、阳性预测值、阴性预测值。结果：X 线检查诊断为 DDH 的符合率为72．2％,比超声检查的86．1％低,但差异无统计学意义（χ2＝2．105,P＝0．147）;但两者联合诊断DDH 的符合率达100％,较X线或超声单独诊断均高。X线和超声检查结果的kappa值为0．794,可见两种检查结果基本一致。超声Graf法诊断DDH 的敏感度、特异度、符合率、阳性预测值和阴性预测值分别为86．1％、100％、91．7％、100％、82．8％,而用超声 Graf法测量的α角和β角独立诊断DDH 的敏感度、特异度、符合率、阳性预测值和阴性预测值分别为83．3％、100％、90．0％、100％、80．0％和77．8％、100％、86．7％、100％、75．0％。结论：对于婴儿DDH 的诊断符合率,超声检查较X线高,而两者联合应用可达100％。两项检查各有特点,需要临床医师结合婴儿及设备等情况合理选择。     

军事训练致膝关节滑膜炎的高频超声诊断

目的评价高频超声对创伤性膝关节滑膜炎诊断及观察疗效的价值。方法回顾性分析42例创伤性膝关节滑膜炎患者的临床资料,分析其高频超声（超声组）声像图表现,并将患者滑膜厚度、关节积液测量值与X线平片（X线组）及磁共振（MRI组）做比较。结果创伤性滑膜炎急性期滑膜厚度、关节腔积液的数值,超声组为（4．1±1．4）mm、（15．8±3．7）mm,X线组为（1．9±0．5）mm、（9．4±2．0）mm,MRI组为（4．2±1．2）mm、（16．2±4．1）mm。超声组与X线组比较均有统计学差异（P〈0．05）,与MRI组比较均无统计学差异。治疗前后滑膜厚度、关节腔积液及滑膜内血流信号高频超声测值比较有统计学差异（P〈0．05）。结论高频超声在诊断创伤性膝关节滑膜炎、判断病情和随访中有较高的应用价值。     

哪些情况需要换人工髋关节

髋关节骨性关节炎主要包括原发性骨关节炎和继发性骨关节炎。表现为髋关节疼痛、功能受限，X线片可见髋关节间隙变窄，关节周围有骨质增生，甚至髋关节变形破坏。     

X线、CT、MRI三种技术诊断退行性膝关节炎的临床价值

目的通过对比分析退行性膝关节炎X线、CT和MRI的影像学表现,为临床诊治退行性膝关节炎提供参考依据。方法回顾性分析在我院术前同时进行X线、CT和MRI检查,并经临床手术或关节镜证实的90例退行性膝关节炎的影像学资料,并加以比较。统计学方法采用SPSS 19.0处理软件,对计数资料做百分比和卡方检验,设置P0.05有统计学意义。结果 X线平片能够直接显示膝关节骨质增生、胫骨髁间嵴的变尖以及关节关系的改变;CT在X线显示征象的基础上,还可以显示关节内的钙化和游离体,对部分半月板变性也能显示,MRI在显示早期骨质增生、钙化不如X线和CT,对关节内较小游离体显示不够清楚,但对滑膜、韧带、透明软骨、软骨下骨改变较X线和CT更有优势。结论对于退行性膝关节炎,主要还是要根据病史及全面系统的骨科检查,三种影像学技术互补长短,X线平片可以作为初步筛查;CT及MRI可为临床治疗提供更精细的信息。     

高频彩色多普勒超声对早期、活动期类风湿性关节炎患者指、腕关节病变诊断价值

目的探讨高频彩色多普勒超声对早期、活动期类风湿性关节炎(RA)患者指、腕关节病变的诊断价值。方法选取自2016年9月至2017年1月于沈阳军区总医院就诊的50例RA早期患者作为RA组;同时,选择43例健康体检者,作为常规组。超声检测两组滑膜厚度、关节腔积液及骨侵蚀程度;X线影像检查RA组患者的关节骨侵蚀程度;超声检测RA组活动期患者治疗前后增生滑膜内血流信号。结果常规组860个关节中,滑膜均未见明显增厚,关节腔内均未见明显积液;RA组1 000个关节中,75.4%(754/1 000)出现滑膜增厚,58.6%(586/1 000)有关节腔积液,5.6%(56/1 000)出现骨侵蚀。两组滑膜厚度及关节腔积液比较,差异有统计学意义(P<0.05)。治疗前,RA组35例活动期患者中,28.3%(283/1 000)的关节出现血管增生。经1~2个月治疗后,283个血管增生关节中,0级血流由0增加到56.5%(160/283),Ⅰ级血流由59.7%(169/283)减少至24.0%(68/283),Ⅱ级血流由24.0%(68/283)减少至15.2%(43/283),Ⅲ级血流由16.3%(46/283)减少至4.3%(12/283),差异均有统计学意义(P<0.05)。X线检出RA组患者骨侵蚀关节个数占9.0%(9/100),而超声检出骨侵蚀个数占25.0%(25/100),差异有统计学意义(P<0.05)。结论采用高频彩色多普勒超声诊断早期、活动期RA患者指、腕关节病变,可动态观察疾病的发展变化,可作为RA早期诊断及随访的常规辅助检查。     

骨关节系统

腘窝囊内钙化体:一种特征性 X 线表现在腘窝囊内的钙化体有特征性的 X 线表现,它可经关节造影证实。真正的关节内的钙化体可发生于创伤、造成关节破坏的关节病或滑膜骨软骨瘤病。这些钙化的游离体可通过后方的关节—滑囊通     

针刀松解对膝骨性关节炎足部生物力学及X线表现的影响

 目的 探讨针刀松解对膝骨性关节炎足部生物力学及X线表现的影响.方法 选择2005-07至2008-12在我院治疗的58例膝骨性关节炎患者,随机分为针刀观察组和电针对照组各29例,比较两组JOA评分、足部生物力学及X线改变.结果 两组治疗前后以及随访时的JOA评分比较具有显著性意义(P＜0.01),足底压力分值比较差异有统计学意义(P＜0.05),两组间得分差值比较,差异具有统计学意义(P＜0.05);观察组在关节间隙变窄、髌骨外移、髌骨高位、关节腔积液方面,治疗后、随访与对照组相比,差异有统计学意义(P＜0.05),而在髁间棘骨质增生和软骨下骨硬化方面的发生率无明显差别(P＞0.05).结论 针刀疗法可直接松解、剥离压痛部分,将病灶消除,同时具有改变解除关节内外异常应力,促使关节的力学平衡恢复的作用,为临床治疗膝骨性关节炎提供了有效的治疗手段.     

肌骨超声技术观察针刀治疗膝骨关节炎患者的临床效果与影像学变化

目的探讨肌骨超声技术在观察针刀治疗膝骨关节炎患者中的影像学变化及与临床效果的相关性。方法随访观察我院2015年1月～2017年2月收治的100例(112膝)膝关节骨性关节炎患者,均采用针刀治疗,治疗前后行肌骨超声检查,并评价疼痛程度和膝关节功能,分析其相关性。结果肌骨超声在I期、II期和III期KOA患者中诊断阳性率均高于X线摄影,组间差异有统计学意义(P 0. 05)。但伴随KOA程度加重,组间差异逐渐变小。治疗后所有患者滑膜厚度、关节软骨厚度和关节积液范围均低于治疗前,组内差异有统计学意义(P 0. 05)。治疗后所有患者VAS评分为(2. 63±1. 05)分,低于治疗前的(6. 89±1. 35)分,且治疗后Lequesne指数为10. 56±2. 05,低于治疗前的17. 92±2. 86,组间差异有统计学意义(P 0. 05)。结论肌骨超声技术在膝关节骨性关节炎患者的早期诊断中具有重要的筛查价值,且对行针刀治疗患者的疗效评价具有重要的参考意义。     

细胞核因子κB受体活化因子配基在强直性脊柱炎的表达及意义

目的 检测细胞核因子κB受体活化因子配基(RANKL)在强直性脊柱炎(AS)患者脊柱外关节滑膜组织中的表达．并以类风湿关节炎(RA)、骨关节炎(OA)患者和健康者外周关节滑膜组织为对照,了解RANKL表达在AS患者关节炎症病理机制中的意义。方法 应用单克隆抗体,通过免疫组织化学方法检测13例AS、16例RA、17例OA及6例健康对照关节滑膜组织中RANKL、CD68蛋白表达及分布情况,通过计算机辅助图像分析系统和半定量分析方法确定RANKL在各滑膜组织中的表达水平,分析RANKL的表达与炎性指标及关节X线分期之间的相关性。结果 AS和RA患者组滑膜组织RANKL表达水平明显升高,阳性细胞主要见于滑膜组织衬里层和滑膜软骨交界区,OA患者组和健康对照组滑膜组织中则未见阳性表达信号。AS和RA患者滑膜组织中RANKL表达水平与关节X线分期呈正相关(相关系数r分别为0．41、0．73,P值分别为0．021、0．003)。结论 RANKL在AS患者骨质破坏的病理机制中具有重要作用,其表达量的多少在一定程度上可反映AS患者骨质破坏程度,AS患者滑膜组织中RANKL表达模式与RA相似,提示AS外周关节骨质破坏的病理机制可能与RA类似。     

153Sm-citrate-HA滑膜切除术治疗类风湿关节炎患者57例近期疗效分析

目的观察^153 Sm-柠檬酸-羟基磷灰石（citrate—HA）滑膜切除术治疗类风湿关节炎（RA）所致膝关节滑膜增生的近期疗效。方法对57例RA患者103个有明显滑膜增生的膝关节行关节腔内注射^153 Sm—citrate．HA5×37MBq（0．5～1m1），比较治疗前后关节症状（疼痛、肿胀、积液、功能活动度、上下楼及蹲站受限）变化情况，按优效、良效、微效、无效4级标准评判疗效，并对不同X线分期患者的疗效进行分析。结果治疗后1周开始起效，在半年内疗效逐渐明显，患者关节症状逐渐减轻甚至消失；总有效率为98．1％，其中Ⅰ、Ⅱ期患者的优效率分别为100％和91．3％。结论^153 Sm-citrate—HA滑膜切除术对RA滑膜增生性变是一项简单、安全、有效的治疗方法。     

Popliteal cysts in adults. Prevalence, associated intraarticular lesions, and results after arthroscopic treatment.

The objective of this prospective study was to determine the prevalence of popliteal cysts and the associated intraarticular lesions in a group of 100 patients scheduled for arthroscopic surgery of the knee and to evaluate the results of arthroscopic treatment for these intraarticular lesions without removal of the cyst. One hundred patients without any knee complaints served as a control group. The diagnosis of a popliteal cyst was made on the basis of ultrasonography. The prevalence of popliteal cysts was 20% in the study group and 0% in the control group. Patients with a popliteal cyst had a significantly higher prevalence of medial meniscal tears (70% versus 19%) and of chondral lesions (85% versus 28%). Tears of the lateral meniscus, however, were more evenly distributed (20% versus 36%). Sixteen of 20 patients with a popliteal cyst were available for a follow-up examination 1 to 3 years after the arthroscopic procedure. Eleven popliteal cysts had persisted. Chondral lesions were the most relevant prognostic factor; all patients with persisting cysts had grade III or grade IV lesions. We conclude that the popliteal cyst is a secondary phenomenon and that treatment should address the underlying intraarticular lesions. In cases of osteoarthritis it may be impossible to treat the chondral lesion successfully in terms of eliminating the effusion.     

膝关节滑膜囊肿的CT诊断及临床价值

目的 :探讨膝关节滑膜囊肿的CT表现及诊断价值。方法 :回顾性分析 45例经手术和病理证实的膝关节滑膜囊肿临床和CT检查资料。结果 :45例中 ,发生于窝的滑膜囊肿 3 8例 ,发生于膝关节内侧鹅足腱滑膜囊肿 4例 ,胫侧副韧带滑膜囊肿 3例 ;伴骨质增生者 43例 ,伴关节积液者 3 4例 ,伴半月板损伤 2例 ,未发现伴随病变但有外伤史者 1例。结论 :根据所有滑膜囊肿典型CT表现 ,均可明确诊断 ,并有助于发现原发病 ,可为临床治疗进行精确定位 ,制定适当的治疗方案。     

MR findings in knee osteoarthritis

Knee osteoarthritis (OA) is a leading cause of disability. Recent advances in drug discovery techniques and improvements in understanding the pathophysiology of osteoarthritic disorders have resulted in an unprecedented number of new therapeutic agents. Of all imaging modalities, radiography has been the most widely used for the diagnosis and management of the progression of knee OA. Magnetic resonance imaging is a relatively recent technique and its applications to osteoarthritis have been limited. Compared with conventional radiography, MR imaging offers unparalleled discrimination among articular soft tissues by directly visualizing all components of the knee joint simultaneously and therefore allowing the knee joint to be evaluated as a whole organ. In this article we present the MR findings in knee OA including cartilage abnormalities, osteophytes, bone edema, subarticular cysts, bone attrition, meniscal tears, ligament abnormalities, synovial thickening, joint effusion, intra-articular loose bodies, and periarticular cysts. Electronic Publication     

Radiographic joint space narrowing in osteoarthritis of the knee: relationship to meniscal tears and duration of pain

OBJECTIVE: The objective of this study was to assess, with knee radiography, joint space narrowing (JSN) and its relationship to meniscal tears, anterior cruciate ligament (ACL) ruptures, articular cartilage erosion, and duration of pain in patients with knee osteoarthritis. MATERIALS AND METHODS: A total of 140 patients who had knee osteoarthritis and underwent primary total knee replacement (TKR) surgery, with unicompartmental medial tibiofemoral JSN (grade 1 or greater) and normal lateral compartments, were recruited. Polytomous logistic regression was used to assess the relationship between JSN and risk factors. RESULTS: All patients with JSN were categorized as grade 1 (n = 14, 10.0%), grade 2 (n = 64, 45.7%), or grade 3 (n = 62, 44.3%). Women presented with indications for a TKR at a younger age than men (mean age, 69 vs 73 years, P < 0.05). There were 123 (87.9%) meniscal tears and 58 (41.4%) partial (insufficient or attenuated ACL fibers) and 10 (7.1%) complete ACL ruptures; 115 of 134 (85.8%) patients had moderate to severe cartilage erosion. A higher grade of JSN was correlated with a higher frequency of meniscal tears [odds ratio (OR) 6.00, 95% CI 1.29-27.96 for grade 2 vs grade 1 JSN] and duration of knee pain (OR 1.25, 95% CI 1.01-1.53 for grade 3 vs grade 1 JSN). A higher grade of JSN was not correlated with a higher frequency of ACL rupture or articular cartilage erosion. CONCLUSION: A higher grade of JSN is associated with a higher frequency of meniscal tears and long duration of knee pain in patients with knee osteoarthritis.     

The popliteal cyst

A popliteal cyst, originally called Baker’s cyst, is a synovial fluid-filled mass located in the popliteal fossa. The most common synovial popliteal cyst is considered to be a distension of the bursa located beneath the medial head of the gastrocnemius muscle. Usually, in an adult patient, an underlying intra-articular disorder is present. In children, the cyst can be isolated and the knee joint normal. The anatomy, etiopathogenesis, clinical presentation, differential diagnosis, imaging and treatment modalities of the popliteal cyst are presented. The authors try to answer some questions dealing with this condition. Is the cyst isolated, can it be treated as such, is its origin always well-defined and does surgical excision provide a permanent cure?     

Diagnostic imaging for the study of popliteal masses in dialyzed patients

A new type of amyloidosis, secondary to the massive deposition of beta 2-microglobulin, has been identified which is peculiar to long-term (greater than or equal to 5 years) hemodialysis. Popliteal masses have recently been described as a possible manifestation of this type of amyloidosis. We report the results of a clinical-radiologic study of the popliteal region in 28 patients (14 males, 14 females; age 52.9 +/- 12.6 years) undergoing chronic hemodialysis for 60-212 months (mean 127 +/- 40). We aimed at determining the role of diagnostic imaging (conventional radiography, ultrasonography, Computed Tomography) in this pathologic condition. Clinics detected popliteal masses in 4 patients (bilateral in 1). US allowed 2 more cases to be detected and demonstrated the cystic nature of the lesion. Ultimately, popliteal masses could be demonstrated in 6 (bilateral in 5) of 28 patients (incidence 21.4%). In the 3 patients who were investigated by CT, cysts were seen to communicate with the joint cavity (Baker's cysts). In 1 case, immunocytochemical analysis showed diffuse beta 2-microglobulin positive amyloid deposition within the synovial wall of the surgically removed cyst. All the 6 patients experienced some of the major features of dialysis-related amyloidosis: carpal tunnel syndrome (6 cases), destructive arthropathy (5 cases), carpal and shoulder bone radiolucencies (5 and 4 cases, respectively). These findings, while documenting the high prevalence of popliteal cysts among long-term hemodialysis patients and the strong correlation with dialysis-related amyloidosis, stress the importance of diagnostic imaging in the detection and follow-up of such lesions.     

膝关节骨关节炎MRI表现

目的：评价MRI在膝关节骨关节炎临床诊治中的价值。方法：对127例184个受累膝关节骨关节炎MRI各序列图像进行分析。结果：所有膝关节均表现不同程度MRI异常信号改变,15个仅表现为单纯软骨下骨质水肿．27个表现为I级软骨损伤,35个表现为Ⅱ级软骨损伤,40个表现为Ⅲ级软骨损伤,67个表现为Ⅳ级软骨损伤,82个关节间隙不均匀变窄,103个膝关节存在轻一中等度滑膜增厚,少一中等量关节腔积液。软骨损伤MRI分别表现为高信号软骨内异常低信号影．软骨面毛糙、缺损、完全缺失、骨赘形成。软骨下骨单纯水肿在T1wI上表现为片状低信号,FS-T1WI-FLASH上呈高信号,骨质吸收破坏呈斑片状长T1长T2影,境界清晰,骨质增生硬化在MRI各序列上均呈片状、条状、环状及分隔状低信号。结论：MRI能准确反映膝关节骨关节炎损伤的程度、范围,为临床对骨关节炎的诊治提供了可靠、直接的依据。     

关节镜下治疗腘窝囊肿35例报道

目的:探讨关节镜技术治疗腘窝囊肿的方法及其临床疗效。方法:2002年10月至2004年7月,采用关节镜技术对35例腘窝囊肿患者进行治疗,其中男性14例,女性21例,年龄42～68岁,平均49.7岁。窝囊肿均为单侧,其中右膝16例,左膝19例。在处理关节内疾患的同时,在后内侧间室扩大窝囊肿与关节腔之间的通道口。4例巨大囊肿(直径>5cm)同时行后路关节镜下囊壁切除术。根据Rauschning和Lindgren分级方法评定手术效果。结果:本组35例腘窝囊肿患者在术中均可发现伴有关节内疾患,其中内侧半月板撕裂24例,外侧半月板撕裂7例,前交叉韧带撕裂4例,骨性关节炎27例,痛风性关节炎1例。术后未出现血管、神经或手术切口并发症。术后2～3天出院。随访时间6～29个月,平均11个月,94.2%的病例未出现囊肿复发。Rauschning和Lindgren分级结果:术前Ⅰ级4例,Ⅱ级12例,Ⅲ级19例;术后0级30例,Ⅰ级4例,Ⅱ级1例。结论:关节镜下治疗窝囊肿具有创伤小、恢复快、复发率低的优点。     

膝关节及周围常见疾病的超声诊断研究

目的：探讨超声检查对膝关节及周围常见疾病的诊断价值。方法：运用超声对膝关节及周围常见疾病进行诊断。结果：对21例胭窝囊肿和20例胭窝脂肪瘤及ll例膝关节腔积液的超声检查结果与手术病例证实,符合率达100％;对74例膝关节共148个半月板超声检查结果与关节镜检查结果进行对照分析,结果148个半月板中,关节镜发现半月板损伤46个,超声检查准确做出半月板损伤诊断38个,漏诊8个,阴性97个,假阳性5个。超声诊断半月板损伤的准确率91．2％,敏感性82．6％,特异性95．1％,阳性结果预测值88．4％,阴性结果预测值92．4％。结论：超声检查无创、方便、诊断膝关节及周围疾病的准确性较高,可作为基层医院一种广泛开展的检查方法。     

Giant synovial cyst of knee treated arthroscopically through a cystic portal

Synovial cysts are well-defined fluid filled cysts that can extend for a variable distance outside the joint space. These cysts can sometimes grow to a large size making its treatment challenging especially when associated with intra-articular pathologies.We describe a case of giant synovial cyst arising from the left knee and extending to the medial proximal calf in a 77-year old female who presented with knee joint pain, episodes of locking and calf mass occurring within 2 months of onset. Imaging studies also showed associated medial and lateral meniscal tears with medial compartment and patellofemoral osteoarthritis. The cyst was treated by disrupting the valvular mechanism using a standard posteromedial portal and complete excision of the cyst wall via a posteromedial cystic portal. The meniscal lesions were dealt with through the standard anterior portals. At 25-month follow up there were no signs of recurrence of the cyst clinically or with MRI. The cystic portal technique is effective in treating a giant synovial cyst of the knee even in the presence of meniscal tears and high grade chondral lesions. An erratum to this article can be found at