超声激励脉冲编码技术对膝关节疾病的诊断价值

目的探讨超声激励脉冲编码技术对类风湿性关节炎(rheumatoidarthritis,RA)和骨关节炎(osteoarthritis ,OA)中膝关节病变的诊断价值。方法对5 6例类风湿性关节炎患者112个膝关节和4 1例骨关节炎82个膝关节进行了详细的二维及彩色多普勒检查,并与MRI检查结果进行比较。结果RA/OA组髌上囊或关节腔积液及髌上囊内滑膜增生的诊断结果经对比,超声与MRI无明显的差异(P >0 .0 5 ) ;对髌上囊两侧隐窝内的滑膜增生,MRI优于超声,超声为MRI的76 % ;对RA/OA组软骨Ⅰ级退变的显示,MRI明显高于超声;对软骨Ⅱ～Ⅳ级的退变,超声与MRI结果基本一致。RA组与OA组对比,RA患者以滑膜增生为主;OA患者以软骨及骨质破坏为主。结论超声激励脉冲编码技术是一项有价值的诊断技术,对RA和OA的诊断具有高度的特异性和敏感性。     

膝类风湿性关节炎和骨关节炎的MRI表现特点和比较

目的 分析膝关节类风湿性关节炎（RA）和骨关节炎（OA）各自的MRI特点并提出诊断和鉴别诊断方法。材料与方法 77例82个膝OA和25例36个膝RA关节行MRI各个方位的SE T1WI、T2WI和3D－FFE。结果 RA膝关节MRI显示软骨破坏较OA严重而广泛（P＜0．01）,OA软骨磨损以承重或摩擦大的部位好发。MRI见RA骨结构改变也较OA广泛（P＜0．01）。OA的滑膜增生比RA局限,通常伴随半月板病变和游离体。结论 根据膝关节各结构病变的程度、部位和范围的差异,MRI对OA和RA的诊断和鉴别诊断有一定的帮助,3D－FFE判断软骨病变具有很高的应用价值。     

3.0 T MRI与X线平片上分别测量膝关节间隙宽度的对比研究

目的 研究3.0 T MRI各向同性梯度回波序列用于测量正常人及不同程度骨性关节炎(0A)患者关节间隙的可行性.方法 选取正常志愿者,轻度OA患者(Kellgren-Lawrence分级1～2级)及重度OA患者(Kellgren-Lawrence分级3～4级)各30例,各30个膝关节,分别采用Philips DR和Siemens 3.0 T MR进行检查.由两名观察者分别在3.0TMR采用各向同性快速小角度激发成像(FLASH)梯度回波序列三维重组冠状位像上和X线平片上测量膝关节间隙,并采用t检验观察两名观察者间在MRI上的测量差异.然后对三组受试对象的X线与MRI检测结果及在MRI及平片上测得组组间的数据运用t检验分别行统计学差异比较.结果 在3.0T MR各向同性FLASH梯度回波序列三维重组冠状位像上测量正常人膝关节间隙,与在X线平片上测量的关节间隙在两名观察者间可重复性较高;对志愿者组、轻度OA组及重度OA组测得的内外侧胫股关节间隙宽度,在MRI与X线平片之间无统计学差异(志愿者组内侧胫股关节间隙t=0.53,P=0.60,外侧t=0.11,P=0.91;轻度OA组内侧胫股关节间隙t =0.25,P=0.80,外侧t=0.07,P=0.94;重度OA组内侧胫股关节间隙t=0.09,P=0.93,外侧t=0.11,P=0.91);志愿者组与轻度OA组间及轻度OA组与重度OA组间在MRI上测量的内外侧胫股关节间隙宽度有统计学差异(志愿者组与轻度OA组间内侧胫股关节间隙t=2.71,P＜0.01,外侧t=2.95,P＜0.01;轻度OA组与重度OA组间内侧胫股关节间隙t =3.77,P＜0.01,外侧t=1.93,P＜0.01).结论 使用MRI可以准确测量正常及不同程度OA患者的关节间隙宽度,MRI测量关节间隙的有效性与平片一致.     

膝关节直立位CT:承重对关节力线的影响

正摘要目的前瞻性比较仰卧位非承重位和直立位承重位CT扫描中髌股关节和股胫关节评估关节力线的差异。方法26例病人分别在多层CT和锥形束四肢CT获取非承重条件下(NWBCT)和承重条件下(WBCT)膝关节CT影像[年龄21~81岁,平均(57.0±15.9)岁]。2名骨肌系统放射医师分别独立测量股胫关节旋转角、胫骨结节-滑车凹距离、髌骨外侧倾斜角、髌骨外侧位移和内侧及外侧股胫关节间隙宽度,对关节力线进行量化评估。研究发现非承重CT和承重CT间差异具有统计学意义(Wilcoxon秩和检验法,P0.05)。结果比较多项参数间差异均有统计学意义,包括股胫关节     

膝类风湿关节炎的MRI与病理对照研究

目的通过对膝类风湿关节炎(RA)病人关节软骨、软骨下骨髓及半月板进行MR-病理对照分析,探讨膝RA的MRI特点及病变发生机制。方法收集我院2008年11月—2014年12月间确诊为膝RA并行全膝关节置换术的11例病人(共13只膝关节)资料。评价关节软骨、软骨下骨髓及半月板的MRI表现,并在显微镜下对观察膝RA病人膝关节各部位组织的病理学特点。当细胞成分不确定时,使用免疫组织化学方法确定细胞种类。对关节软骨损伤MRI分级和半月板损伤MRI分度以及不同部位关节软骨下骨髓水肿和关节软骨、半月板损伤的病理学表现分度进行分析,并采用Mann-Whitney U检验对位于裸区和远离裸区的软骨下骨髓水肿的病理学表现分度进行比较。结果本组膝RA病人中大部分病人的MRI关节软骨破坏程度为4级,半月板破坏程度为4度。MRI显示52处软骨下骨髓水肿的部位中有18处(34.6%)于骨髓水肿上方覆盖有关节软骨且远离裸区,而34处(65.4%)的骨髓水肿位于裸区且邻近滑膜。在软骨下骨髓水肿的病理学表现中,纤维化、骨小梁镶嵌样结构及淋巴细胞浸润为最常见的表现。位于裸区和远离裸区骨髓水肿的两组间各种病理学表现分度差异均无统计学意义(均P0.05)。在关节软骨破坏的病理学表现中,纤维环、关节软骨破坏变薄及关节软骨增生为最常见的镜下病理表现。在全部13只切除的膝关节共26个半月板标本中,仅发现5个(19.2%)残留半月板标本,在MRI上均表现为萎缩、变薄,信号不均,其最常见的病理学表现为纤维化和吞噬包裹钙化碎片。结论晚期膝RA病人半月板及关节软骨破坏严重,骨髓水肿可发生于关节裸区或远离裸区部位,提示膝RA可同时累及多个部位,导致病人关节功能严重减退甚至丧失。     

外侧(盘状)半月板损伤合并色素沉着结节性滑膜炎1例报告

鲁×,女,37岁,病历号:138224.反复左膝关节“交锁”、肿胀、疼痛一年余.查体:左膝肿胀,股四头肌萎缩,外侧半月板皮肤投影处局限性压痛,浮髌试验(+),麦氏征(+)伴弹响,侧方挤压试验(-),阿氏试验(-),右侧无明显异常.X线平片示左膝关节间隙及各骨质未见异常.初诊;左膝外侧半月板损伤.术中见左膝关节腔内血性积液,关节滑膜弥漫性充血、增厚,呈黄褐色.十字韧带、外侧半月板前角处病变呈绒毛结节状.外侧半月板为盘状,体部有—0.5cm水平撕裂.病理报告;色素沉着绒毛结节性滑膜炎(以下简称色素滑膜炎)盘状半月板,半月板水平撕裂.     

髌股关节紊乱的MRI表现与临床

目的：探讨髌股关节紊乱(PFD)的MRI表现。方法：膝关节正常组6例(10个膝)及病例组42例(70个膝)受试者均行MRI检查,对病理性髌股关系及髌骨支持带的表现进行分析。结果：所有病例(70个膝)髌骨外侧半脱位程度6～15 mm,60％为双侧。其他恒定的异常包括股骨滑车发育不良、髌骨内侧支持带薄、髌外侧支持带增厚以及...     

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。     

单纯髌股关节退行性改变的MRI表现

目的:探讨单纯髌股关节退行性改变的MRI特征,旨在提高对该病的认识。方法:回顾性分析33例患者37个膝关节单纯髌股关节退行性改变的MRI资料,观察病灶分布及软骨与软骨下骨质的形态、信号等影像表现。结果:33例37个膝关节中,病灶发生于髌骨外侧面13个,髌骨内侧面3个,髌骨纵脊部3个,外侧滑车面3个,内侧滑车面2个,股骨中央沟2个,混合多发11个。其中,9个表现为单纯软骨下骨质骨髓水肿样改变,3个表现为单纯软骨下骨质囊肿样改变,25个表现为不同程度软骨损伤合并软骨下骨质异常改变。结论:MRI能清晰显示单纯髌股关节退行性改变的软骨及骨质损伤部位、范围、程度,对临床诊断和治疗有重要的指导意义。     

膝关节半月板周缘性移位 MRI 诊断与分析

目的：应用 MRI 观察半月板周缘性移位现象,确定半月板周缘性移位严重程度与膝关节周围结构的关系,探讨其临床意义。方法回顾分析148例患者膝关节 MRI 检查图像,将患者按年龄大小分为中青年组、中老年组、老年组,以半月板关节囊缘超出胫骨平台边缘定义为半月板周缘性移位,以膝关节内侧半月板与膝关节内侧副韧带、外侧半月板与髂胫束之间的位置关系来确定半月板移位的严重程度。结果148例患者半月板移位总发生率为48.6%(72/148),中青年组发生率为34.8%(8/23)、中老年组发生率为46.1%(35/76)、老年组发生率为59.2%(29/49),各年龄组间比较差异有统计学意义(χ2=4.15,P <0.05),半月板移位发生率随年龄增加而增加,移位程度随年龄增加而严重。结论半月板移位及严重程度与患者年龄密切相关;以膝关节内、外侧半月板与内侧副韧带、外侧髂胫束之间的位置关系来确定半月板移位严重程度有重要的临床意义。     

Knee injury and Osteoarthritis Outcome Score (KOOS) - validation of a Swedish version

The Knee injury and Osteoarthritis Outcome Score (KOOS) is a self-administered instrument measuring outcome after knee injury at impairment, disability, and handicap level in five subscales. Reliability, validity, and responsiveness of a Swedish version was assessed in 142 patients who underwent arthroscopy because of injury to the menisci, anterior cruciate ligament, or cartilage of the knee. The clinimetric properties were found to be good and comparable to the American version of the KOOS. Comparison to the Short Form-36 and the Lysholm knee scoring scale revealed expected correlations and construct validity. Item by item, symptoms and functional limitations were compared between diagnostic groups. High responsiveness was found three months after arthroscopic partial meniscectomy for all subscales but Activities of Daily Living.     

The acutely limping child

Acute limping may be the result of multiple pathologies in children. The differential diagnosis varies based on the age of the child. Irrespective of age, the initial imaging work-up includes AP and frog leg radiographs of the pelvis and ultrasound; MRI may sometimes be helpful. In children less than 3 years, infections and trauma are most frequent. MRI is the imaging modality of choice when osteomyelitis is clinically suspected. Between the ages of 3 and 10 years, transient synovitis of the hip and Legg-Calvé-Perthes disease are main considerations but infection, inflammation and focal bony lesions are also considered. In children over 10 years, slipped capital femoral epiphysis also is considered.     

Do Balance Board Training Programs Reduce the Risk of Ankle Sprains in Athletes?

Introduction Ankle sprains are the most common musculo-skeletal injury that occurs in athletes,particularly in sports that require jumping and landing on one foot such as soccer,and basketball(1-4).These injuries often result in significant time loss from participation,long-term disability,and have a major impact on health care costs and resources(5-8).     

High Intensity Interval Training:New Insights

KEY POINTS ·High-intensity interval training(HIT)is characterized by repeated sessions of relatively brief，intermittent exercise.often performed with an“a11 out”effort or at an intensity close to that which elicits peak oxygen uptake(i.e.，≥90%of VO2 peak).     

Endovascular management of carotid-cavernous fistulas

Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas （CCF） and their complications such as pseudoaneurysms. Methods： Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coll embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stem management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% （4/22）. A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% （8/22）. Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.     

Developmental validation of the PowerPlex(®) ESI 16 and PowerPlex(®) ESI 17 Systems: STR multiplexes for the new European standard

In response to the ENFSI and EDNAP groups’ call for new STR multiplexes for Europe, Promega^® developed a suite of four new DNA profiling kits. This paper describes the developmental validation study performed on the PowerPlex^® ESI 16 (European Standard Investigator 16) and the PowerPlex^® ESI 17 Systems. The PowerPlex^® ESI 16 System combines the 11 loci compatible with the UK National DNA Database^®, contained within the AmpFlSTR^® SGM Plus^® PCR Amplification Kit, with five additional loci: D2S441, D10S1248, D22S1045, D1S1656 and D12S391. The multiplex was designed to reduce the amplicon size of the loci found in the AmpFlSTR^® SGM Plus^® kit. This design facilitates increased robustness and amplification success for the loci used in the national DNA databases created in many countries, when analyzing degraded DNA samples. The PowerPlex^® ESI 17 System amplifies the same loci as the PowerPlex^® ESI 16 System, but with the addition of a primer pair for the SE33 locus. Tests were designed to address the developmental validation guidelines issued by the Scientific Working Group on DNA Analysis Methods (SWGDAM), and those of the DNA Advisory Board (DAB). Samples processed include DNA mixtures, PCR reactions spiked with inhibitors, a sensitivity series, and 306 United Kingdom donor samples to determine concordance with data generated with the AmpFlSTR^® SGM Plus^® kit. Allele frequencies from 242 white Caucasian samples collected in the United Kingdom are also presented. The PowerPlex^® ESI 16 and ESI 17 Systems are robust and sensitive tools, suitable for the analysis of forensic DNA samples. Full profiles were routinely observed with 62.5 pg of a fully heterozygous single source DNA template. This high level of sensitivity was found to impact on mixture analyses, where 54–86% of unique minor contributor alleles were routinely observed in a 1:19 mixture ratio. Improved sensitivity combined with the robustness afforded by smaller amplicons has substantially improved the quantity of data obtained from degraded samples, and the improved chemistry confers exceptional tolerance to high levels of laboratory prepared inhibitors.     

Bronchial stump fistula :treatment with covered retrievable hinged metallic stents-preliminary clinical experience

Objective To evaluate the preliminaily clinical efficacy and retrievability of a retrievable hinged covered metallic stent in the treatment of the bronchial stump fistula （BSF）. Methods Between April 2003 and March 2005, 8 patients with bronchial stump fistula after pneumonectomy or lobectomy were treated with two types （A and B） of retrievable hinged covered metallic stents. Type A stent was placed in 6 patients and type B in 2 under fluoroscopic guidance. The stent was removed with a retrieval set when BSF was healed or complications occurred. Results Stent placement in the bronchial tree was technically successful in all patients, without procedure-related complications. Immediate closure of the BSF was achieved in all patients after the procedure. Stents were removed from all patients but one. Removal of the stents was difficult in two patients due to tissue hyperplasia. Patients were followed up for 6 - 21 months. Placement of the stents remained stable in all patients except one due to severe cough. Permanent closure of BSF was achieved in 7 （87.5%） of 8 patients. Conclusion Use of a retrievable hinged covered expandable metallic stent is a simple, safe, and effective procedure for closure of the BSF. Retrieval of the stent seems to be feasible. （J Intervent Radiol, 2007, 16： 253-257）     

Prevalence and severity of hip and groin pain in sub‐elite male football: a cross‐sectional cohort study of 695 players

The purpose of this study was twofold: (a) to investigate the prevalence of hip and groin pain in sub‐elite male adult football in Denmark and (b) to explore the association between prevalence and duration of hip and groin pain in the previous season with the Copenhagen Hip and Groin Outcome Score (HAGOS) in the beginning of the new season. In total 695 respondents from 40 teams (Division 1–4) were included. Players completed in the beginning of the new season (July–Sept 2011) a self‐reported paper questionnaire on hip and/or groin pain during the previous season and HAGOS. In total 49% (95% CI: 45–52%) reported hip and/or groin pain during the previous season. Of these, 31% (95% CI: 26–36%) reported pain for >6 weeks. Players with the longest duration of pain during the previous season had the lowest HAGOS scores, when assessed at the beginning of the new season, P < 0.001. This study documents that half of sub‐elite male adult football players report pain in the hip and/or groin during a football season. The football players with the longest duration of pain in previous season displayed the lowest HAGOS scores in the beginning of the new season.