Distribution of radiation in synovectomy of the knee with 166Ho-FHMA using image fusion

BACKGROUND: Radiation synovectomy is an effective technique for the treatment of chronic synovitis in patients with rheumatoid arthritis (RA), and is an alternative for surgical synovectomy. Holmium ferric hydroxide macroaggregates (166Ho-FHMA) is suitable for radiation synovectomy, especially because it emits high-energy beta particles and a smaller proportion of low-energy photons that are suitable for gamma-camera imaging. OBJECTIVE: The aim of this study was to develop a method to fuse 166Ho-FHMA single photon emission computed tomography (SPECT) and magnetic resonance (MRI) images, to show the distribution of 166Ho-FHMA inside the joint with images that localize synovitis. METHODS: The knees of 6 patients with RA were treated with 166Ho-FHMA. (99m)Tc-human immunoglobulin ((99m)Tc-HIG) SPECT images and MRI images were taken before 166Ho-FHMA injections. 166Ho-FHMA SPECT images were taken 4, 28, and 40 hours after injections. SPECT and MRI images were merged using a specific image fusion method, called mutual information algorithm, to study associations between anatomical and metabolic information from these images. RESULTS: Fusion of SPECT and MRI images indicated that intensity of radioactivity was associated with the amount of synovitis. Activity distribution of 166Ho-FHMA could be registered using anatometabolic images. CONCLUSIONS: A new method to fuse the distribution of radiation in the synovectomy of the knee was developed using SPECT/MRI image registration. Image registration of SPECT and MRI can be used to determine the activity distribution of radioisotopes in relation to synovitis.     

Radiosynoviorthesis in osteoarthritis and other disorders with concomitant synovitis in comparison to rheumatoid arthritis

AIM: The aim of this study was to evaluate the effectiveness of radiosynoviorthesis (RSO) in osteoarthritis and other disorders with concomitant synovitis versus rheumatoid arthritis by means of a standardized questionnaire. METHODS: Eight-hundred and three RSO treatments were monitored in 691 patients by seven centers in three countries, using standardized questionnaires. Patients were assigned to three groups according to their age (20-40, 41-60, and 61-80 years). Additionally, the data was analyzed separately for patients with rheumatoid arthritis (group A) and those with osteoarthritis, psoriasis arthritis, pigmental villonodular synovitis, or persistent effusions after joint replacement (group B). RESULTS: Quality of life improved in 78% of group A and 59% of group B (p < 0.01). Ameliorations of joint pain, swelling/effusion, or flexibility were found in 80% of group A and 56% of group B (p < 0.01). The response rate was similar for small- and large-sized joints in group A, but was significantly higher for large-sized joints in group B (p < 0.01). The positive effects on joint pain, swelling/effusion, or flexibility lasted longer in group A (p < 0.01). Repeated RSOs were as effective as initial RSOs. The clinical outcome was not influenced by age, gender, or transient immobilization for 48 hours after RSO. CONCLUSION: Although slightly more efficient in rheumatoid arthritis, RSO represents an effective treatment option also in osteoarthritis and other disorders with concomitant synovitis.     

膝关节镜术后疼痛原因分析及相关处理

目的探讨膝关节镜术后疼痛的发生原因及处理对策。方法回顾自2005年1月-2007年12月我科开展膝关节镜手术356膝（76例双膝），随访3-25个月（平均10.6个月），记录患者术后情况。结果术后出现疼痛并发症者24膝，占6.74％，其中术后3个月疼痛减轻或消失者17膝，随访超过3个月仍感疼痛者7膝，占1.97％。结论提高对疾病的认识和手术操作技术水平，熟悉关节内解剖，正确指导患者术后康复锻炼，术后合理用药，是降低术后疼痛发生率的关键。     

Magnetic resonance imaging in knee synovitis: Clinical utility in differentiating asymptomatic and symptomatic meniscal tears

It is well documented that meniscal tears may be found frequently by MRI as an incidental finding in asymptomatic knees. We aim to review the literature regarding the ability of MRI to differentiate between asymptomatic and symptomatic meniscal tears. Ovid MEDLINE, MEDLINE inProcess, Cochrane reviews, Web of Science, Embase and CINAHL were systematically searched. A total of 1251 publications were screened based on their titles, abstracts and full texts, of which 1213 publications were excluded because they did not address the relationship between synovitis and meniscal tears, were case reports or reviews, concerned atypical patient populations or reported surgical research. Of the 38 retained publications, only two reported results specific to perimeniscal synovitis, while 36 discussed less specific but relevant findings. The small number of heterogeneous results describing perimeniscal synovitis precluded meta‐analysis. In the symptomatic knee, identification of the likelihood of a meniscal tear contributing to the patient's pain is of significance to the orthopaedic surgeon. In our literature review, we have identified that localised synovitis and displacement of the meniscus are two features that may assist in identifying the subgroup of patients that may benefit from meniscal intervention.     

膝关节滑膜源性肿瘤的临床特征、诊断和治疗

目的 研究膝关节滑膜源性肿瘤的临床特征,探讨并分析滑膜肿瘤的临床表现并提出鉴别诊断及治疗方法.方法 回顾我院从2005年至2009年收治的38例经病理证实为膝关节滑膜源性肿瘤患者的诊断、治疗及随访观察,分析各类型滑膜肿瘤病变的临床表现、影像学的特点及手术方法,并观察各类型滑膜病变的不同病理特征.结果 膝关节滑膜源性肿瘤好发于各个年龄段,38例患者包括色素沉着绒毛结节性滑膜炎,滑膜软骨瘤病,滑膜血管瘤,滑膜肉瘤,滑膜脂肪瘤,术后得到随访的31例患者中(平均随访时间28.4个月),色素沉着绒毛结节性滑膜炎复发4例(22%),滑膜软骨瘤病1例(17%),滑膜肉瘤1例(50%),膝关节功能总体优良率为83.9%.结论 膝关节滑膜源性肿瘤病种复杂,易误诊误治,应通过详细地询问病史,仔细对患者做体格检查,配合实验室及影像学检查,采用切开直视的手术方法减少误诊率并提高治疗效果.     

膝部肿瘤切除后关节功能重建的方法分析

目的 探讨膝部肿瘤切除后关节功能重建的方法选择和疗效。方法 54例膝关节周围肿瘤中，骨巨细胞瘤25例，非骨化性纤维瘤2例，成纤维性纤维瘤2例，动脉瘤样骨囊肿1例，软骨黏液性纤维瘤2例，骨肉瘤15例，软骨肉瘤2例，恶性纤维组织细胞瘤5例。23例采用瘤体切除，吻合血管的自体髂骨、腓骨联合移植术，12例瘤段切除灭活再植术，19例瘤段切除人工假体置换术。结果 54例平均随访5年6个月，成活病例术后功能评价优良率为76％。结论 膝部肿瘤切除后关节功能的重建，应根据肿瘤的大小、包壳的完整性、软组织的侵及情况，以及肿瘤的病理组织学性质，选择适当的手术方法。瘤体切除，吻合血管的自体髂骨、腓骨联合移植术，是治疗膝关节周围良性侵袭性肿瘤或低度恶性肿瘤较为理想的方法。     

关节镜滑膜切除术联合放射治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎

目的观察关节镜下滑膜切除术联合术后放射治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎的疗效。方法26例膝关节弥漫型色素沉着绒毛结节性滑膜炎患者,行关节镜下滑膜切除术,同时6例伴有半月板损伤患者行半月板部分切除术,1例关节僵硬患者行关节松解术,1例软骨剥脱患者行微骨折术。手术后4周关节外放射治疗,采用直线型加速器6my—X线,照射范围包括患膝关节及手术切口上下缘3cm,每次2Gv,每周5次,总剂量30Gy。术后定期随访并进行Lysholm膝关节功能评分,评分结果进行统计学分析。结果所有患者均获得随访,随访时间12—40个月,平均29．5个月,术后未见复发及放射性治疗并发症,Lysholm评分术前43．28-4-4．1分,术后6个月85．73±3．4分,术后12个月94．89±5．1分,差别有统计学意义。结论关节镜下滑膜切除术联合术后放射治疗是治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎、减少术后复发的有效方法。     

膝关节色素绒毛结节性滑膜炎术后放疗的效果

目的：观察术后放疗对色素沉着绒毛结节性滑膜炎复发的预防作用，并比较普通放疗与立体定向放疗的优劣。方法：11例术后患者分为2组，普通放疗组6例，6MVX线两侧对穿照射，单次量DT2．0Cy，每周照射5次，总量为DT34．0Cy；立体定向放疗组5例，设3—4个适形野，单次剂量DT3．OCy，总量为DT18．0Gy-21．0cy，隔日照射1次。结果：放疗后，患者膝关节疼痛肿胀明显缓解，11例均无复发，立体定向放疗5例膝关节功能均优，普通照射2例优、4例良。结论：放射治疗对本病的复发有明显预防作用，立体定向精确照射疗效明显，放疗副反应轻。     

手术联合术后放疗对膝关节弥漫型色素沉着绒毛结节性滑膜炎的疗效分析

目的:探讨手术联合术后放疗治疗膝关节弥漫型色素沉着绒毛结节性滑膜炎（DPVNS）的临床效果。方法:对19例经病理确诊并行手术切除的膝关节DPVNS患者术后行关节外放射治疗DT36.0Gy/18～20f。结果:术后随访5个月～10年,3例失访,16例均无复发,放疗皮肤反应Ⅰ度。术前Lysholm膝关节评分为（36.8±5.8）分,放疗后至末次随访Lysholm膝关节评分为（87.5±6.6）分,且术后联合放疗组复发率明显低于单纯手术组,差异具有统计学意义（P<0.05）。结论:DPVNS患者术后辅以放射治疗可有效预防复发,且安全性好。     

盐酸氨基葡萄糖治疗膝骨关节炎的临床研究

目的观察盐酸氨基葡萄糖治疗膝骨关节炎的临床疗效。方法选择160例患者随机分成A、B两组,A组给予塞来昔布胶囊口服,疗程3周,联合盐酸氨基葡萄糖（奥泰灵）口服,疗程6周;B组给予塞来昔布胶囊口服,疗程3周,联合玻璃酸钠注射液膝关节腔内注射,疗程5周。比较两组的疗效。结果治疗后1周时有效率盐酸氨基葡萄糖组（40．0％）不如玻璃酸钠组（60．0％）,但随治疗时间的延长,6周时盐酸氨基葡萄糖组治疗的总有效率（75．0％）与玻璃酸钠组（77．5％）相比无显著性差异（P〈0．05）。结论盐酸氨基葡萄糖治疗膝骨关节炎安全、有效。     

髌骨骨巨细胞瘤的外科治疗

目的探讨髌骨骨巨细胞瘤的外科治疗效果。方法回顾性分析2004年2月～2009年5月收入我院的1例和外院会诊的3例髌骨骨巨细胞瘤患者的临床资料。其中男性和女性各2例;年龄20～37岁,平均26．8岁;左膝3例,右膝1例。所有患者均以前膝痛为首发症状,X线片显示髌骨溶骨性病变,骨皮质膨胀,边缘硬化。CampanacciⅠ级1例和Ⅱ级2例行病变刮除植骨术,Ⅲ级1例行髌骨全切术。术后病理均确诊为骨巨细胞瘤。结果3例刮除植骨的患者分别随访24、31-162个月,所有患者症状消失,局部无复发,元肺转移,膝关节活动正常,随访X线片显示不同程度的骨融合。髌骨切除的患者通过加强膝关节屈伸和股四头肌功能锻炼,术后13个月除行走稍跛行外,膝关节活动正常。结论对于前膝痛的年轻患者,应警惕髌骨肿瘤的可能性。髌骨骨巨细胞瘤CampanacciⅠ级和Ⅱ级的病变可采用刮除植骨术,Ⅲ级选择髌骨全切术。临床疗效满意。     

Effects of radiosynovectomy with p-32 colloid therapy in hemophilia and rheumatoid arthritis

AIM: The aim of this study was to assess the effects of treatment with our locally produced P-32 colloidal suspension on knee synovitic inflammations of hemophilic and rheumatoid arthritis (RA) patients, as well as to compare results with chemical synovectomy or corticoid intra-articular injections and evaluate the cost-benefit ratio. MATERIALS AND METHODS: Thirty-six hemophilic male patients, 4-28 years of age and sent by the Hemophilic Foundation (Buenos Aires, Argentina), were enrolled for knee radiosynovectomy (RS) with P-32 colloid (26 patients), or the antibiotic rifampicin with the cooperation of orthopaedists (10 patients). Parents' informed consent was obtained. The following procedures were performed: routine blood tests, X-ray, ultrasound, a 3-phase bone scan, plus monthly methylene diphosphonate (MDP) controls. Patients were included in this study only if several knee episodes had occurred. Exclusion criteria included bone destruction and big Baker's cyst. Twelve RA patients were included, with similar selection criteria: 6 RA patients received P-32 therapy, and the other 6 patients intra-articular corticoids. Clinical, blind evaluation (state of joint involvement, pain, motility, requirements of antihemophilic factors, corticoids, or analgesics) was registered in follow-up charts. If required, joint aspiration was carried out. Intra-articular instillation of saline plus flushing was done before the needle was withdrawn. P- 32 Bremsstrahlung emission was used in the gamma camera for early and late imaging to confirm the absence of leakage. For intra-articular chemical injections therapy, 4 MBq of Tc-99m MAA (macroaggregates) was used. Immobilization and relative rest for 72 hours followed the procedures. RESULTS: There were neither local or systemic effects, nor leakage during P-32 treatment. Intra-articular rifampicin and corticoids procedures required frequent injections. Comparison of regions of interest (ROIs) in treated knees during soft-tissue scintigraphies in pre- and post-third MDP control showed knee improvement. The follow-up evaluation demonstrated an increase in joint motion, diminished volume, and less requirement and frequency of the use of antihemophilic factors (AHF) in 80% of the radiosynovectomies (21 of 26), thus lowering health costs. Five female RA patients (5 of 6) had decreased joint swelling and pains, resulting in increased joint motion. CONCLUSIONS: Radiosynovectomy in RA showed a 3-month pain palliative effect. One intra-articular knee radiosynoviorthesis in haemophilic patients provides a more than 3- month relief of symptoms after treatment with locally produced P-32 (11 patients). This turned out to be a safe, economic alternative procedure in emerging nations where the availability of AHF is difficult and expensive.     

膝骨关节炎关节镜治疗指征及手术方法探讨

目的探讨膝骨关节炎关节镜治疗指征及手术方法。方法回顾性分析2004年1月至2006年12月应用关节镜治疗、年龄〉45岁膝骨关节炎患者305例412膝,统计其性别、年龄、镜下病理变化、镜下手术方法,术前及术后2年膝关节功能Hss评分。结果获得2年以上随访有289膝,其中单膝113膝,双膝88例176膝,随访率70％。在随访的289膝中,优：78膝,良：108膝,中：64膝,差：39膝,优良率64％。结论关节镜治疗膝骨关节炎需要根据不同病理改变采取针对性治疗。选择合适的指征,手术中精确、合理的关节镜治疗,有希望获得理想的疗效。     

内侧撑开胫骨高位截骨Tomofix内固定治疗膝内翻的初步观察

目的探讨内侧撑开胫骨高位截骨结合Tomofix内固定治疗膝内翻畸形的手术方法及短期疗效.方法 2009年10月至2010年8月,采用内侧撑开胫骨高位截骨(open wedge high tibial osteotomy,OWHTO)结合Tomofix锁定钢板内固定治疗膝内翻9例10个膝关节.术前、术后、术后2个月、6个月行X线片检查测量胫骨平台后倾角、胫骨股骨角、Insall-Salvati指数、并行Lysholm功能评分.结果患者术后随访2-10个月,平均6.2个月.胫股角从术前185.8°±2.5°降至 174.4°±2.7°,术前与术后胫骨平台后倾角、Insall-Salvati指数、Lysholm评分无明显差异,患者术后3-4周基本恢复负重行走,术后6个月截骨处均一期愈合,无感染、骨不愈合、膝关节不稳及神经损伤等并发症,终末随访无膝内翻复发,术后疼痛及行走功能改善显著.结论内侧撑开胫骨高位截骨Tomofix内固定操作较简单,创伤小,并发症少,对关节正常解剖影响较小,可作为治疗膝内翻畸形和单间室骨关节炎的有效方法之一.     

External beam radiotherapy as postoperative treatment of diffuse pigmented villonodular synovitis

PURPOSE: Diffuse pigmented villonodular synovitis is a rare proliferative disorder of synovial membranes with invasive and expansive growth patterns. Radical synovectomy is regarded as the treatment of choice. However, because of the high recurrence rates, additive treatment might be useful. Radiotherapy (RT) has been evaluated with positive results, but the optimal treatment schedules are vague. We have reviewed our experience with postoperative RT in cases of suspected or proven residual disease. METHODS AND MATERIALS: Between December 1996 and January 2006, 7 diffuse pigmented villonodular synovitis patients underwent RT at our institution. The most common location was the knee joint (5 patients). All patients underwent radical surgery and were treated subsequently with 6-MV photon RT. The total doses applied were 30-50 Gy, depending on the resection status and estimated risk of relapse. For analysis, we retrospectively reviewed all patients in April 2006. RESULTS: The mean follow-up time was 29 months (range, 3-112 months). RT had no acute adverse effects. At the assessment, no evidence was found of recurrent or persisting disease in any patient. Of the 7 patients, 6 reported asymptomatic limb function and excellent quality of life; 1 patient had persistent restriction of joint movement after repeated surgery. No radiotherapeutic late effects were seen. CONCLUSION: The results of our series have confirmed the efficacy and safety of postoperative RT for diffuse pigmented villonodular synovitis. Hence, this treatment should be considered for patients with suspected or proven residual disease.     

胫骨骨巨细胞瘤自体骨移植单髁置换中短期疗效观察

目的探讨胫骨单髁骨巨细胞瘤行肿瘤切除,应用自体髂骨移植、单髁置换重建膝关节功能的临床应用,提出手术步骤及方法,观察其疗效。方法2008年7月至2012年6月,我院收治胫骨近端单髁骨巨细胞瘤患者6例,男4例,女2例;内侧髁3例,外侧髁3例,年龄22～45岁,平均38岁,均为初次发病,病史3～10个月。按照CT横截面,肿瘤破坏最大横轴线≤1／2,关节软骨面明显受侵,2例有周围软组织受侵,3例有病理骨折;采用肿瘤整块切除,行自体髂骨移植、单髁表面置换术重建膝关节功能。结果经6个月至4年随访,肿瘤无复发,根据国际保肢学会功能评分标准,术后依疼痛程度、功能活动、心理接受程度、是否需用外部支持、行走能力及步态6个指标来评价效果。本组优5例,良1例。患膝关节活动范围均在0°～120°之间,关节稳定性好,效果满意。结论胫骨单髁骨巨细胞瘤,行肿瘤骨单髁切除、自体骨移植加单髁表面置换术,重建膝关节功能,经中短期观察疗效满意,膝关节功能恢复良好。     

Rhenium-188-HEDP therapy for the palliation of pain due to osseous metastases in lung cancer patients

Rhenium-188-hydroxyethylidine diphosphonate (188Re-HEDP) is a novel and attractive radiopharmaceutical that localizes in areas of osseous metastases and emits beta particles with energy sufficient to be therapeutically useful. The aim of this study is to evaluate the effectiveness of 188Re-HEDP in patients with lung cancer for the palliation of painful osseous metastases. Intravenous administration of activities ranging between 1.15 GBq (31 mCi) and 4.6 GBq (124 mCi) of 188Re-HEDP was given to each of 30 patients with painful osseous metastases from lung cancer. The patients were clinically followed at weekly intervals for the first 2 months, and monthly thereafter up to 1 year. Hematologic testing was performed before treatment and thereafter for 6 weeks. Pain response was scored by a four-point pain-rating scale as complete, marked, mild, and no response. Prompt and significant relief of bone pain occurred in 80% with no significant side-effects or hematopoietic toxicity. Forty-six percent (46%) of the patients discontinued analgesics after treatment. This clinical study indicated that 188Re-HEDP can offer significant pain palliation and is a useful radiopharmaceutical for treating painful osseous metastases from lung cancer.     

循证护理对膝关节骨肉瘤患者置换术后疼痛及生活质量的影响

目的探讨循证护理对膝关节骨肉瘤患者置换术后疼痛及生活质量的影响。方法选取2019年4月至2021年4月间郑州市骨科医院收治的100例膝关节骨肉瘤患者,采用随机数表法分为观察组和对照组,每组50例。对照组患者采用传统常规护理干预,观察组患者采用循证护理干预,比较两组患者的疼痛评分、膝关节功能、睡眠质量及生活质量。结果护理后,两组患者疼痛评分均低于护理前,膝关节功能评分均高于护理前,且观察组疼痛评分低于对照组,膝关节功能评分高于对照组,差异均有统计学意义(均P <0.05)。护理后,两组患者的睡眠质量评分均低于护理前,生活质量评分均高于护理前,且观察组睡眠质量评分低于对照组,生活质量评分高于对照组,差异均有统计学意义(均P <0.05)。结论循证护理干预行置换术的膝关节骨肉瘤患者,可降低患者的术后疼痛,改善膝关节功能,提高睡眠质量和生活质量。     

膝关节骨坏死:自发性和继发性两种类型的区别

目的 比较自发性和继发性膝关节骨坏死的临床特点、影像学特征并总结两者的区别.方法 分析2004年1月至2008年1月诊治的25例(29膝)膝关节骨坏死病例的临床资料和随访结果,对自发性和继发性两种类型的膝关节骨坏死进行鉴别诊断分析.结果 8例诊断为自发性骨坏死病例均为老年女性,平均年龄63岁.临床表现为单侧膝关节突发剧痛,损伤局限在单侧股骨髁或胫骨平台,好发于股骨髁中部,软骨下骨剥脱为主要表现.17例继发性骨坏死病例中青年男性患者多见,平均年龄35岁.诱发因素明确,酗酒与激素为主要诱发因素.临床症状表现为轻微疼痛或隐痛,损伤范围广泛,累及股骨远端和胫骨近端的骨髓腔,较少累及关节面.MRI是临床重要的诊断手段,也是临床分类的重要依据.结论 自发性和继发性膝关节骨坏死由于发病机制不同而引起不同的损伤病理变化导致两者在临床表现、损伤部位、范围及影像学表现的本质不同.     

关节镜在单髁置换术中的应用

目的总结关节镜在膝关节单髁置换术中的意义。方法2010年3月至2012年5月,我院为31例膝（33个膝1关节内侧间室骨关节炎患者,行单髁置换中的常规关节镜探查清理。对比其术前查体、影像学检查、术中情况及术后结果,分析关节镜在单髁置换术中的应用价值。结果通过镜检发现所有患者病变主要位于内侧室,内侧室关节面软骨呈现OuterbrigeⅢ～Ⅳ度退变,外侧室关节面软骨正常或退变〈OuterbrigeⅡ度（5个膝关节外侧室关节面软骨退变OuterbrigeⅠ～Ⅱ度）。24个膝关节存在不同程度的内侧半月板损伤及退变,10个膝关节合并OuterbrigeⅠ～Ⅱ度髌股软骨退变,6个膝关节合并外侧半月板损伤及退变,1个膝合并前交叉韧带后外束部分断裂,患者改行全膝置换术。HSS评分：术前平均（67．56±2．929）分,术后平均（90．22±3．816）分,差异有统计学意义（t=24．992,P〈0．05）;膝关节屈曲度：术前平均（103．16±6．802）°,术后平均（114．75±4．765）°,差异有统计学意义（t=11．666,P〈0．05）;负重位膝内翻角：术前平均（12．16±2．102）°,术后平均（8．75±2．015）°,差异有统计学意义（t=17．646,P〈0．05）;屈曲挛缩：术前平均（11．36±1．902）°,术后平均（6．75±2．632）°,差异有统计学意义（t=16．036,P〈0．05）;关节镜探查清理时间平均（9．54±2．019）min。结论（1）尽管关节镜探查延长了手术时间,但在筛选手术适应证方面具有更严谨的作用;f2）对于选择单髁置换合并其它间室病变的患者,关节镜是一种必不可少的治疗手段;f3）对于术前影像学检查及查体提示合并其它间室病变的患者,关节镜探查清理应是单髁置换前的常规步骤。