超声早期诊断无症状高尿酸血症患者关节病变

目的探讨高频超声对早期诊断无症状高尿酸血症患者关节病变的价值。方法采用高频超声随机检查75例无症状高尿酸血症患者(无症状组)和100名健康体检者(对照组)的双侧第一跖趾关节、踝关节、膝关节(共1050个关节)。声像图中出现以下征象之一为超声检查阳性:滑膜增厚、关节腔积液、晶体沉积、痛风石、骨侵蚀、滑膜内出现血流信号。结果无症状组关节病变的超声检出率为16.00%(12/75),远高于对照组(0)。无症状组有14个病变关节(14/450),均位于第一跖趾关节。病变关节的超声表现:滑膜增厚8个,关节腔积液3个,晶体沉积5个,骨侵蚀6个;20~60岁不同年龄段无症状高酸尿血症患者均可能出现关节病变。结论无症状高尿酸血症患者可能已出现关节病变。高频超声能早期诊断无症状高尿酸血症患者关节病变,可作为常规影像学筛查手段,应以第一跖趾关节作为检查的重点。     

高频超声在四肢关节病变早期诊断中的应用

目的探讨高频超声在四肢关节病变早期诊断中的应用。方法收集有症状而行四肢关节超声检查的患者65例314个关节,其中有25例157个关节同时行X线检查。结果65例患者中有57例（87．7％）,314个四肢关节中有214个关节（68．2％）检出有不同程度的异常改变。同时行超声检查和X线检查的25例患者中,超声检查检出病变22例（88％）,157个四肢关节中有99个（63．1％）检出病变;X线检查检出病变14例（56％）,57个关节（36．3％）检出病变。两者间病例检出率的差异有统计学意义（X^2=4．083,P〈0．05）,以超声较高（88％VS56％）;超声关节病变检出率比X线检查高（63．1％ VS 36．3％）,差异有统计学意义（X^2=20．050,P〈0．01）。结论超声检查对于四肢关节病变早期诊断有良好的临床应用价值。联合超声和X线检查可显著提高四肢关节病变的检出率。     

多种影像学方法对痛风性关节炎诊断价值的临床研究

目的比较X线、CT、MRI和超声对痛风性关节炎(gouty arthritis,GA)的临床诊断价值。方法 65例临床确诊的GA患者,通过X线、CT、MRI和超声主要观察分析病变关节的关节滑膜、关节积液、关节周围软组织、骨质破坏及痛风结节。结果本组患者实验室检查均为阳性。对于关节病变的观察,X线和CT检查除关节积液外其余无显著性差异(P0.05),MRI和超声检查无显著性差异(P0.05)。对于骨质破坏及痛风结节的观察,X线、CT、MRI、超声间比较均无显著性差异(P0.05)。对关节滑膜增厚、关节积液及关节周围软组织炎症的观察,MRI、超声与X线、CT比较均有显著性差异(P0.05)。结论 X线和CT检查主要用于评价中晚期GA患者的关节损害。超声检查对于GA关节病变的观察与MRI相似,可以做为早期诊断GA疾病的首选检查方法。     

滑膜软骨瘤病13例临床分析

目的 探讨滑膜软骨瘤病外科诊断和治疗经验。方法 对１９８６－１９９７年期间经治的１３骨膜罗骨瘤病的诊断、治疗及其病理进行总结、分析。结果 滑膜软骨瘤病临床多表现为间歇性关节疼痛、肿长、功能受限,活动时关节有弹响声或磨擦感,少数有关节交锁有的可及活动性人;Ｘ线片显示关节内游离体数目往往秒于关节内游离体的实际数目;术中肉眼可见病变滑膜充血、增厚、表面粗糙;镜下风 管增生、淋巴细胞聚集、滑膜囊层细胞及纤     

下肢静脉超声检出肌肉骨骼系统病变的临床价值

目的探讨下肢静脉超声检出肌肉骨骼系统病变的临床价值。方法回顾性收集因临床疑诊或需除外下肢深静脉血栓接受下肢静脉超声检查的8 288例患者的资料,分析下肢静脉超声检查对于肌肉骨骼系统病变的检出率及合并深静脉血栓等超声表现。结果下肢静脉超声检出肌肉骨骼系统病变134例,以腘窝囊肿(90/134,67.16%)最常见,其后依次为血肿(31/134,23.13%)、肌肉撕裂(5/134,3.73%)、脓肿(2/134,1.49%)、肿瘤(2/134,1.49%)、肌层囊肿(2/134,1.49%)、腘窝术后积液(1/134,0.75%)及膝关节滑膜增生(1/134,0.75%)。不同肌肉骨骼系统病变超声表现各异。腘窝未破裂囊肿最大径大于破裂囊肿(F=5.266,P=0.024)。134例中20例合并下肢深静脉血栓,其中肌肉撕裂患者最易合并血栓(1/5,20.00%)。结论下肢静脉超声检查可在判别有无深静脉血栓的同时检出肌肉骨骼系统病变,有助于修正或补充临床诊断及治疗方案,具有较高临床价值。     

髋关节滑膜软骨瘤病的诊断与治疗

[目的]探讨髋关节滑膜软骨瘤病的早期诊断与手术疗效。[方法]5例髋关节原发性滑膜软骨瘤病患者,左侧3例,右侧2例。采用髋关节Smith-Petersen切口十字形切开关节囊进入关节腔切除增生肥厚滑膜、清除游离体。[结果]随访6～48个月,平均28个月,全部治愈。[结论]该病早期诊断困难,临床、放射学及病理检查相结合是确诊关键;采用髋关节前外侧入路显露术清除游离体、切除病变滑膜,疗效确切。     

肌肉骨骼超声技术对风湿性疾病的诊断价值

目的探讨肌肉骨骼超声技术在诊断风湿性疾病病情活动中的应用价值。方法选择2016年1月至2018年9月在我院接受治疗的112例风湿性疾病患者,采用肌肉骨骼超声技术对患者进行关节、骨骼、肌肉及软组织扫描,观察治疗前后滑膜厚度、关节积液、骨面缺损、滑膜血流变化、痛风石、双轨征等影像学表现并进行评分比较,评价肌肉骨骼超声技术对风湿性疾病的诊断价值。结果风湿性疾病患者中,有57例(50. 89%)发生类风湿关节炎,超声表现为关节滑膜增厚,关节积液深度增加,形成血管翳,发生骨侵蚀;有29例(25. 89%)发生痛风性关节炎,超声主要表现为痛风石、多点状强回声和双轨征;有26例(23. 21%)发生骨性关节炎,超声主要表现为关节软骨退化、关节滑膜增厚和关节积液。治疗后超声检查显示,除了骨表面缺损和软骨退化以外,其他主要超声观察指标明显改善(P0. 05)。结论肌肉骨骼超声技术能够全面、细致、动态地检测风湿性疾病的组织病变程度及发展情况,对风湿性疾病的影像学诊断和治疗具有很高的应用价值。     

髋关节结核临床诊疗进展

<正>髋关节结核的发病率约占全身骨关节结核的15%,仅次于脊柱结核[1]。近年来骨关节结核病死灰复燃,为骨科工作者敲响了警钟[2]。髋关节结核可表现为滑膜结核或骨结核。骨结核可以是关节内的也可以是关节外的。滑膜结核和关节内结核的症状、体征以及放射学表现可以与其他关节内疾病很相似,如滑膜炎、类风湿性关节炎、骨关节炎以及骨坏     

肌骨超声在中老年退行性膝关节病变的临床应用价值

目的探讨肌骨超声对中老年退行性膝关节病变的临床诊断价值。方法选取我院临床诊断为退行性膝关节病变患者60例(87个膝关节),男32例,女28例;年龄55～78岁,平均(61.5±6.5)岁。所有患者患侧膝关节均行US、MRI检查及关节镜手术。通过膝关节US和MRI检查结果与关节镜手术后诊断进行比较,分析肌骨超声(ultrasound,US)诊断退行性膝关节病变的临床价值。结果肌骨US可以清晰地显示关节软骨病变、滑膜增厚及关节积液,并且可以观察增生滑膜内的血流信号丰富程度,其与MRI的诊断符合率比较,差异无统计学意义(P0.05)。但是对于诊断肌腱、半月板及韧带的损伤,MRI明显优于肌骨US,二者比较差异有统计学意义(P0.05)。结论肌骨US对退行性膝关节早期病变的诊断价值与MRI相同,可作为中老年膝关节病的常规检查,值得临床推广应用。     

类风湿关节炎指骨关节超声改变与骨质疏松的相关性

目的 探讨类风湿性关节炎（RA）指骨关节病变超声改变与骨量变化的相关性。方法应用高频超声 对100例RA患者的手指关节进行扫查, 观察其滑膜厚度、关节腔、骨面、关节周围软组织及血流供应情况 ,并采用双能X线吸收法测定腰椎和股骨颈的骨密度。结果 高频超声可清晰显示手部指骨关节腔积液、关 节滑膜增生、关节侵蚀及骨质疏松情况,伴随着骨质疏松危险因素的RA患者,骨密度与RA的性别、年龄、 病程呈负相关,年龄越大、病程越长, 其骨密度越低(P＜0.05)。RA女性患者发生骨质疏松症明显高于男 性。结论 骨量变化及超声表现与患者性别、年龄、病程具有明显相关性。骨密度检测结合超声检查更能 够实时的反映RA的骨量变化。     

Value of ultrasonic diagnosis in transient coxitis]

In this paper the method of ultrasound examination of the hip and the results in 38 cases with acute and subacute hip complaints, suspect of transitory arthritis of the hip, are described. We could state that the increase of joint synovial fluid, causing typical complaints and clinical symptoms can be demonstrated with this method and its measure can be determined. The possibility to follow with objective method the whole time of regression of the process is also given. Based on our results we suggest the use of this method in the examination of cases suspect of the transitory arthritis of the hip as a supplement of the methods used until now.     

Superoxide dismutase and hyperbaric oxygen therapy of the patient with rheumatoid arthritis

Cu, Zn-SOD values were measured by enzyme immunoassay in the synovial fluid, leukocytes in the synovial fluid, synovial membrane, and leukocytes in blood of the patients with rheumatoid arthritis. SOD activity, lipoperoxide value in serum, ESR, and Lansbury's index of the patients with rheumatoid arthritis under hyperbaric oxygen (HBO) therapy were also investigated. SOD values of synovial fluid and of leukocytes in synovial fluid from rheumatoid arthritis group were found to be higher than those from osteoarthritis group. No significant difference was found the SOD values in leukocytes of blood and synovial membrane between two groups. In the patients with rheumatoid arthritis under HBO therapy the SOD activity was increased, whereas lipoperoxide values was decreased. Furthermore, ESR and Lansbury's index showed a remarkable recovery. These results suggest that HBO therapy may be an effective treatment for the patients with rheumatoid arthritis.     

Interleukin-16 in synovial fluids from cases of various types of arthritis

OBJECTIVES: To examine the characteristic relationship between interleukin-16 (IL-16) and clinical data in various types of arthritis. METHODS: We measured IL-16 levels of the synovial fluids (SF) of patients with various types of arthritis, which included rheumatoid arthritis, traumatic arthritis, pseudogouty arthritis, gouty arthritis, and osteoarthritis, by an enzyme immunosorbent assay, and examined their correlations with clinical parameters. RESULTS AND CONCLUSIONS: Higher levels of IL-16 in synovial fluid from patients with rheumatoid arthritis, traumatic arthritis, and pseudogouty arthritis, compared to those with osteoarthritis, and gouty arthritis were indicated. Also, synovial IL-16 levels in patients with rheumatoid arthritis correlated significantly, especially with synovial matrix metalloproteinase-3 levels. But the IL-16 levels of both synovial fluid and peripheral blood did not correlate with conventional inflammatory parameters such as C-reactive protein, erythrocyte sedimentation rate, or rheumatoid factor. Although the function of IL-16 in inflammatory arthritis has not yet been defined, these data indicated some essential features of IL-16.     

Performance of a new rapid diagnostic test the lactate/glucose ratio of synovial fluid for the diagnosis of septic arthritis

ObjectiveTo evaluate the diagnostic performance of the synovial lactate, glucose and lactate/glucose ratio assay for the diagnosis of septic arthritis.MethodsIn this monocentric cross-sectional study, synovial fluids were prospectively obtained from patients with acute joint effusion (<30 days) on native joint. Septic arthritis was defined using Newman's criteria. To evaluate diagnostic performance, Receiver Operating Characteristic (ROC) curves with Area under the curve (AUC), Sensitivities (Se), Specificities (Sp), LR+ their 95% confidence intervals were calculated. Synovial fluid cultures with gram staining, crystal analyses, synovial fluid white blood cell counts (WBC), lactate and glucose assays were performed.ResultsA total of 233 synovial fluids were included. 25 patients had septic arthritis and 208 had non-septic arthritis (104 crystal-induced arthritis, 15 RA, 8 SpA, 6 reactive arthritis, and 75 acute arthritis of undifferentiated origin). Synovial lactate/glucose ratio performed higher than the synovial lactate or glucose assay separately (AUC: 0.859 [0.772–0.945]). Best synovial lactate/glucose ratio threshold to differentiate septic arthritis from non-septic arthritis was 5 Se 52% [0.34–0.7], Sp 98.1% [0.95–0.99], LR+ 27.0[9.50–76.00]).ConclusionThe diagnostic performance of synovial lactate/glucose allows septic arthritis to be effectively and very quickly distinguished from other types of arthritis.     

Role of serum and synovial procalcitonin in differentiating septic from non-septic arthritis- a prospective study

IntroductionSeptic arthritis is a serious orthopaedic emergency that must be diagnosed and managed early to prevent devastating complications. The current gold standard for diagnosing septic arthritis is synovial fluid culture, but results are delayed by 48–72 h, and the sensitivity of the test is very low. Differentiating Septic from non-septic arthritis is vital to prevent unnecessary use of antibiotics and prevent complications. Serum Procalcitonin (PCT) is a useful marker in differentiating septic from non-septic arthritis but there are very few studies that have studied the role of synovial PCT for the same.AimTo determine the role of serum and synovial PCT in differentiating acute Septic from non-septic arthritis.Materials and methodsProspective clinical study in which 60 patients presenting with acute inflammatory arthritis (<2 weeks duration) were enrolled from May 2018 to May 2020. Serum and synovial fluid samples were drawn at presentation and routine blood investigations, synovial fluid culture sensitivity, and Procalcitonin levels were measured. Patients were divided into 3 groups, with group-1 having confirmed pyogenic, group-2 having presumed pyogenic, and group-3 having non –pyogenic patients, respectively. All data was tabulated and statistically analysed using appropriate tests.ResultsMean serum PCT values in groups 1, 2 and 3 were 1.06 ± 1.11, 0.85 ± 0.74, and 0.11 ± 0.24, respectively. Patients in the Pyogenic group (group1 and group 2) had significantly higher mean serum PCT as compared to group3 (p < 0.0001). Group 1 had higher serum PCT as compared to group 2, but the difference was not significant (p = 0.58). Mean synovial PCT in group 1, 2 and 3 were 2.42 ± 1.98, 1.89 ± 1.18, and 0.22 ± 0.40, respectively. Patients in the Pyogenic group (Group1 and Group2) had significantly higher mean synovial PCT as compared to Group 3 (p < 0.0001). Group 1 had higher mean synovial PCT as compared to group 2, but the difference was not significant (p = 0.54). The area under the ROC curve of the serum levels of PCT was 0.0.895, and the area under the ROC curve of the synovial fluid levels of PCT was 0.914, which was higher than the serum PCT level.ConclusionSerum and synovial Procalcitonin may be used as a diagnostic marker in differentiating septic from inflammatory arthritis and can help in reducing unnecessary use of antibiotics and early diagnosis and management of septic arthritis, thereby preventing complications.     

Synoviale Erkrankungen und freie Körper des Hüftgelenks

Synovial disorders and loose bodies are one of the most common indications for hip arthroscopy. Arthroscopic intervention has been reported for loose bodies, synovial plicae, synovial chondromatosis, pigmented villonodular synovitis (PVNS) as well as rheumatoid and septic arthritis. One major advantage in comparison to radiologic imaging is the ability to inspect, biopsy, and treat within one procedure. In contrast to an arthrotomy, hip arthroscopy avoids the potential risks of extensive surgical exposure and prolonged rehabilitation. Nevertheless, hip arthroscopy cannot be promoted as curative in all synovial disorders. In patients with loose bodies, synovial plicae, initial septic arthritis and, to a certain extent, PVNS curative therapy and "restitutio ad integrum" can be achieved. In contrast, in patients with synovial chondromatosis and rheumatoid arthritis, the goal of hip arthroscopy is to enable the correct diagnosis and to provide symptomatic relief and maintain or improve joint function. Success or failure of arthroscopic treatment depends on proper patient selection and a correct arthroscopic technique.     

Imaging in rheumatoid arthritis of the elbow

Early specific radiologic changes of rheumatoid arthritis can usually be detected in the hands and feet. Later stages of the disease process show a typical centripetal spread of the affected joints, i.e., shoulder, elbow, and knee. For prognostic assessment of cubital rheumatoid arthritis, conventional radiography still remains the gold standard. X-rays allow objective scoring and thus classification into standardized stages. A concentric destruction of the rheumatic joint as compared to deformity in the degenerative joint is the typical radiologic symptom to look for. For soft tissue assessment, ultrasound (US) should be the diagnostic tool of choice. Due to the thin surrounding soft tissue layer, as well as the advanced high-resolution technology, bony structures can also be well demonstrated in any plane. In the early arthritic stages, particularly the small changes, e.g., minimal erosions of the cortical area, are very well detectable by US. The use of "color" allows good evaluation of the synovial inflammatory status. Modern imaging methods such as computer- assisted tomography (CAT) scan and magnetic resonance imaging (MRI) are restricted to a few set indications and should not be chosen for routine examination. More invasive methods such as arthrography are no longer indicated for assessment of cubital rheumatoid arthritis.     

Matrix Metalloproteinases 2 and 9 Activity in Bovine Synovial Fluids

Matrix metalloproteinases (MMPs) are important enzymes found in connective tissues and thought to be involved in cartilage degradation. They are detectable in bovine synovial fluid and may play a destructive role in bovine septic arthritis. The MMP gelatinase enzymes were detected by gelatin zymography using image analysis of the gels. The active gelatinase levels were determined by a gelatin degradation enzyme‐linked immunosorbent assay (ELISA). Increased concentrations of MMP‐9 activity were found in the synovial fluids of cows with septic arthritis (P < 0.001) in comparison with fluids from normal joints. Using the gelatin degradation ELISA the net active gelatinases were measured, and significant increases were found in gelatinase bioactivities in synovial fluids from septic joint disease cases (P < 0.001). Increased concentrations of MMP‐2 activity were found in the synovial fluids of cows with aseptic arthritis, which appeared to be playing an important role in degradation of articular cartilage in joint disease. This finding required further investigation.     

Diseases of the hip joint in childhood and adolescence--ultrasonic differential diagnoses

A total of 329 children with hip pain were examined by ultrasound, which indicated transient synovitis (n = 161), rheumatoid arthritis (n = 16), tuberculoid arthritis (n = 3), septic arthritis (n = 16), Legg-Calvé-Perthes disease (n = 102), and slipped capital femoral epiphysis (n = 31). Using the standard planes described by DEGUM and DGOOC, it is possible to analyze the joint capsule, the surface of the femoral head, and the periarticular structures. In cases of synovitis or joint effusion, a capsular distension can be diagnosed by ultrasound. This distension is typical in transient synovitis, septic and tuberculoid arthritis, juvenile rheumatoid arthritis, and the onset phase of Perthes disease. Because capsular distension exhibits no significant differences in the various diseases, differentiation is not possible with ultrasound in the absence of osseous abnormalities. In cases with both capsular distension and osseous abnormalities, ultrasound usually allows a differentiation between slipped capital femoral epiphysis and Perthes disease as well as septic and unspecific arthritis.