膝关节置换与关节镜治疗膝关节色素沉着绒毛结节性滑膜炎

背景：外科治疗色素沉着绒毛结节性滑膜炎能够最大程度的切除病变滑膜,最大限度的恢复关节功能。目的：探讨人工全膝关节置换与关节镜下滑膜切除治疗膝关节色素沉着绒毛结节性滑膜炎的膝关节功能和复发率。方法：回顾性分析中南大学湘雅医院骨科2006年12月至2011年12月收治的34例膝关节色素沉着绒毛结节性滑膜炎行手术治疗患者,治疗后病检均为弥漫性色素沉着绒毛结节性滑膜炎,其中24例患者行膝关节镜下滑膜切除,10例色素沉着绒毛结节性滑膜炎患者行人工全膝关节置换,治疗后根据病情行辅助放疗。膝关节镜下滑膜切除组采用Lysholm功能评分,人工全膝关节置换组采用美国膝关节协会评分,比较两组患者治疗前后膝关节功能,随访观察比较两组间的膝关节功能恢复情况及复发率。结果与结论：34例膝关节色素沉着绒毛结节性滑膜炎患者均获有效随访,随访时间12-66个月,平均41.3个月。统计学分析结果表明关节镜下滑膜切除组治疗后膝关节Lysholm功能评分为(86.3±10.3)分,明显高于治疗前的(55.5±13.2)分(t=3.81,P =0.016,P < 0.05)。人工全膝关节置换组美国膝关节协会评分由治疗前的(40.7±2.2)分提高到(90.2±1.1)分(t =6.27,P < 0.01);关节镜下滑膜切除组美国膝关节协会评分由治疗前的(34.2±3.9)分提高到(80.8±1.9)分 (t =16.58,P < 0.01)。证实,关节镜下滑膜切除结合辅助放疗治疗膝关节色素沉着绒毛结节性滑膜炎可取得较好效果,人工全膝关节置换治疗晚期膝关节弥漫型色素沉着绒毛结节性滑膜炎可较好恢复膝关节功能,且复发率较低。中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程全文链接：     

关节镜下病灶清除治疗膝关节结核性滑膜炎

目的探讨关节镜下病灶清除治疗膝关节结核性滑膜炎的疗效。方法 89例膝关节结核性滑膜炎患者,采用关节镜活检和病变清除,通过12～36个月的随访,观察治疗效果。结果 89例随访患者,术前Lysholm膝关节功能评分为（48.2±3.2）分,术后随访Lysholm膝关节功能评分为（92.0±3.7）分,术前JOA膝关节功能评分为（43.4±3.6）分,术后随访JOA膝关节功能评分为（89.3±1.6）分。结论关节镜下病灶清除术治疗膝关节结核性滑膜炎是一种有效的治疗方法。     

关节镜在不同膝关节滑膜病变中的诊疗分析

目的观察关节镜在不同膝关节滑膜病变中的诊断、治疗作用,分析不同病变的临床疗效。方法选取50例关节镜下诊断、治疗的膝关节滑膜病变患者为研究对象,术前拟诊为类风湿性关节炎10例,色素沉着绒毛结节性滑膜炎11例,膝关节慢性感染5例,慢性非特异性滑膜炎12例,膝关节滑膜结核5例,半月板损伤4例,不明原因3例,记录关节镜对膝关节滑膜病变的诊治效果。结果关节镜结合病理检查结果,术后10例患者更正临床诊断,所有伤口均一期愈合,无严重并发症发生。出院后所有患者均获得随访,6例色素沉着绒毛结节性滑膜炎,2例类风湿性关节炎,1例滑膜结核,1例慢性非特异性滑膜炎术后复发,其余患者术后膝关节功能均获得显著改善,总有效率80.0%。结论关节镜检查有利于明确诊断,而且微创可彻底切除病变的滑膜组织,耐受性好。     

32P磷酸铬胶体治疗膝关节色素沉着绒毛结节性滑膜炎术后复发3例

色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis,PVNS)特别是弥漫性PVNS患者,即使在关节镜下细致手术也难以彻底清除病灶,术后易复发.2005年2月至2009年3月我科门诊用32P磷酸铬胶体腔内注射治疗3例膝关节色素沉着绒毛结节性滑膜炎术后复发患者,取得满意效果,现报告如下. 1 资料与方法 1.1 临床资料 3例患者均为男性,年龄分别为23岁、26岁和32岁.因膝关节弥漫肿胀、疼痛、关节腔积液伴偶有关节交锁等症状到当地医院就诊拍X光片未见骨性损伤,按关节滑膜炎对症治疗效果不佳,做MRI检查诊断为PVNS.2例患者行关节镜下滑膜切除术,1例患者行传统开刀手术切除.术后患者关节疼痛肿胀消失,功能恢复正常.病理诊断为PVNS.3例患者分别于术后8个月、11个月、13个月患膝关节再次疼痛肿胀,MRI检查诊断为PVNS复发.来我院门诊就诊要求核素治疗.     

前稳定型垫片在全膝关节置换术中的早期临床研究

目的探讨全膝关节置换术(TKA)中应用前稳定型(AS)垫片的临床效果。方法 2018年1月至2018年12月选取北京大学人民医院收治的107例终末期骨性关节炎行全膝关节置换患者,术中采用邦美公司提供的后交叉韧带保留型(CR)Vanguard膝关节假体,其中使用AS垫片组45例,CR垫片组62例。统计全部患者的手术时间,术后伤口引流量,感染并发症,术前、术后膝关节活动度和膝关节协会评分,比较AS垫片组和CR垫片组之间的差异。结果全部病例均获得随访,随访时间为12~24个月,平均(20.3±2.8)个月。术前AS垫片组、CR垫片组膝关节活动度分别为平均90.2°±17.4°、92.7°±18.6°,术后末次随访时AS垫片组、CR垫片组分别为平均108.5°±22.3°、110.6°±19.3°。膝关节协会评分术前AS垫片组为临床评分(50±15)分、功能评分(52±21)分,CR垫片组为临床评分(49±13)分,功能评分(52±19)分;术后末次随访时AS垫片组临床评分(80±16)分、功能评分(82±20)分;CR垫片组临床评分(82±15)分、功能评分(83±22)分。上述各评价指标、手术时间、术后伤口引流量两组间差异均无统计学意义。所有病例均未出现感染并发症。结论 TKA术中应用AS垫片术后早期膝关节活动度、膝关节协会评分结果良好,与CR垫片相比较效果相当。     

全髋关节置换术治疗晚期髋关节色素沉着绒毛结节性滑膜炎的临床疗效

目的探讨全髋关节置换术治疗晚期髋关节色素沉着绒毛结节性滑膜炎的临床疗效。方法对2000年1月至2015年3月经病理检查证实的34例晚期髋关节色素沉着绒毛结节性滑膜炎患者实施病变滑膜切除术联合人工全髋关节置换术,术前均行骨盆X射线片、CT及MRI检查,手术前后行Harris髋关节功能评分,术后进行系统的康复训练,定期复查髋关节X射线片。结果 34例均获随访,随访时间1.5~7年,平均5.2年,术后假体位置良好并获得了满意的关节活动度。术前髋关节功能Harris评分为(45.0±6.4)分,术后1年髋关节功能Harris评分为(90.2±3.2)分,差异具有统计学意义(t=0.468,P0.05)。无复发病例。结论病变滑膜切除术联合人工全髋关节置换术治疗晚期髋关节色素沉着绒毛结节性滑膜炎可获得良好的临床效果,复发率低。     

膝关节滑膜皱襞综合征的临床诊断和关节镜疗效分析

目的探讨膝关节滑膜皱襞综合征的临床诊断标准和关节镜治疗疗效。方法分析我院自2010年至2016年收住的24例27膝关节内滑膜皱襞综合征患者,用关节镜探查关节腔并行滑膜皱襞清理。按Lysholm评分标准评价手术治疗前后膝关节功能,用配对t检验分析随访结果,评价关节镜治疗效果。结果按Lysholm评分标准评定:术前评分56.296±6.445,术后评分78.481±6.262,t=12.995,P0.001,具有统计学意义。结论膝关节内滑膜皱襞综合征的诊断需依靠临床症状及体征,膝关节MRI平扫可有效提高诊断率,关节镜诊断为金指标,关节镜手术创伤小恢复快,关节清理术治疗效果显著。     

关节镜下空心螺钉固定ACL胫骨止点撕脱骨折

目的观察关节镜下空心螺钉固定ACL胫骨止点撕脱骨折的临床效果。方法 2010年2月~2011年3月,关节镜下空心螺钉固定ACL胫骨止点撕脱骨折13例,在关节镜下复位骨折块,空心螺钉固定骨折块。通过1年以上随访行疗效评定。患者膝关节功能以Lysholm评分系统评分。结果全部病例获完整随访,平均随访16m(12~25m)。Lysholm膝关节功能评分:术前23~65分,平均(48.45±5.23)分;术后83~96分,平均(91.34±6.53)分。优11例,良1例,中1例,优良率92.3%。结论关节镜下空心螺钉固定ACL胫骨止点撕脱骨折创伤小、恢复快,是一种可行的方法。     

关节镜诊治滑膜软骨瘤病的近期疗效

目的:全面分析关节镜手术对滑膜软骨瘤病的诊疗疗效.方法:2011年1月至2016年12月,中国人民解放军兰州总医院骨科中心运动医学科明确诊治了膝滑膜软骨瘤病共17例,术前负重行走时疼痛视觉模拟评分(Visual Analogue Scale,VAS)为3.81±2.02;Lysholm评分为43.27±7.91.完善术前相关检查及检验后采用关节镜对患者进行诊断及治疗,并将关节内的软骨样游离体送致病例检查以明确诊断,同时行关节镜下探查清理术.术后给予玻璃酸钠+曲安奈德注射液腔内注射.结果:术后病理检查结果均为滑膜软骨瘤病,患者随访4～24(平均12.7)个月,患者术后体征缓解,膝关节屈曲活动度较术前改善,无其他并发症,我科随访期间未见滑膜软骨瘤病复发患者.行VAS评分下降至末次随访时的2.5±0.4,差异有统计学意义(P＜0.05);Lysholm评分提升至近期随访时的86.5±4.2,差异有统计学意义(P＜0.05).结论:滑膜软骨瘤病具有较强的隐匿性,采用关节镜手术对滑膜软骨瘤病可明确诊断,结合局部封闭镇痛治疗是目前治疗滑膜软骨瘤病的可行性办法.     

膝内翻患者全膝关节置换术后保留轻度内翻对临床效果的影响

目的 评价膝内翻患者全膝关节置换术后保留轻度内翻对临床效果的影响。方法 对2016年3月至2019年11月于武汉大学人民医院因膝内翻膝关节骨性关节炎行TKA治疗的93例（93膝）患者的临床资料进行回顾性分析。其中,男17例,女76例;年龄71 ～ 87岁,平均77岁。按患者术后下肢力线角度将患者分为中立组、轻度内翻组、严重内翻组。用ROM、HSS、AKS评分量表评价患者膝关节功能。结果 患者随访时间15 ～ 47个月,平均（24.4±8.9）个月,ROM术前平均（49.9±6.7）°,术后末次随访中立组、轻度内翻组、严重内翻组分别为平均（111.4±5.3）°、（112.2±5.0）°、（103.1±2.7）°,HSS评分术前平均（52.4±3.0）分,术后末次随访中立组、轻度内翻组、严重内翻组分别为平均（84.2±3.0）分、（87.1±2.6）分、（81.6±1.9）分,AKS功能评分术前平均（49.8±2.8）分,术后末次随访中立组、轻度内翻组、严重内翻组分别为平均（73.2±5.3）分、（80.1±3.0）分、（72.6±1.5）分,AKS活动评分术前平均（60.5±3.7）分,术后末次随访中立组、轻度内翻组、严重内翻组分别为平均（86.0±2.6）分、（89.9±2.0）分、（80.6±2.9）分,三组术后HSS、AKS评分均较术前有所提高,差异有统计学意义。结论 从短期随访来看,膝内翻患者全膝关节置换术后保持3° ～ 6°的轻度内翻会带来更好的临床疗效,但目前还不能判断内翻对齐和翻修率之间是否存在关联。     

Asymmetry of the internal connections of the striate cortex of the cat in the projection zone of the center of the field of vision

Studies were carried out on the organization of the internal connections of the striate cortex in cats in the projection zone of the center (0–5°) of the field of vision by microintophoretic application of horseradish peroxidase to electrophysiologically identified orientational columns. The area containing neurons showing retrograde labeling in most cases extended in the mediolateral direction. Labeled cells were located in the upper (II, III) and lower (V, VI) layers of the cortex, and the shapes and orientations of the areas containing labeled neurons in these layers coincided. Spatial asymmetry was detected in the distribution of labeled neurons relative to the orientational column studied. Labeled cells were located predominantly medial to the columns, regardless of the distance from the projection of the area centralis. Considering the visuotopical map of field 17, the asymmetry detected here provides evidence that neurons in orientational columns have more extensive connections with neurons of the peripheral part of the cortex. An asymmetrical distribution of “silent” zones around the receptive fields of neurons in orientational columns is suggested, and that these appear to receive influences from the periphery of the visual field. Laboratory of Visual Physiology and Laboratory of Central Nervous System Morphology, I. P. Pavlov Institute of Physiology, Russian Academy of Sciences, 6 Makarov Bank, 199034 St. Petersburg, Russia. Translated from Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 82, No. 12, pp. 23–29, December, 1996.     

Effects of the lesion of the postcommissural part of the septum on the behavior of the rat.

The effects of the lesion of the postcommissural part of the septum on behavior of the rat has been studied. Results may be summarized as follows. An increase in the exploratory behavior in the open field which decreases rapidly; a decrease in the number of defecations in this test and a decrease in time leaving a dark environment for exploration. In the shuttle box test, no facilitation of the acquisition, but a permanent and quite significant increase in the intertrial activity has been found. We conclude that the lesions tend to decrease the emotivity of the subjects. An interpretation on the basis of the species -- specific defensive reactions explains the transitory and permanent effects of the lesions on the spontaneous activity.     

The development of the ligament of the head of the femur

The hip joints of 30 human male and female fetuses and stillborns between 20 mm and 350 mm crown-rump length were studied by light microscopy. The ligament of the head of the femur developed in situ as a condensation of mesenchyme at the end of the second month of intra-uterine life (IUL), and was vascularized by branches of acetabular vessels early in the fourth month. In the majority of fetuses older than 5.5 months IUL, vessels in the ligament passed a short way into the femoral head within cartilage canals, to supply a small region around the fovea capitis. The remainder of the head was supplied by vessels in canals from around the upper part of the neck. The ligament changed from predominantly cellular to fibrous during the last 4 months of IUL. This increase in strength suggested significant mechanical functions in utero: limitation of adduction-flexion and opposition to postero-superior dislocation were the most likely.     

Counterpointing the functional role of the forebrain and of the brainstem in the control of the sleep-waking system

This paper reviews the lifetime contributions of the author to the field of sleep-wakefulness (S-W), reinterprets results of the early studies, and suggests new conclusions and perspectives. Long-term cats with mesencephalic transection show behavioral/polygraphic rapid eye movement sleep (REMS), including the typical oculo-pupillary behavior, even when the section is performed in kittens prior to S-W maturation. REMS can be induced as a reflex. Typical non-rapid eye movement S (NREMS) is absent and full W/arousal is present only after a precollicular section. The isolated forebrain (IF) rostral to the transection exhibits all features of W/arousal and NREMS [with electroencephalographic (EEG) spindles and delta waves], arousal to olfactory stimuli, and including the appropriate oculo-pupillary behaviors. These features also mature normally after neonatal transection. REMS is absent from the IF. After deprivation there is NREMS pressure and rebound in the IF, but the decerebrate cat only shows pressure for REMS. Most IF reactions to pharmacologic agents are within expectations, except for the tolerance/withdrawal effects of long-term morphine use which are absent. In contrast, these effects are supported by the brainstem (i.e. seen in the decerebrate cat). In cats with ablation of the telencephalon, or diencephalic cats, delta waves are absent in the thalamus. EEG thalamic spindle waves are seen triggering S for only 4-5 days after ablation. Therefore, true NREMS is absent in chronic diencephalic cats although pre- and postsomniac behaviors persist. These animals are hyperactive and show a pronounced, permanent insomnia; however, a low dose of barbiturate triggers a dramatic REMS/atypical NREMS rebound. Cats without the thalamus (athalamic cats), initially show a dissociation between behavioral hyperactivity/insomnia and the neocortical EEG, which for 15-20 days exhibits only delta and slower oscillations. Fast, low-voltage W rhythms appear later on, first during REMS, but spindle waves and S postures are absent from the start, such that these cats also display only atypical NREMS. Athalamic cats also show barbiturate-sensitive insomnia. Cats with ablation of the frontal cortices or the caudate nuclei remain permanently hyperactive. They also show a mild, but significant hyposomnia, which is permanent in afrontal cats, but lasts for about a month in acaudates. The polygraphic/behavioral features of their S-W states remain normal. We conclude and propose that: (a) the control of the S-W system is highly complex and distributed, but is organized hierarchically in a well-defined rostro-caudal manner; the rostral-most or highest level (telencephalon), is the most functionally complex/adaptative and regulates the lower levels; the diencephalic/basal forebrain, or middle level, has a pivotal role in inducing switching between S and W and in coordinating the lowest (brainstem) and highest levels; (b) W can occur independently in both the forebrain and brainstem, but true NREMS- and REMS-generating mechanisms exist exclusively in the forebrain and brainstem, respectively; (c) forebrain and brainstem S-W processes can operate independently from each other and are preprogrammed at birth; this helps understanding normal and abnormal polygraphic/behavioral dissociations in humans and normal dissociations/splitting in aquatic mammals; (d) NREMS homeostasis is present in the IF, but only REMS pressure after deprivation persists in the decerebrate cat; (e) the thalamus engages in both NREMS and W; (f) insomnia in diencephalic cats is the result of an imbalance between antagonistic W- and S-promoting cellular groups in the ventral brain (normally modulated by the telencephalon); (g) the EEG waves, which are signature for each S-W state, appear to truly drive the concomitant behaviors, e.g. a hypothetical human IF could alternate between behavioral NREMS and W/arousal/awareness; (h) a role for REMS is to keep the individual sleeping at the end of the self-limiting NREMS periods. The need for accelerating research on telencephaling NREMS periods. The need for accelerating research on telencephalic S-W processes and downstream control of the lower S-W system levels is emphasized.     

Topical organization of the projections of neurons of the substantia nigra and the ventral field of the tegmentum of the midbrain to the head of the caudate nucleus of the cat

Neuroscience and Behavioral Physiology -     

Involvement of the striatum in the central regulation of the hormonal functions of the gonads

Studies reported here show that intrastriatal administration of corticoliberin to rats decreases the blood testosterone level. However, in conditions of chemical deficiency of dopaminergic transmission in the dorsal striatum induced by injection of 6-hydroxydopamine, the effect of this neurohormone did not appear. It is concluded that extrahypothalamic corticoliberin is involved in regulating the hormonal reproductive system acting via dopaminergic mechanisms. Translated from Rossiiskii Fiziologicheskii Zhurnal imeni I. M. Sechenova, Vol. 85, No. 4, pp. 594–597, April, 1999.     

Ultrastructure of the endothelium of the drainage system of the eye

The endothelium of the ocular drainage system (Schlemm’s canal, collector tubules, and aqueous veins) in primary juvenile glaucoma undergoes degenerative dystrophic changes with compensatory hypertrophy and proliferation at the initial stages of the glaucomatous process and atrophy and desquamation at advanced and terminal stages. Progressive decrease in the pinocytous function of endotheliocytes, reduction of the protein-synthesizing and mitochondrial compartments of the cytoplasm, and formation of autophagosomes reflect the process of endotheliocyte degeneration in general. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 145, No. 5, pp. 574–577, May, 2008