关节镜诊断和治疗膝关节骨关节炎

自１９９０年７月￣１９９５年７月，作者对７９例（９１膝）膝关节骨关节炎（ＯＡ）患者进行关节镜检查及镜下清理术。镜检结果：２３例（２７膝）获得早期诊断，关节镜分级与临床表现呈正相关，与Ｘ线片改变程度的符合率较低（４７．１％）。随访２￣５年，平均３．９年。术后综合评估：１￣２年，优良率７７．２％，２年以上优良率６０．８％。软骨退变程度与疗效关系：术后１￣２年优良率：软骨Ｉ度退变１００％、Ⅱ度７１．４％     

颈椎管狭窄症的影像学所见与临床表现的对照研究

作者对４７例经手术证实颈椎管狭窄症患者的临床、ＭＲＩ和Ｘ线资料作对照研究。采用日本矫形外科协会用ＪＯＡ标准评定，最低６分，最高１４分，平均１０．１３分。Ｔｏｒｇ指数均小于正常值，以Ｃ＿４为最小。ＭＲＩ示颈髓前后代偿间隙，颈髓矢状径均减少，以病变节段最为明显。Ｔｏｒｇ指数、ＭＲＩ的脊髓矢状径与ＪＯＡ评分密切相关（Ｐ＜０．０１，相关系数分别为０．０９９３和０．４８１５，其中ＭＲＩ明显优于Ｘ线（Ｐ＜０．０１）。ＭＲＩ的特征变化为正中矢状面上蛛网膜下腔减少或消失、和／或伴有脊髓的压迫形变、髓内改善。进而对ＭＲＩ表现以：（１）狭窄范围；（２）狭窄方向；（３）狭窄程度和（４）髓内改变四方面行详尽分类。此分类较准确地联系临床，对颈椎管狭窄症的准确诊断和术式选择有指导意义。     

静脉注射不同剂量异丙酚对血流动力学及通气功能的影响

应用阻抗法和分气流监测法观察静脉注射不同剂量异丙酚（Ｐｒｏｐｏｆｏｌ，ＰＲＯ）后患者血流动力学（ＭＡＰ、ＮＲ、ＳＬＣＩ、ＩＦＩ、ＶＥＴ、ＥＶＩ、ＳＶＲＩ、ＩＣ、ＰＦＩ、ＬＳＷＩ）与通气功能（ＶＴ、ＲＲ、ＶＥ、ＦＥＶ１％、ＥＴＣＯ２、ＳＰＯ２、 Ｉ－ＥｔＯ２）的变化。 ４０例（ＡＳＡⅠ～ Ⅱ）随机分成四组，ＰＲＯ剂量分别为 １．０ｍｇ／ｋｇ、１．５ｍｇ／ｋｇ、２．０ｍｇ／ｋｇ、２．５ｍｇ／ｋｇ。结果：（１）１～４组呼吸暂停发生率为０％、２０％、３０％、８０％，苏醒时间分别为３ ０±１．５、７．４±２．３、９．１±３．６、９．６±４．２分钟：（２）静脉注射不同剂量ＰＲＯ启ＳＡＰ、ＤＡＰ、ＭＡＰ、ＳＩ下降，ＨＲ、ＣＩ、ＳＶＲＩ无明显变化，心肌收缩性（ＩＣ、ＰＦＩ、ＥＶＩ）明显减弱，ＳＶＲＩ减少；（３）ＰＲＯ对呼吸有抑制作用，以ＶＴ和ＶＥ影响最大，与剂量呈正相关；对面罩吸氧患者ＳｐＯ２、ＲＲ、ＥＴＣＯ２无明显改变，Ｉ－ＥｔＯ２减少；舌后坠者托起下颌对ＶＴ、ＶＥ的恢复颇为有效。     

双能X线和单光子吸收法及定量超声诊断骨质疏松症的比较

了解三种方法诊断骨质疏松症（ＯＰ）之间的关系。方法应用双能Ｘ线吸收法（ＤＸＡ）和单光子吸收法（ＳＰＡ）及定量超声（ＱＵＳ），同时随机测量２９４例受试者腰椎后前位和侧位、左侧髓部和前臂骨矿密度（ＢＭＤ）及右侧胫骨超声速度（ＳＯＳ）。结果ＤＸＡ和ＳＰＡ测量桡骨ＯＰ的检出率分别为２５．９％和２１．４％，ＤＸＡ测量腰椎后前位、侧位、侧位兴趣区、Ｗａｒｄ’ｓ区和股骨颈ＯＰ检出率分别为１６．０％、２２．８％、２６．２％、１９．４％和４．４２％，ＱＵＳ的ＯＰ检出率为１７．７％。三种方法及不同部位之间的测量结果呈显著相关（ｒ＝０．４９４～０．９６７，Ｐ＜０．０１）。ＤＸＡ测量前臂１／３处ＢＭＤ显著高于ＳＰＡ。诊断ＯＰ的齐同率ＤＸＡ各部位相互之间平均为４０．１％±１５．５％，ＤＸＡ与ＳＰＡ平均为４８．４％±１９．０％，ＱＵＳ与ＤＸＡ和ＳＰＡ平均为３８．８％±１０．２％，各平均值之间无显著差异。结论ＯＰ的检出率取决于受检部位，腰椎侧位兴趣区和挠骨是检出率最高的部位，股骨颈和尺骨是最低的部位。ＳＰＡ与ＤＸＡ测量前臂ＢＭＤ高度相关，诊断结果无显著性差别。     

膝骨关节炎病因、X线片及临床表现分析

目的探讨国人膝骨关节炎病因,临床表现和Ｘ线片的相关性,为临床诊治提供依据。方法对骨科门诊膝骨关节炎患者进行病因,临床表现调查,摄单腿站立位膝关节正侧位、髌骨轴位片,分析Ｘ线征象并作骨关节炎分级、分型。结果膝骨关节炎原发性占８７％,继发性占１３％,膝骨关节炎分型：初期型３８％,股型２８．５％,内侧－髌股型２３．２％。随关节炎分类程度的加重,稞症状向严重发展（Ｐ〈０．０１）。胫股角越大,Ｘ线分级趋向病     

DXA、QCT和SPA方法测量47例绝经后妇女骨质疏松症的比较

以骨密度测量应用最广的３种方法（ＤＸＡ─双能ｘ线吸收法，ＱＣＴ─定量ＣＴ法和ＳＰＡ─单光子吸收法）测量绝经后妇女的骨矿密度，比较其测量值、诊断结果和相关关系。首先用ＳＰＡ法测量绝经后妇女１８１例，诊断骨质疏松（ＯＰ）４７例。三种方法测量骨矿密度的均值分别低于峰值骨量的Ｍ─２ｓ的９％、２１．４％和２１％，且ＤＸＡ和ＱＣＴ两种方法测量的均值都在骨折阈值范围内。ＤＸＡ和ＱＣＴ诊断４７例ＯＰ之间无显著性差异，当排除椎骨骨质增生后的ｘ２＝０．２３７，且ＤＸＡ和ＱＣＴ测量值之间为正相关，ｒ＝０．７９９，而ＤＸＡ、ＱＣＴ和ＳＰＡ之间的相关系数，ｒ＝０．１８５和０．２８５，ＤＸＡ诊断ＯＰ的敏感性为８６．６％，特异性为７０％。     

七氟醚对犬颅内压影响的实验研究

１２只成年杂种犬，观察了０．５、１．５ＭＡＣ七氟醚对颅内压的影响。七氟醚吸入顺序Ａ组：０．５→１．５ ＭＡＣ，Ｂ组：１．５→０．５ ＭＡＣ。结果表明：Ａ组吸入０．５ＭＡＣ七氟醚（呼末浓度）５、１５、３０分钟颅内压分别上升２８％、１６％、１５％（Ｐ＜０．０１），吸入１．５ＭＡＣ时分别上升３７％（Ｐ＜０．０１）、１１％、１１％；Ｂ组吸入１．５ＭＡＣ时颅内压分别上升４９％、３１％、２３％（Ｐ＜０．０１），吸入０．５ ＭＡＣ时其接近基础值；与正常ＰａＣＯ２相比，吸入 ０．５ＭＡＣ七氟醚，过度通气后颅内压下降 １３％（Ｐ＝０．０５４），吸入１．５ＭＡＣ时颅内压无显著性变化。结果提示：七氟醚对颅内压影响轻微；低吸入浓度保留了脑血管对ＣＯ２的反应性．高吸入浓度可能抑制脑血管对ＣＯ２反应性。     

免疫印迹法分析抗SPIM抗体与临床应用

采用聚丙烯酰胺凝胶电泳和免疫印迹法分析不育症病人抗精浆免疫抑制物抗体（ＳＰＩＭ－Ａｂ）对特异抗原的免疫反应，并与ＥＬＩＳＡ法进行比较，结果表明，免疫印迹法检测血清，精浆ＳＰＩＭ－Ａｂ阳性率分别为３０．３％（３２／１０７）和２９．０％（３６／１２４）ＥＬＩＳＡ法检测分别为３３．６％（３６／１０７）和３１．５％（３９／１２４），Ｘ＾２＝１２９．５８，Ｐ〈０．０１，免疫印迹法分析的６８从不育症病人的血清     

尸体肾移植术后137例急性排斥反应的治疗体会

自１９８５年２月至１９９３年３月施行尸体肾移植４７５例，术后均应用环抱素Ａ（ＣｓＡ）、硫唑嘌呤（Ａｚａ）及强的松（Ｐｒｅｄ）治疗，其中发生急性排斥反应（ＡＲ）１３７例（２８．８％），经正确的使用免疫抑制剂，并分别应用甲基强的松龙（ＭＰ），ＯＫＴ３及ＡＬＧ冲击治疗，９６例逆转（７０．０％），２９例摘除移植肾（２１．２％），１２例死亡（８．８％）。就发生ＡＲ的原因，诊断与鉴别诊断及处理进行讨论。     

肝癌影像诊断与临床病理特征的对比研究

目的探讨综合影像诊断在肝癌诊断与临床病理特征判断中的应用价值。方法对本院１９９１～１９９８年间手术治疗的肝癌３０４例做回顾性总结。总的ＴＮＭ分期分别为Ⅰ期６例、Ⅱ期５５例、Ⅲ期１３５例、ⅣＡ期７０例、ⅣＢ期３８例。行彩色超声波检查２３９例、增强ＣＴ２１４例、ＭＲＩ１２３例、ＤＳＡ８４例、ＮＩ（核素显像）２１例。结果各种检查肝癌诊断符合率分别是彩色超声波检查８７０％,增强ＣＴ８９２％（１９１／１２４）,ＭＲＩ９０２％（１１１／１２３）,ＤＳＡ９０５％（７６／８４）。各种检查所见肝癌临床病理特征与手术后临床病理诊断均有一定差距,其中增强ＣＴ比其它方法为好,但对肝癌卫星灶、脉管癌栓、淋巴结转移三者的检出率仍比较低,分别为５４％（４２／７８）,４８％（２８／５８）和２８％（８／２９）。结论各种影像检查对较小的卫星灶、脉管癌栓和淋巴结转移的检出均存在一定的局限性。     

Magnetic resonance imaging of the knee: correlation with arthroscopy

Magnetic resonance imaging (MRI) was used to diagnose acute and chronic intraarticular knee pathology in 23 knees. The results were compared with arthroscopic findings of meniscal, ligamentous, and articular cartilaginous pathology using a double-blind prospective protocol. The overall accuracy for meniscal tears was 78%, with a sensitivity of 88% and a specificity of 72%; for cruciate ligaments, MRI was 82% accurate, with a sensitivity of 67% [anterior cruciate ligament (ACL) only] and a specificity of 86%. In select clinical situations, MRI of the knee is a useful diagnostic tool.     

Detection of Small Periprosthetic Bone Defects after Total Knee Arthroplasty

Large bone defect around total knee prostheses is among the most critical challenges in revision surgery. However, it is difficult to detect bone defects around a prosthesis in early stage. We compared the efficacy of the detection of small bone defects between fluoroscopically guided plain radiography, CT, MRI, and a novel tomographic technique (tomosynthesis) using the six pig knee models. No bone defects were detected with plain radiography and MRI. The sensitivity and specificity of CT were 61.5% and 64.1%, respectively. The sensitivity and specificity of tomosynthesis were 85.4% and 87.2%, respectively. The radiation dose of tomosynthesis was 6% of that of CT. The cost of tomosynthesis was 28% of that of CT. Tomosynthesis was superior in terms of diagnosis, radiation dose, and cost.     

MRI对诊断膝关节内损伤的准确性评估

目的 评价MRI诊断膝关节内损伤的准确性.方法 以关节镜检查为金标准,对514例膝关节损伤患者术前MRI检查结果进行统计分析.结果 MRI诊断半月板损伤的敏感性、特异性、准确性分别为86.6%、87.5%、88.9%;对前交叉韧带损伤诊断的敏感性、特异性、准确性分别为70.3%、85.5%、87.0%;对关节面软骨损伤诊断的敏感性、特异性、准确性分别为64.9%、96.4%、80.5%.结论 MRI对关节内损伤的诊断具有较高准确性和特异性,但是其诊断准确性受到很多因素的影响.     

膝半月板损伤的临床、MRI及关节镜对比研究

[目的]比较分析膝关节半月板损伤的临床、MRI和关节镜诊断，以提高诊断率。[方法]对本院176例同时行MRI检查及关节镜治疗，且至少临床、MRI或关节镜之一诊断为半月板损伤的患者MRI及病历资料作回顾性对照分析。以关节镜诊断为标准，计算临床和MRI诊断的敏感性、特异性、准确度，应用卡方检验比较临床和MRI诊断与关节镜诊断的差异。[结果]临床诊断的敏感性、特异性、准确度分别为79．3％、26．3％、73．8％；临床诊断与关节镜诊断差异有统计学意义（z。：7．52，P〈0．01）。MRI诊断的的敏感性、特异性、准确度分别为94．1％、92．9％、93．4％；MRI对半月板撕裂的诊断与关节镜诊断差异无统计学意义（x^2=0．375，P〉0．05）。[结论]MRI是诊断半月板破裂极有价值的无创方法，是膝关节镜术前的重要检查。MRI与临床诊断相结合可提高半月板撕裂伤的诊断率，避免不必要的关节镜手术。     

The detection of loose bodies in the elbow: the value of MRI and CT arthrography

Our aim was to determine the clinical value of MRI and CT arthrography in predicting the presence of loose bodies in the elbow. A series of 26 patients with mechanical symptoms in the elbow had plain radiography, MRI and CT arthrography, followed by routine arthroscopy of the elbow. The location and number of loose bodies determined by MRI and CT arthrography were recorded. Pre-operative plain radiography, MRI and CT arthrography were compared with arthroscopy. Both MRI and CT arthrography had excellent sensitivity (92% to 100%) but low to moderate specificity (15% to 77%) in identifying posteriorly-based loose bodies. Neither MRI nor CT arthrography was consistently sensitive (46% to 91%) or specific (13% to 73%) in predicting the presence or absence of loose bodies anteriorly. The overall sensitivity for the detection of loose bodies in either compartment was 88% to 100% and the specificity 20% to 70%. Pre-operative radiography had a similar sensitivity and specificity of 84% and 71%, respectively. Our results suggest that neither CT arthrography nor MRI is reliable or accurate enough to be any more effective than plain radiography alone in patients presenting with mechanical symptoms in the elbow.     

Accuracy of routine magnetic resonance imaging in meniscal and ligamentous injuries of the knee: comparison with arthroscopy

The aim of this study was to detect the accuracy of routine magnetic resonance imaging (MRI) done in different centres and its agreement with arthroscopy in meniscal and ligamentous injuries of the knee. We prospectively examined 70 patients ranging in age between 22 and 59 years. History taking, plain X-ray, clinical examination, routine MRI and arthroscopy were done for all patients. Sensitivity, specificity, accuracy, positive and negative predictive values, P value and kappa agreement measures were calculated. We found a sensitivity of 47 and 100%, specificity of 95 and 75% and accuracy of 73 and 78.5%, respectively, for the medial and lateral meniscus. A sensitivity of 77.8%, specificity of 100% and accuracy of 94% was noted for the anterior cruciate ligament (ACL). We found good kappa agreements (0.43 and 0.45) for both menisci and excellent agreement (0.84) for the ACL. MRI shows high accuracy and should be used as the primary diagnostic tool for selection of candidates for arthroscopy. Level of evidence: 4.     

Diagnosis of a tear of the tibiofibular syndesmosis. The role of arthroscopy of the ankle

In 52 patients we compared the accuracy of standard anteroposterior (AP) radiography, mortise radiography and MRI with arthroscopy of the ankle for the diagnosis of a tear of the tibiofibular syndesmosis. In comparison with arthroscopy, the sensitivity, specificity and accuracy were 44.1%, 100% and 63.5% for standard AP radiography and 58.3%, 100% and 71.2% for mortise radiography. For MRI they were 100%, 93.1% and 96.2% for a tear of the anterior inferior tibiofibular ligament and 100%, 100% and 100% for a tear of the posterior inferior tibiofibular ligament. Standard AP and mortise radiography did not always provide a correct diagnosis. MRI was useful although there were two-false positive cases. We suggest that arthroscopy of the ankle is indispensable for the accurate diagnosis of a tear of the tibiofibular syndesmosis.     

The knee skyline radiograph: its usefulness in the diagnosis of patello-femoral osteoarthritis

The aim of this study was to determine the usefulness of the skyline radiograph in the diagnosis of patellofemoral osteoarthritis. Additionally, we wanted to assess the usefulness of patello-femoral crepitus as a clinical sign of this condition. Seventy-seven patients scheduled to undergo knee surgery had standard antero-posterior, lateral and skyline X-rays of their affected knee. The presence of clinical patello-femoral crepitus was also documented preoperatively. At the operation, their patellofemoral joints were graded into two groups according to the presence or absence of osteoarthritis. The lateral and skyline view X-rays as well as patello-femoral crepitus were compared individually against the operative findings. The skyline view had a sensitivity of 79% and a specificity of 80%. The lateral view had a sensitivity of 82% and specificity of 65%. Patello-femoral crepitus as a sign had a sensitivity of 89% and a specificity of 82%. There was no statistically significant difference between the two radiological views in terms of sensitivity and specificity in the diagnosis of patellofemoral osteoarthritis. Hence, we cannot recommend the skyline view as a routine radiological investigation in all cases of suspected patellofemoral osteoarthritis.     

Diagnostik von Knorpelschäden des Kniegelenks

BACKGROUND: The study was aimed to evaluate the validity of clinical, radiological and MRI examination for cartilage defects of the knee compared with arthroscopic finding. METHODS: Seven-hundred seventy-two patients who were suffering from knee pain over more than 3 months were evaluated clinical (grinding-sign) and with radiography and magnetic resonance imaging (MRI) and subsequent arthroscopy. RESULTS: The grinding sign had a sensitivity of 0.39. The association of a positive grinding test with high grade cartilage defects was significant (p<0.000). In 97.4% an intact chondral surface correlated with a normal radiological finding. Subchondral sclerosis, exophytes and a joint space narrowing was significantly associated with high grade cartilage defects (p<0.000). The accuracy of MRI was 59.5%. The MRI resulted in an overestimation in 36.6% and an underestimation in 3.9%. False-positive results were significant more often assessed in low-grade cartilage defects (p<0.000). CONCLUSIONS: Clinical signs, x-ray imaging and MRI correlate with arthroscopic findings in cases of deep cartilage lesions. In intact or low-grade degenerated cartilage often results an overestimating of these findings.     

Deficiencies of MRI in the diagnosis of chronic symptomatic lateral ankle ligament injuries

BackgroundStress radiography and more recently magnetic resonance imaging have been used to study the integrity of lateral ankle ligaments in chronic symptomatic instability after injury.AimOur aim was to see if magnetic resonance imaging was as good as examination under anaesthesia and stress radiography, for diagnosing injury to the lateral ankle ligaments.MethodologyFifty eight patients, 47 men and 11 women, who were athletes or military personnel, with symptomatic instability of their ankle were included in the study. This cohort of patients had MRI scans, stress radiography and arthroscopy of their ankle. Integrity of the calcaneo-fibular ligament (CFL) was recorded arthroscopically.The sensitivity, specificity, positive and negative predictive value of MRI and stress views, in assessing integrity of the CFL, were compared against arthroscopic findings.ResultsStress radiography under anaesthesia and MRI had sensitivity of 94% and 47% respectively and specificity of 98% and 83% respectively, for diagnosing injury to the CFL. Stress radiography has a higher accuracy in diagnosing CFL injuries as compared to MRI.ConclusionThe results of this study casts doubt on the efficacy of MRI in the diagnosis of serious ankle ligament injuries.