颞下颌关节滑膜软骨瘤病的影像诊断

目的对颞下颌关节滑膜软骨瘤病的临床、影像、病理学进行综合分析,提高对该病的认识。方法对8例具有完整病例资料并经手术病理证实的颞下颌关节滑膜软骨瘤病患者的临床资料、影像学征象及病理改变进行总结。结果临床表现:8例患者均有耳前区疼痛、肿胀伴张口受限,术中见关节腔内大量游离体。影像学表现:X线示颞下颌关节间隙增宽、髁突周围多发不透亮区;CT示关节腔内软组织密度影伴周围多发钙化,4例见骨质破坏;MR示关节腔内软组织肿块伴积液,周围多发长T_1WI、短T_2WI信号,增强后呈不均匀强化,动态增强扫描时间-信号强度变化曲线呈平坦型。病理表现:关节腔内游离体由透明软骨构成,伴周围纤维化、钙化。电镜下见大量透明软骨细胞覆盖以成纤维样滑膜细胞。结论颞下颌关节滑膜软骨瘤病具有典型的临床、影像及病理特点。     

关节镜治疗肩关节滑膜囊肿合并多发游离体的疗效分析

目的 探讨关节镜治疗肩关节滑膜囊肿合并多发游离体的疗效。方法 回顾性分析2015年1月-2019年1月该院收治的3例肩关节滑膜囊肿合并多发性游离体患者的临床资料,观察患者伤口愈合、感染和肩关节功能等情况。结果 全部患者均获得随访。伤口甲级愈合,术后6个月患侧美国肩肘外科协会（ASES）肩关节功能评分较高。无复发病例。结论 肩关节滑膜囊肿合并多发游离体具有典型影像学特征,肩关节镜治疗效果优异。     

Synoviale Erkrankungen der Hüfte

Synovial diseases and loose bodies are one of the most common indications for hip arthroscopy. Arthroscopic intervention has been reported in the literature for loose bodies, irritating synovial plicae, synovial chondromatosis, pigmented villonodular synovitis (PVNS) as well as rheumatoid and septic arthritis. One major advantage of arthroscopy in comparison to radiological imaging is the ability to inspect, biopsy and treat within one procedure. In contrast to arthrotomy hip arthroscopy avoids the potential risks of extensive surgical exploration which is associated with a higher morbidity and prolonged rehabilitation. Nevertheless, hip arthroscopy cannot be promoted as curative for all synovial disorders. In patients with loose bodies, synovial plicae, septic arthritis at an early stage and to some extent synovial chondromatosis and localized PVNS, curative therapy and full recovery can be achieved. In contrast, in patients with highly active synovial chondromatosis, diffuse PVNS and rheumatoid arthritis, the goal of hip arthroscopy is to enable the correct diagnosis, to provide symptomatic relief and maintain or improve joint function and to decide whether adjuvant therapy, systemic medication or secondary open surgery is necessary. Success or failure of arthroscopic treatment depends on correct patient selection and correct arthroscopic technique.     

Anatomy of the temporomandibular joint.

The temporomandibular joint (TMJ), also known as the mandibular joint, is an ellipsoid variety of the right and left synovial joints forming a bicondylar articulation. The common features of the synovial joints exhibited by this joint include a fibrous capsule, a disk, synovial membrane, fluid, and tough adjacent ligaments. Not only is the mandible a single bone but the cranium is also mechanically a single stable component; therefore, the correct terminology for the joint is the craniomandibular articulation. The term temporomandibular joint is misleading and seems to only refer to one side when referring to joint function. Magnetic resonance imaging has been shown to accurately delineate the structures of the TMJ and is the best technique to correlate and compare the TMJ components such as bone, disk, fluid, capsule, and ligaments with autopsy specimens.     

Synovial chondromatosis in an elite cyclist: a case report

Primary synovial chondromatosis is a rare disorder that can present as chronic hip and groin pain. It is characterized by formation of osteocartilaginous nodules arising from the synovium. We report the first case, to our knowledge, of an Olympic-caliber cyclist, in her mid thirties, with primary synovial chondromatosis of the left hip. Clinical examination showed decreased internal rotation, external rotation, forward flexion, and abduction of the left hip. A radiograph of the left hip showed slight hip-joint narrowing centrally. A magnetic resonance imaging arthrogram showed a small anterior labral tear and innumerable small intermediate-intensity filling defects situated diffusely within the joint fluid. Fluoroscopically guided injection of the left hip with local anesthetic and cortisone produced temporary pain relief. Conservative treatment was marginally helpful. Results of a rheumatology workup were unremarkable. Arthroscopic removal of loose bodies and synovectomy were performed. The diagnosis of primary synovial chondromatosis was confirmed by histologic examination. At the 17-month follow-up, our patient was essentially pain free and had returned to her previous athletic activities.     

滑膜骨软骨瘤病的影像表现

目的探讨关节滑膜骨软骨瘤病的影像学表现及鉴别要点。材料与方法回顾性分析15例关节滑膜骨软骨瘤病患者的X线、CT和MRI的影像资料。结果 15例中11例经手术病理证实,4例关节镜证实。X线、CT和MRI均可见游离体形成。游离体体在X线和CT上表现为高密度的钙化小体,圆形或椭圆形,大小不一。小结节影在MR T1WI呈低信号,在T2WI信号不均,钙化部分呈低信号,而未钙化部分呈中等或高信号。CT检查可以发现隐蔽游离体、增厚的滑膜和关节腔积液。MRI能发现关节内未钙化的游离体,除可见关节游离体外,还清晰显示软骨、滑膜、周围软组织的改变和关节积液等表现。结论游离体是滑膜骨软骨瘤病的特征性影像表现,是影像诊断的主要依据,X线诊断简便、快捷,CT、MRI可提供更多的信息。     

Outcome in the arthroscopic treatment of synovial chondromatosis of the knee

Background. Synovial osteochondromatosis is a disease in which loose cartilaginous bodies develop around large joints, usually the knee. It is caused by synovial metaplasia of unknown etiology. Symptoms are due either to mechanical problems caused by the loose bodies or to the degenerative arthritis that follows after several years. Surgical or arthroscopic removal of the loose bodies appears to be the only effective treatment. This article reports treatment outcome in synovial chondromatosis of the knee. Material and methods. We treated 13 patients: 11 by arthroscopy and 2 by arthrotomy. The follow-up examination was performed at least two years after after surgery. Results. There were 6 good and very good outcomes, while 2 patients required arthroscopic re-operation. Conclusions. Arthroscopy seems to be the treatment of choice in synovial chondromatosis of the knee.     

Diagnostic imaging: magnetic resonance imaging, computed tomography, and ultrasound.

The temporomandibular joint (TMJ) is a synovial joint. The TMJ is a freely movable articulation between the condyle of the mandible and the squamous portion of the temporal bone at the base of the skull. The bilateral articulation of the mandible to the cranium implies that the left and right TMJs must act as a single unit. Physical examination alone is inaccurate in determining the status of the joint. The primary rationale for imaging the TMJ lies in the fact that mechanical internal derangement is treated differently from the multiple miscellaneous disorders. It is mandatory to have a correct knowledge of the joint anatomy and normal function that correlates with conventional and cross-sectional imaging studies. The TMJ is illustrated with an overview of imaging strategies and techniques, especially magnetic resonance imaging, computed tomography, and ultrasound.     

LncRNA PVT1 induces chondrocyte apoptosis through upregulation of TNF-α in synoviocytes by sponging miR-211-3p

Temporomandibular joint osteoarthritis (TMJ OA) is an important subtype of temporomandibular disorders (TMD). Articular cartilage destruction is considered a common pathological feature of TMJ OA, which is reported to be mainly induced by chondrocyte apoptosis. Synovial sterile inflammation is an initial factor of TMJ OA-associated articular cartilage destruction. Therefore, determining the mechanism of synovial membrane inflammation-induced articular cartilage destruction in TMJ OA is important for the TMJ OA therapy. In this study, we detected the function of synoviocytes in chondrocyte apoptosis under lipopolysaccharide (LPS)-induced inflammatory conditions and explored the underlying mechanism. We found that synoviocytes in inflammatory conditions facilitated LPS-induced chondrocytes apoptosis by secreting increased Tumor Necrosis Factor α (TNF-α), which was induced by long non-coding RNA plasmacytoma variant translocation 1 (PVT1) upregulation. PVT1 served as a competing endogenous RNA that sponged the microRNA miR-211-3p and prevented the inhibition of TNF-α expression. In conclusion, our in vitro study revealed that PVT1 has a previously unknown role in chondrocyte apoptosis, which may also be a mechanism underlying synoviocyte involvement in TMJ OA.     

Synovial osteochondromatosis

Synovial osteochondromatosis is a benign disorder in which cartilaginous loose bodies develop about the large joints, usually the knee. It is caused by synovial metaplasia of unknown etiology. Symptoms are due either to mechanical problems caused by the loose bodies or to the degenerative arthritis that usually follows in several years. Surgical or arthroscopic removal of the loose bodies appears to be the only effective treatment. Loose bodies may recur, necessitating synovectomy.     

间接性颞下颌关节损伤后的组织学变化(英文)

目的通过观察颞下颌关节(temporomandibularjoint,TMJ)间接性损伤后的组织结构改变及转归,探讨颞下颌关节损伤与颞下颌关节病(temporomandibularjointdisorder,TMJD)和颞下颌关节骨关节病(temporomandibularjointosteoarthrosis,TMJOA)的关系。方法选用四川简阳努比山羊20只,雌性8只,雄性12只,体重10～12kg,年龄4～6个月,均属生长期。按随机数字表法分为A、B、C、D4组,每组5只(雌性2只,雄性3只)。用自制撞击装置间接造成羊右侧关节损伤,左侧关节为对照。分别于伤后2h,1,3,6个月取材,通过组织学观察TMJ伤后病理改变。结果TMJ伤后2h出现关节囊内血肿,关节盘及滑膜撕裂;伤后1个月出现髁突表面软骨碎裂;伤后3,6个月出现髁突骨质吸收、破坏及骨赘形成,滑膜增生,关节盘纤维断裂,穿孔。结论一定程度的TMJ间接性损伤可导致TMJOA的发生。     

关节镜下治疗膝关节滑膜软骨瘤病

目的 探讨关节镜治疗膝关节滑膜软骨瘤病的疗效.方法 2005年1月-2009年10月,对23例(28膝)滑膜软骨瘤病患者入院行X线片、关节活动度检查、视觉模拟评分以及Lysholm膝关节功能评分.根据镜下所见分为表浅型6例,游离体型17例.结合病理学检查行Milgram分期,Ⅱ期16例,Ⅲ期7例.所有患者均行关节镜下病...     

Ultrasound of the elbow.

This article describes the use of ultrasound (US) in the evaluation of the elbow. US is able to visualize several abnormalities affecting tendons, muscles, ligaments and bursae around the elbow joint as well as to delineate the nature of soft-tissue swelling, such as a space-occupying lesion or synovial enlargement. Occult fractures, osteophytes and intra-articular loose bodies can be depicted with this technique as well. At the cubital tunnel, US allows accurate imaging of the ulnar nerve and to document changes that occur in compressive syndromes. Over other imaging modalities, US offers several key advantages, including cost effectiveness, availability and ability to perform a dynamic examination of tendon movement and joint motion. With continued experience, it is likely that the use of US will increase further with regards to evaluation of soft-tissue abnormalities of the elbow.     

Propofol Bolus Facilitates Reduction of Luxed Temporomandibular Joints

Abstract\“Locked” or dislocated temporomandibular joint (TMJ) is a common problem in emergency medicine. Like many other joint dislocations, the repositioning of the joint can be facilitated by conscious sedation and muscular relaxation. Propofol is a useful agent for use in the emergency department because of its extremely short half-life, its antiemetic properties, and its safety record. We report two cases of locked TMJ that were repositioned under sedation with propofol. We review methods for repositioning the locked TMJ and review appropriate agents for sedation and muscular relaxation.     

Technik, M?glichkeiten und Grenzen der Arthroskopie am Gro?zehengrundgelenk

Arthroscopy of the first metatarsophalangeal joint allows good visualization of pathological conditions of the joint including the sesamoids and the adjacent ligament structures. Arthroscopy can be indicated in arthrofibrosis, chondromalacia, osteoarthritis, osteochondral defects, osteophytes, loose joint bodies, pathological changes of the sesamoids and synovitis of the first metatarsophalangeal joint. The major advantage of arthroscopy is the limited soft tissue trauma and fast postoperative rehabilitation. The clinical results are limited by the underlying pathology. Good and excellent results can be expected in patients with synovitis and loose bodies in the joint. However, a persistent limited range of motion and some persistent pain is common in patients with extensive cartilage damage.     

The wrist pivot method, a novel technique for temporomandibular joint reduction

Temporomandibular joint (TMJ) dislocation is an infrequent dislocation of the mandible. The usual technique of reduction, recommended by most Emergency Medicine textbooks, consists of downward forces applied to the mandible. In the authors' experience this is often painful and requires significant sedation. We present a patient in whom the usual manner of TMJ dislocation reduction was difficult. We describe a novel technique for TMJ dislocation reduction that uses the intrinsic biomechanical properties of the mandible.     

Disseminated histoplasmosis presenting as an acute tenosynovitis

Disseminated histoplasmosis is usually a multifocal process with a wide variety of clinical presentations. Despite frequent bone marrow involvement, overt bone and joint disease is uncommon and isolated synovial involvement is extremely rare. We describe in this report an unusual case of disseminated histoplasmosis presenting as acute tenosynovitis. To our knowledge, this is only the second reported case of synovial involvement by H. capsulatum without a concomitant osseous lesion.     

Facial Pain, Headache, and Temporomandibular Joint Inflammation

We studied one hundred patients with suspected temporomandibular joint (TMJ) arthropathy in whom 64 also complained of headache and/or facial pain, using high field surface coil magnetic resonance (MR) imaging, and found that headache and facial pain are commonly observed in association with inflammatory arthropathy of the TMJ. Each patient complained of pain and/or tenderness localized to the immediate vicinity of at least one TMJ. Pathologic joint effusion was demonstrated by MR in 88 of the painful joints studied. Significant meniscus displacement, with or without meniscus deformity and alteration of intrinsic signal intensity was present in 94 of the 100 painful joints examined. Fascial inflammation and atrophy of the ipsilateral muscles of mastication were observed occasionally with painful joints. There were no mechanical TMJ symptoms, such as joint clicking, crepitus or locking in 14 internally deranged and painful joints, 12 of which exhibited joint effusion and local inflammation. At least 80 patients described occlusal changes within 12 months of imaging. 28 of the pathologic joints in the series underwent subsequent meniscectomy, including routine histologic evaluation of surgical material. We conclude that internal derangement and inflammation of the TMJ should be considered in patients with unexplained headache and/or facial pain, even if mechanical TMJ symptoms are absent.     

Multidetector computed tomography of temporomandibular joint: A road less travelled

This article reviews the imaging anatomy of temporomandibular joint(TMJ), describes the technique of multi-detector computed tomography(MDCT) of the TMJ, and describes in detail various osseous pathologic afflictions affecting the joint. Traumatic injuries affecting the mandibular condyle are most common, followed by joint ankylosis as a sequel to arthritis. The congenital anomalies are less frequent, hemifacial microsomia being the most commonly encountered anomaly involving the TMJ. Neoplastic afflictions of TMJ are distinctly uncommon, osteochondroma being one of the most common lesions. MDCT enables comprehensive evaluation of osseous afflictions of TMJ, and is a valuable tool for surgical planning. Sagittal, coronal and 3D reformatted images well depict osseous TMJ lesions, and their relationship to adjacent structures.