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磁共振技术评估膝关节软骨退变研究进展 总被引:1,自引:1,他引:0
磁共振成像(magnetic resonance imaging,MRI)扫描序列及参数的合理选择对清晰成像及临床研究结果的客观评价至关重要。全膝关节磁共振成像积分,波士顿利兹骨关节炎评分系统,MRI膝骨关节炎评分系统,膝骨关节炎软骨修复评分系统等全膝关节的半定量评分系统都能够全面评价膝骨关节炎进展时各组织的影像学改变。随着MRI技术的不断发展,关节软骨的形态学及生理成分的改变可以被定量评估。T2图、弥散加权成像、延迟动态增强成像等软骨成分的定量评估技术能定量监测软骨基质成分的变化,可以在关节软骨形态学破坏之前更早地发现软骨病变。这些定量、半定量评价技术有助于膝骨关节炎的早期诊断和早期预防,同时也为精确评价干预措施的疗效提供了可能。 相似文献
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膝关节骨关节炎滑液和软骨骨桥蛋白水平与其病变程度的相关性 总被引:1,自引:0,他引:1
目的 探讨膝关节骨关节炎(osteoarthritis,OA)患者滑液和关节软骨骨桥蛋白(osteopontin,OPN)水平及其与病变严重程度的关系.方法 随机选取50例膝关节OA患者[男15例,女35例;年龄48~81岁,平均(61.8±7.4)岁]和10名健康对照者[男4例,女6例;年龄59~68岁,平均年龄(63.2±6.0)岁]作为研究对象.采用Mankin评分评价疾病严重程度,Kellgren-Lawrence标准进行放射学分级,酶联免疫吸附法测定关节滑液OPN水平,免疫组化方法测定关节软骨OPN光密度值.结果 OA患者与对照者相比,关节滑液OPN水平[(4519.60±1830.37)pg/ml:(1179.70±303.39)pg/ml)和关节软骨OPN光密度值[(0.60±-0.06):(0.43±0.07)]均明显升高.关节滑液OPN水平与关节软骨OPN表达呈正相关(r=0.411,P=0.003).关节滑液OPN水平与OA病变严重程度(KL分级)呈正相关(r=0.581,P<0.001).关节软骨OPN表达与OA病变严重程度(Mankin评分)呈正相关(r=0.675,P<0.001).结论 关节滑液和关节软骨OPN水平与病变严重程度相关. 相似文献
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Objective To examine osteopontin (OPN) levels in both synovial fluid and articular cartilage of patients with primary knee osteoarthritis (OA) and to investigate their relationship with severity of the disease. Methods Fifty patients with knee OA and 10 healthy controls were enrolled in this study.There were 15 males and 35 females with an average age of 61.8±7.4 years in OA group. The control group included 4 males and 6 females with an average age of 63.2±6.0 years. Mankin score were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed using the Kellgren-Lawrence criteria. OPN levels in synovial fluid were measured using enzyme-linked immunosorbent assay. OPN levels in articular cartilage were assessed by immunohistochemical methods. Results Compared to healthy controls, the knee OA patients had higher OPN concentration in synovial fluid ([4519.60±1830.37] pg/ml vs. [1179.70±303.39] pg/ml) and articular cartilage([0.60±0.06] vs. [0.43 ±0.07]). In addition, synovial fluid OPN levels showed a positive correlation with articular cartilage OPN levels (r=0.411,P=0.003). Subsequent analysis showed that the OPN levels in synovial fluid significantly had been correlated with severity of disease using Kellgren-Lawrence criteria (r=0.581, P< 0.001). Furthermore,the levels of OPN in the articular cartilage also were correlated with disease severity using Mankin score (r=0.675, P< 0.001).Conclusion The data suggest that OPN in synovial fluid and articular cartilage is related to progressive joint damage and could be a predictive biomarker respect to disease severity and progression in knee OA. 相似文献
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Objective To examine osteopontin (OPN) levels in both synovial fluid and articular cartilage of patients with primary knee osteoarthritis (OA) and to investigate their relationship with severity of the disease. Methods Fifty patients with knee OA and 10 healthy controls were enrolled in this study.There were 15 males and 35 females with an average age of 61.8±7.4 years in OA group. The control group included 4 males and 6 females with an average age of 63.2±6.0 years. Mankin score were taken to determine the disease severity of the affected knee. The radiographic grading of OA in the knee was performed using the Kellgren-Lawrence criteria. OPN levels in synovial fluid were measured using enzyme-linked immunosorbent assay. OPN levels in articular cartilage were assessed by immunohistochemical methods. Results Compared to healthy controls, the knee OA patients had higher OPN concentration in synovial fluid ([4519.60±1830.37] pg/ml vs. [1179.70±303.39] pg/ml) and articular cartilage([0.60±0.06] vs. [0.43 ±0.07]). In addition, synovial fluid OPN levels showed a positive correlation with articular cartilage OPN levels (r=0.411,P=0.003). Subsequent analysis showed that the OPN levels in synovial fluid significantly had been correlated with severity of disease using Kellgren-Lawrence criteria (r=0.581, P< 0.001). Furthermore,the levels of OPN in the articular cartilage also were correlated with disease severity using Mankin score (r=0.675, P< 0.001).Conclusion The data suggest that OPN in synovial fluid and articular cartilage is related to progressive joint damage and could be a predictive biomarker respect to disease severity and progression in knee OA. 相似文献
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关节镜膝关节清理术治疗中重度软骨退变的膝骨关节炎 总被引:1,自引:1,他引:1
目的探讨关节镜下膝关节清理术治疗中重度软骨退变的膝骨关节炎的效果. 方法采用关节镜下膝关节清理术联合术后康复训练治疗17例(21膝)中重度软骨退变的膝关节骨关节炎. 结果手术时间55~100 min,平均75 min.无并发症发生.术后住院15~20 d,平均13 d.术中关节被动活动范围0°~120°,术后关节活动度0°~110°.随访5~36个月,平均21个月,良好6例(8膝),尚可9例(11膝),差2例(2膝).关节活动范围0°~120°结论关节镜下膝关节清理术对中重度软骨退变的膝关节骨关节炎有一定的治疗效果. 相似文献
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目的 探讨膝关节尸体标本解剖与磁共振成像(MRI)三维序列-扰相梯度回波序列(3D-FS-SPGR)测量关节软骨厚度的差异,并分析软骨组织主要成分在关节软骨不同位置的差异.方法选用国人青壮年中等身材、无明显关节病变的成年男性尸体膝关节标本2具,首先进行3D-FS-SPGR序列矢状位扫描.复冻后按解剖部位进行矢状位解剖,分别对股骨及胫骨内、外髁负重区前、后面及髌骨面软骨厚度进行测量.关节软骨石蜡切片进行维多利亚蓝-丽春红复合染色并观察.结果 软骨尸体标本解剖与3D-FS-SPGR序列测得的膝关节软骨厚度:股骨外侧髁前负重面平均分别为2.25、2.25 mm,股骨外侧髁后负重面平均分别为2.70、2.75 mm,胫骨外侧髁前负重面平均分别为2.00、2.10 mm;胫骨外侧髁后负重而平均分别为2.35、2.25 mm,股骨内侧髁前负重面平均分别为2.20、2.20 mm,股骨内侧髁后负重面平均分别为2.15、2.30 mm,胫骨内侧髁前负重面半均分别为2.20、2.45mm,胫骨内侧髁后负重面平均分别为2.70、2.95 mm,髌骨面软骨平均分别为3.08、3.15 mm.软骨组织学染色显示:关节软骨表层胶原纤维含量相对较多,软骨细胞及其周围基质相对较少;在关节软骨深层,胶原纤维含量相对较少,而软骨及软骨周围基质相对较多.结论 3D-FS-SPGR序列能够相对真实地反映关节软骨的形态及厚度.胶原纤维主要集中在软骨表层,其分布与软骨的功能相一致.Abstract: Objective To compare corpse sampling and MR imaging with 3D-FS-SPGR sequences in measurement of the articular cartilage thickness and to investigate knee cartilage topography. Methods Two fresh specimens of the knee joint were obtained from 2 normal young adult male corpses of medium stature. MR1 scanning was carried on the 2 specimens in sagittal 3D-FS-SPGR MR sequences. After defrosted,the knee specimens were dissected longitudinally, and the cartilage thicknesses were measured at different locations of the knee joint. Paraffin sections of the knee cartilage were observed following compound staining with victoria blue and ponceau red. Results The average cartilage thicknesses measured by dissection and MR imaging sequence were respectively: 2. 25 mm and 2. 25 mm at the anterior weight-loading surface of the femoral lateral condyle, 2. 70 mm and 2. 75 mm at the posterior weight-loading surface of the femoral lateral condyle, 2. 00 mm and 2. 10 mm at the anterior weight-loading surface of the tibial lateral condyle,2. 35 mm and 2. 25 mm at the posterior weight-loading surface of the tibial lateral condyle, 2. 20 mm and 2. 20mm at the anterior weight-loading surface of the femoral medial condyle, 2. 15 mm and 2. 30 mm al the posterior weight-loading surface of the femoral medial condyle, 2. 20 mm and 2.45 mm at the anterior weight-loading surface of the tibial medial condyle, 2. 70 mm and 2. 95 mm at the posterior weight-loading surface of the tibial medial condyle and 3. 08 mm and 3. 15 mm at patella cartilage surface. Collagen fibers were rich at the periphery of the articular cartilage with sparse chondrocytes and matrixes, while the opposite was observed at the center of the articular cartilage. Conclusions MR imaging with 3D-FS-SPGR sequences can display the actual knee cartilage topography. Collagen fibers mainly concentrate at the periphery of the articular cartilage, which accounts for the function of the articular cartilage. 相似文献
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目的 探讨髌骨软骨退变Outerbridge分级对保留髌骨型全膝关节置换术疗效的影响。方法 对2007年2月至2010年1月因膝关节退变性骨关节炎行保留髌骨型全膝关节置换术的151例进行回顾性分析。男65例,女86例;年龄56~82岁,平均(65±5.0)岁。随访时间2~5年,平均3.5年。术中对髌骨软骨退变分级的评定采用Outerbridge标准,统计末次随访时不同髌骨软骨退变分级患者的满意度及膝前痛发生情况,视觉模拟评分(visual analogue scale,VAS)>3分判定为有膝前痛;比较不同髌骨软骨退变分级患者的美国膝关节学会评分(Knee Society Scale,KSS)及髌骨评分。结果 OuterbridgeⅠ级18例、Ⅱ级36例、Ⅲ级62例、Ⅳ级35例。膝前痛发生率4.0%(6/151),其中轻度疼痛4例、中度2例。无翻修病例,总体满意率96.7%(146/151)。不同髌骨软骨退变分级患者的满意度(H=5.54,P=0.14)、膝前痛发生率(H=0.56, P=0.91)、KSS膝评分(F=1.95, P=0.12)、功能评分(F=2.11,P=0.10)及髌骨评分(F=1.35, P=0.26)的差异均无统计学意义。结论 不同髌骨软骨退变分级患者行保留髌骨型全膝关节置换术后疗效无差异,对退变性骨关节炎患者行全膝关节置换术时无须置换髌骨。 相似文献
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目的:统计关节镜下不同年龄段患者膝关节软骨损伤情况,分析关节软骨损伤发生的特点,为临床治疗方案的选择提供依据。方法:自2004年11月到2005年9月,解放军总医院骨科共对568例膝关节疾病患者进行关节镜检查手术,男242例,女326例,年龄12~80岁,平均(43.0±11.2)岁。所有患者在术中采用医学影像处理系统进行拍照或录像记录软骨损伤情况。将上述568例划分为青少年组(≤44岁)和中老年组(>44岁),青少年组272例,中老年组296例,分别对2组患者软骨损伤发生的原因、分布的部位、损伤的程度进行回顾性分析并总结其特点。结果:在568例中389例发现923处软骨损伤,其中关节镜手术中关节软骨损伤13处。青少年组121例发现212处软骨损伤,中老年组268例发现711处软骨损伤;软骨损伤的原因青少年组主要是半月板损伤(57/121),中老年组主要是骨性关节炎(218/268);软骨损伤部位2组均以股骨内髁、股骨外髁和髌骨关节面最为常见;软骨损伤程度中老年组以Ⅳ度损伤为主(330处),而青少年组以Ⅲ度损伤为主(71处)。结论:膝关节软骨损伤是一种十分普遍的现象,不同年龄段患者其软骨损伤的特点存在差异,对不同年龄段软骨损伤患者的处理措施应区别对待。 相似文献