Sea urchin spine injuries of the hand

Sea urchin spine injuries are common. They usually cause local pain and swelling that subsides. Chronic granulation is rare. We report two cases of sea urchin granulomata involving finger metacarpophalangeal joints. Both resolved following surgery.     

脊椎嗜酸性肉芽肿（附14例报告）

报道经病理证实的脊椎嗜酸性肉芽肿１４例的治疗结果。其中１２例随访１～１８年，平均４年８个月，９例不全瘫痪者中，７例完全恢复，２例部分恢复；１例完全瘫痪者部分恢复。通过临床资料分析，着重阐述了脊椎嗜酸性肉芽肿的诊断和治疗方法的选择，认为有神经根或脊髓受压者，应以手术治疗为主，结合放疗或化疗；而无神经根或脊髓受压者，以放疗为主，结合化疗。早期诊断和正确的治疗是防止瘫痪发生的关键。     

Extraosseous extradural tuberculous granuloma of the cervical spine: A case report and review of intraspinal granulomatous infections

A 70-year-old woman presented with a 5-month history of tetraparesis. Her cerebrospinal fluid and roentgenographic examination of the cervical spine were both normal. Myelography showed an extradural type of spinal cord compression at the C7 level. At operation, an extraosseous extradural mass of granulation tissue was removed, which proved on histological and bacteriological examination to be a tuberculous granuloma.     

Invasive Mycobacterium marinum infection of the hand

Abstract

Mycobacterium marinum infection of the hand is rare. We report the case of a 39-year-old man with M marinum infection that resulted in a chronic soft tissue infection, extensor tendon synovitis, and arthritis of the metacarpophalangeal (MCP) joints. The cause was probably tropical freshwater fishes.     

The dorsal approach to silicone implant arthroplasty of the proximal interphalangeal joint

Silicone implant arthroplasty (SIA) has been an effective alternative in the treatment of arthritic conditions of the proximal interphalangeal (PIP) joints since its introduction into surgical practice in the early 1960s. Patients with post-traumatic, degenerative, and rheumatoid arthritis all may be candidates for PIP joint SIA. The indications for SIA of the PIP joint include pain, limited joint mobility, and angular deformity of the joint with underlying articular destruction. Contraindications include ankylosis of the joint due to bony or soft-tissue restrictions, infection, inadequate soft-tissue support for coverage, absence of flexor and/or extensor tendon function, and considerable periarticular bone loss in the proximal and middle phalanges. Proximal interphalangeal joint SIA can be accomplished by dorsal, volar, or midaxial approaches. The dorsal approach has the advantages of relative technical ease, excellent visibility of the articular surfaces for preparation of the implant canals, access to the extensor mechanism for correction of central slip abnormalities, and preservation of the collateral ligaments. The surgical technique is outlined and includes handling of the extensor mechanism and central slip attachment, mobilization of the collateral ligaments, joint surface resection, preparation of the bony canals, implant sizing, implant insertion, and repair of the soft tissues. Pearls and pitfalls of the technique are outlined. Early postoperative mobilization with hand therapy is essential but must include protection of the repaired extensor apparatus. Complications include bony changes, implant failure, recurrent angular deviation or swan-neck deformity, particulate synovitis, and rarely, infection. Complications related to implant failure are most often managed with implant replacement or arthrodesis; those related to poor mobility, angular deformity and tendon imbalance, pain, or infection are managed by arthrodesis. Although SIA of the PIP joint has a relatively high degree of success when measured both subjectively and objectively, careful patient selection is important for achieving desirable results.     

Management of sea urchin spines in the hand

The left palm of a 43-year-old woman was penetrated by sea urchin spines. Localization of the spines by soft tissue technique x-ray films proved to be the key to their easy removal. A review of the literature shows this to be an uncommon problem and that spine removal may be important to avoid long-term sequelae of pain and loss of function.     

踝关节周围截骨术治疗踝关节炎

 目的 探讨和评价踝关节周围截骨矫正术治疗踝关节炎的指征、方法和疗效。 方法 2005 年2 月至2011 年5 月, 采用踝关节周围截骨手术治疗65 例踝关节炎患者。女43 例, 男22 例;年 龄35~74 岁, 平均55.5 岁。Takakura 踝关节炎分级:2 级29 例, 3 级32 例, 4 级4 例。接受单纯踝上胫骨 截骨20 例, 踝上胫腓骨截骨12 例, 踝上胫骨截骨合并跟骨截骨30 例, 踝上胫腓骨截骨合并跟骨截骨3 例。合并行三关节融合术者3 例, 距舟关节融合术者2 例, 第一跖骨基底截骨术者4 例。对43 例患者施 行踝关节内外侧软组织松解和韧带重建手术。比较患者手术前后正、侧位X 线片上胫骨前面角(tibial anterior surface angle, TAS)和胫骨侧面角(tibial lateral surface angle, TLS)差异。应用美国足踝医师协会 后足与踝关节评分(AOFAS-HA评分)对患者手术前后功能情况进行评价。 结果 59 例患者获得平均 35.7 个月(7~94 个月)随访。所有患者均达到骨性愈合, 平均骨愈合时间为7~8 周。AOFAS 评分自术前 平均49.7 分提高到术后12 个月时的平均78.6 分。TAS 术前平均86.1°, 术后6 个月平均93.9°。TLS 不 正常者5 例, 术前平均70.0°, 术后6 个月时平均81.5°。5 例患者术后发生切口延迟愈合, 经伤口护理后 愈合。42 例患者对手术效果表示非常满意, 15 例患者比较满意, 2 例患者满意度一般。 结论 踝关节周 围截骨术治疗非对称性踝关节炎有效, 选择合适指征的患者, 能够减轻病变处关节软骨的负荷, 延长自 身关节的使用时间。     

Rheumatoid arthritis of the hand

Rheumatoid arthritis often begins in the hand, and upper extremity function can be seriously impaired with progression of the disease. When numerous areas are involved, a multitude of deformities can arise. Before initiating treatment of an arthritic patient, the surgeon must understand the natural course of the disease process, the response to medical treatment, and the functional limitations the disease has imposed. This article describes the examination for and treatment of this disease.     

Neonatal Candida arthritis

Fungal arthritis is an uncommon yet serious disorder in the newborn. Delay in diagnosis and management can lead to significant morbidity. We report our experience with management of two such cases. Two preterm neonates with multifocal arthritis caused by Candida were studied. Diagnosis was made by clinical examination, laboratory investigations, radiological investigations and culture. Both were treated by aspiration, arthrotomy and antifungal therapy. One patient recovered fully from the infection while the other had growth disturbances resulting in limb length inequality at recent followup. Prompt and expeditious evacuation of pus from joints and antifungal therapy is imperative for treatment. Associated osteomyelitis leads to further difficulty in treatment.     

Lateral approach to proximal interphalangeal joint implant arthroplasty

Arthroplasty of the proximal interphalangeal joint is indicated for arthritic conditions that fail to respond to conservative treatment. This article describes the lateral approach for the insertion of a proximal interphalangeal joint implant arthroplasty. Clinical experience has confirmed good results in the nonlaborer with arthroplasty of all the digits. Ten surgeries have averaged 68 degrees of motion with a range from 50 degrees to 80 degrees . No patient has required a revision 3 years after surgery.     

环氧化酶-2与关节炎

许多非细菌性关节炎如骨性关节炎 (OA)、类风湿性关节炎 (RA)、强直性脊柱炎 (AS)、痛风性关节炎等 ,尽管病因和发病机制不同 ,但在病理过程中都会出现炎症因子大量释放 ,造成滑膜和关节周围组织炎症、软骨破坏及增生等病变。前列腺素 (PG)尤其前列腺素E2 (PGE2 )是参与上述病理变化的主要介质 ,故作为PG合成和起始步骤关键酶的环氧化酶(COX)对于关节炎的发病和发展具有重要作用和影响。近来随着对COX研究的深入 ,特别是其同工酶的发现 ,给关节炎的认识和治疗也带来了新的变化。1　COX的结构和功能COX属膜结合蛋白 ,主要存在于细…     

Psoriatic arthritis in the hand

Psoriatic arthritis is a polyarthropathy distinct from rheumatoid arthritis and associated with onychodystrophy and skin lesions. Patients present with stiffness, flexion and extension contractures, digital swelling, or painful joints. Psoriatic arthritis mutilans is a rapidly progressive osteolysis resulting in severe deformity. Radiographs reveal widened joint spaces with interphalangeal joint destruction, resorption of the distal tufts, and frequently spontaneous fusion. Surgery involves mainly salvage procedures to relieve pain or improve position, as the increase in motion obtained usually is limited.     

高尿酸血症及痛风性关节炎的动物模型研究概况

痛风是一种古老而又崭新的病种，近年来随着其发病率的升高，对该病的研究也逐渐增多。本文将概述痛风及高尿酸血症的动物模型研究现状并简要介绍我们研制的鸡痛风病模型。     

手腕部痛风的诊断与治疗

目的 探讨手腕部痛风的诊断方法及治疗.方法 对5例术前临床诊断为手腕部痛风的患者行病灶清除和神经、肌腱松解术,其中2例行痛风石切除.切除病变组织常规行病理检查.结果 术后5例患者伤口均Ⅰ期愈合,无感染发生,术后平均随访时间为7个月.病理检查均证实为痛风性关节炎.2例伴有痛风石的患者,术后手指麻木症状好转,活动功能得到明显改善,但半年以后又有复发.3例患者腕部疼痛消除,腕关节活动及握力恢复接近正常,未再次复发.结论 无明显痛风石形成的非典型手腕部痛风的患者,诊断较为困难,有效的治疗方法为手术探查,可早期明确诊断且术后疗效满意.而有明显痛风石形成的患者诊断容易,但术后疗效欠佳.     

生物标志物应用于银屑病关节炎的研究进展

银屑病是一种慢性的、免疫相关的炎症性疾病,20％～30％的银屑病患者最终会发展为银屑病关节炎(PsA),如果患者处于活动期,则可能出现关节破坏,最终致残.现阶段尚无用于PsA早期检测的有效手段,所以能发现用于早期诊断和治疗PsA的潜在生物标志物具有重要的临床意义,本文对此做一综述.     

Rheumatoid arthritis of the cervical spine

There is a high incidence of cervical involvement in patients with rheumatoid disease. Early evaluation of the neck, close follow-up with dynamic radiographs of the cervical spine, and careful neurological assessment are important in the care of these patients. Surgical stabilization should be considered early even in the absence of neurological findings when significant instability is noted since outcome is related to preoperative neurological function. The type of fusion performed is determined by a careful assessment of the location of instability, patient factors, and the experience of the surgeon with various techniques. The type of postoperative immobilization should be decided on an individual basis depending on the quality of fixation achieved at surgery. Patients must be observed closely in the postoperative period for development of early complications and followed-up for the appearance of pseudarthrosis or late instabilities.     

Osteoporosis in rheumatoid arthritis

In 37 women suffering from rheumatoid arthritis, the bone mass was evaluated by measurements of cortical thickness in the hand, forearm and femur, densitometry of the distal femur, and ranking of the degree of osteoporosis in the spine. There was evidence that rheumatoid arthritis produces general osteoporosis, particularly in conjunction with cortico-steroid therapy.Financial support was obtained from Signe och Reinhold Sunds stiftelse för reumatikerforskning R.D.=nr 1380/69, and The Swedish Medical Research Council (B70-23 X-2757-02).     

The hand in systemic diseases other than rheumatoid arthritis

This review outlines the skin, vascular and musculoskeletal symptoms affecting the hand during systemic inflammatory diseases other than rheumatoid arthritis. Skin lesions are diagnosed clinically and their symptomatology is documented through an extensive series of photographs. These conditions may require specific care before a surgical procedure can be performed. Vascular lesions are also diagnosed clinically and their symptomatology is described in detail. It is important to recognize that acrocyanosis is always benign. The surgeon should be able to distinguish between primary, but benign Raynaud's disease and secondary Raynaud's syndrome, which has a high risk of finger necrosis. Current preventative and curative treatments for finger necrosis are described. The clinical, radiological, progressive and therapeutic features of musculoskeletal lesions are reviewed, namely those associated with psoriatic arthritis, systemic sclerosis and lupus.