创伤相关性膝关节髌下脂肪垫病变的MRI表现

目的 探讨创伤相关性膝关节髌下脂肪垫病变的MRI表现.方法 回顾性选取45例经临床和/或关节镜证实的创伤相关性膝关节髌下脂肪垫病变,分析不同病变的发生部位、形态及MRI信号特点.结果 45例创伤相关性膝关节髌下脂肪垫病变中,Hoffa氏综合征8例,髌腱-股骨外侧髁摩擦综合征9例,关节镜术后髌下脂肪垫纤维化10例,Cyc...     

膝关节髌下脂肪垫占位性病变的MRI表现

目的 通过对髌下脂肪垫(IFP)占位性病变的MRI图像进行观察,分析该区域病变的MRI特点,以提高对该区域病变的诊断和鉴别诊断能力.方法 回顾性观察26例经手术、关节镜或病理证实的IFP区占位性病变患者的MRI图像,对其临床资料和影像学表现(病变位置、大小、性状、信号)进行分析.结果 26例中,海绵状血管瘤7例,腱鞘巨...     

髌下脂肪垫劳损的诊断与治疗现况

髌下脂肪垫劳损是一种比较常见的中、老年疾病,是某些因素刺激所造成的急、慢性髌下脂肪垫的无菌性炎症,难于治愈,不同程度影响患者的工作和日常生活。作者在查阅大量国内文献的基础上,就髌下脂肪垫劳损的病因、病理、临床表现、诊断,物理疗法、手法、药物疗法、髌下阻滞或局部封闭疗法、针灸疗法、小针刀疗法、中医疗法、增强股四头肌力量练习,手术治疗,以及治疗注意事项进行了综述。     

全膝关节置换术中保留髌下脂肪垫对髌腱短缩的影响

目的探讨保留髌下脂肪垫在全膝关节置换术中对髌腱短缩的影响。方法将邯郸市第一医院骨科86例(86膝)行全膝关节置换术的骨性关节炎患者按手术方式分为保留组(保留大部分髌下脂肪垫及滑膜)与切除组(切除髌下脂肪垫,选择假体进行置换)各43例。保留组男性13例,女性30例,平均年龄(60.95±5.34)岁。切除组男性15例,女性28例,平均年龄(61.27±5.51)岁。对比两组术前、术后1年HSS膝关节功能评分(疼痛、功能、活动度、肌力、屈膝畸形、稳定性),膝关节活动度(屈膝度、屈曲挛缩),并记录髌腱短缩的发生率、膝前痛发生率及术后并发症发生率。结果保留组髌腱短缩的发生率低于切除组(25.58%vs.46.51%),差异有统计学意义(P=0.043)。两组术后1年疼痛、功能、活动度、肌力、屈膝畸形、稳定性评分均高于术前,差异有统计学意义(P0.05);组间各项目评分比较差异均无统计学意义(P0.05)。两组术后1年屈膝度、屈曲挛缩均低于术前,差异有统计学意义(P0.05);但组间比较差异无统计学意义(P0.05)。所有患者术后均未发生髌腱损伤。保留组术后1年膝前痛发生率低于切除组(2.33%vs.20.93%),差异有统计学意义(P=0.007)。结论保留与切除髌下脂肪垫用于全膝关节置换术在改善膝关节功能、膝关节活动度方面疗效相当,但前者可明显降低髌腱短缩及膝前痛发生率,且并未增加髌腱损伤风险,临床应用价值较高。     

银质针灸治疗慢性髌下脂肪垫损害26例

2009年9月-2010年2月,我们采用银质针灸治疗慢性髌下脂肪垫损害26例,疗效满意,现分析报告如下。     

髌下脂肪垫损伤的MRI表现及临床分析

目的 :探讨髌下脂肪垫(infrapatellar fat pad,IFP)损伤的MRI成像特点及诊断价值。方法 :回顾性分析经临床综合诊断及随访明确诊断为IFP损伤患者105例,并分析其MRI成像特点。结果:105例中,右膝54例,左膝45例,双膝6例。共111个膝关节MRI表现与损伤程度相关,可表现为IFP的信号异常及形态改变,Ⅰ级51个(45.9%),Ⅱ级36个(32.4%),Ⅲ级21个(18.9%),Ⅳ级3个(2.7%),并常伴不同程度关节积液。结论:MRI能清晰显示IFP的形态、信号改变,准确评估其损伤的部位及严重程度,可为临床治疗提供影像学依据。     

髌下脂肪垫的MRI定量检测及其在膝关节骨关节炎中的应用进展

髌下脂肪垫（IPFP）是参与膝关节骨关节炎（KOA）发生、发展的重要关节组织。MRI可以直接观察和量化IPFP的变化,包括其形态学表现、信号强度变化及血流灌注变化等,有助于推测IPFP在KOA发病及进展中的作用。就基于MRI对IPFP的定量检测方法及其在KOA中的研究现状和进展予以综述。     

银质针加手法治疗髌下脂肪垫炎25例

<正> 髌下脂肪垫炎是中老年人的常见病,也是部队训练过程中的多发病。1998年以来。我们运用银质针加手法治疗髌下脂肪垫炎25例,取得满意效果。     

MRI诊断髌下脂肪垫损伤的价值

目的探讨膝关节髌下脂肪垫(infrapatellar fat pad,IFP)损伤的磁共振成像(MRI)特点及临床应用价值。方法回顾性分析我院经临床综合诊断或临床随访明确诊断为IFP损伤的111例患者,归纳总结其特征性MRI表现并分级。结果111例中,左膝57例,右膝39例,双膝15例。共126个膝关节根据IFP的信号、裂隙及形态改变进行损伤程度分级轻度54个(42.9%),中度43个(34.1%),重度29个(23.0%)。根据IFP损伤程度指导临床给予相应治疗,终止治疗4~8周随访。治疗前后膝关节VAS评分有显著差异(P<0.05)。结论MRI能准确评估IFP损伤部位及严重程度,为临床治疗提供影像学依据并有较好的指导作用。     

新兵基础训练期间髌下脂肪垫损害的调查

新兵基础训练期间髌下脂肪垫损害的调查海光剑★周武平★关键词髌下脂肪垫损伤训练调查中国图书资料分类法分类号Ｒ６８４新兵基础训练期间髌下脂肪垫损害并非罕见，往往误诊为创伤性关节炎、膝关节劳损、风湿性关节炎、良性关节痛等。我们自１９９６年１２月１５日至１９...     

关节镜下治疗腘窝囊肿35例报道

目的:探讨关节镜技术治疗腘窝囊肿的方法及其临床疗效。方法:2002年10月至2004年7月,采用关节镜技术对35例腘窝囊肿患者进行治疗,其中男性14例,女性21例,年龄42～68岁,平均49.7岁。窝囊肿均为单侧,其中右膝16例,左膝19例。在处理关节内疾患的同时,在后内侧间室扩大窝囊肿与关节腔之间的通道口。4例巨大囊肿(直径>5cm)同时行后路关节镜下囊壁切除术。根据Rauschning和Lindgren分级方法评定手术效果。结果:本组35例腘窝囊肿患者在术中均可发现伴有关节内疾患,其中内侧半月板撕裂24例,外侧半月板撕裂7例,前交叉韧带撕裂4例,骨性关节炎27例,痛风性关节炎1例。术后未出现血管、神经或手术切口并发症。术后2～3天出院。随访时间6～29个月,平均11个月,94.2%的病例未出现囊肿复发。Rauschning和Lindgren分级结果:术前Ⅰ级4例,Ⅱ级12例,Ⅲ级19例;术后0级30例,Ⅰ级4例,Ⅱ级1例。结论:关节镜下治疗窝囊肿具有创伤小、恢复快、复发率低的优点。     

Conservative treatment for a symptomatic solitary ganglion cyst of the anterior meniscus invading into the infrapatellar fat pad

Symptomatic meniscal cysts without accompanying meniscal tears are uncommon, especially those which are formed from the anterior meniscus and invading into the infrapatellar fat pad (IPFP). The current recommended treatment for such cysts is excision through open method or arthroscopy. To our knowledge, this is the first case study about a symptomatic solitary meniscal cyst invading the IPFP that was successfully treated with needle aspiration and steroid injection after arthroscopic treatment of the associated disorders. In this paper, similar cases are also reviewed to discuss the treatment and the link between meniscal cyst and meniscal tear.     

Infrapatellar fat pad size, but not patellar alignment, is associated with patellar tendinopathy

Patellar tendinopathy (PT) is one of the most common overuse injuries of the knee. Recent reports indicate that increased body mass is frequently associated with tendinopathy, not only biomechanically but biochemically. Abnormalities of other structures within the knee extensor mechanism [patellofemoral joint (PFJ) alignment and patellar tendon length] that can directly influence the strain distribution of the patellar tendon are inconsistently implicated in PT. The aim of this study was to compare the infrapatellar fat pad volume, patellar tendon length and PFJ alignment in people with chronic PT and a group of age-, gender-, height-, and activity-matched controls with normal tendons. Axial magnetic resonance (MR) images, from 26 participants with PT and 28 control participants were obtained. Fat pad size, patellar tendon length and PFJ alignment were measured digitally from the MR images, using measurement software, and the results compared between the PT group and control group. People with PT had a significantly larger fat pad than healthy controls when controlled for height (P=0.04). Patellar tendon length was not significantly different between groups (P=0.16), nor were there between-group differences for the measures of PFJ alignment (P=0.07-0.76). Thus, the infrapatellar fat pad may play an important role in PT.     

关节镜下治疗半月板囊肿的疗效评价

目的探讨关节镜下治疗半月板囊肿的临床疗效。方法 2007年5月—2010年11月,我科共收治15例半月板囊肿患者,其中男10例,女5例,年龄19～37(22.6±4.1)岁。术前行膝关节MRI明确诊断,采用关节镜下囊肿切除、半月板成形术治疗。结果平均随访(12.3±2.4)个月,14例患者膝关节疼痛、肿胀消失,活动范围恢复正常,膝关节间隙表面包块消失,无关节交锁及弹响。1例多房性囊肿因遗留复发。术前Lysholm评分平均为(68.7±5.4)分,末次随访时Lysholm评分平均为(93.5±3.7)分,差异有统计学意义(P<0.01);术后Glasow评分优良率为86.7%。结论关节镜下治疗半月板囊肿具有创伤小、膝关节稳定性好及生理功能干扰小等优点,是治疗半月板囊肿的理想方法。     

Infrapatellar fat pad pressure and volume changes of the anterior compartment during knee motion: possible clinical consequences to the anterior knee pain syndrome

This biomechanical study was performed to measure tissue pressure in the infrapatellar fat pad and the volume changes of the anterior knee compartment during knee flexion–extension motion. Knee motion from 120° of flexion to full extension was simulated on ten fresh frozen human knee specimens (six from males, four from females, average age 44 years) using a hydraulic kinematic simulator (30, 40, and 50 Nm extension moment). Infrapatellar tissue pressure was measured using a closed cell sensor. Infrapatellar volume change in the anterior knee compartment was evaluated subsequent to removal of the fat pad using a water-filled bladder. We found a significant increase of the infrapatellar tissue pressure during knee flexion, at flexion angles of <20° and >100°. The average tissue pressure ranged from 343 (±223) mbar at 0° to 60 (±64) mbar at 60° of flexion. The smallest volume in the anterior knee compartment was measured at full extension and 120° of flexion, whereas the maximum volume was observed at 50° of flexion. In conclusion, the data suggest a biomechanical function of the infrapatellar fat pad at flexion angles of <20° and >100°, which suggests a role of the infrapatellar fat pad in stabilizing the patella in the extremes of knee motion.     

关节镜下成形联合缝合术治疗不稳定型外侧盘状半月板临床分析

目的:回顾分析关节镜下成形联合缝合修补术治疗不稳定型外侧盘状半月板的手术方法和近期疗效。方法:复旦大学附属华山医院运动医学与关节镜外科自2007年6月至2008年10月采用关节镜下半月板成形联合周边缘缝合术治疗不稳定型外侧盘状半月板患者49例(52膝),随访时采用Lysholm评分、HSS膝关节功能评分(hospital for special surgery knee score)及复查MRI评价手术疗效。结果:49例(52膝)术后随访14个月至30个月,平均20.8个月。术前Lysholm评分为43±7.3分,术后90±5.3分(P<0.01),术前HSS评分为40±8.6分,术后89±7.3分(P<0.01),评分优良率分别为86.5%和87.9%。24膝得到MRI复查,21膝完全愈合,3膝部分愈合。结论:采用关节镜下半月板成形联合缝合修补术治疗不稳定型外侧盘状半月板创伤小,手术效果良好。     

银质针透热疗法结合超声波治疗髌下脂肪垫劳损的临床研究

目的观察银质针结合超声波治疗髌下脂肪垫劳损的疗效,探讨该病的治疗方法。方法将74例髌下脂肪垫损害患者,随机分为治疗组和对照组各37例,治疗组采用银质针透热结合超短波治疗,对照组只采用超短波治疗,治疗前后采用活动痛(VAS)、症状改善率作为观测指标,比较两组疗效并进行统计学处理。结果治疗组与对照组的总有效率比较差异有统计学意义(P<0.05),两组治疗前后VAS评分比较差异有统计学意义(P<0.01),治疗组效果更好。结论银质针透热结合超短波对髌下脂肪垫劳损有很好的疗效。     

Atlantoaxial Joint Synovial Cyst: Diagnosis and Percutaneous Treatment

Synovial cysts at the atlantoaxial level are found uncommonly. Lumbar symptomatic cases are treated by percutaneous cyst aspiration with or without corticoid injection or by surgical resection, but synovial cysts at the C1-C2 level are usually treated by surgery. We report here a 92-year-old woman with a retro-odontoid synovial cyst producing spinal cord compression that was treated by percutaneous aspiration of the cyst under CT guidance. To our knowledge, this is the first reported case of an atlantoaxial synovial cyst successfully treated with a minimally invasive procedure.     

膝关节半月板囊肿的MRI特点

目的 探讨半月板囊肿的MRI特点及流行病学特点.方法 对489例膝关节半月板囊肿的发病率、性别、年龄、囊肿的大小、分布、性状及合并半月板撕裂等进行统计,分析半月板囊肿分型与半月板撕裂、撕裂类型及年龄的关系.结果 半月板囊肿的发病率为1.92％,男、女性别无明显差异.内、外侧半月板囊肿的发生比率为1:2.15;外侧半月板囊肿多发生于前角、体部,内侧多发生在后角;根据半月板囊肿的MRI表现分为4型:半月板旁型、半月板内型、滑膜型和混合型;本组病例中合并半月板撕裂者占94.7％,滑膜型半月板囊肿合并半月板撕裂比率明显低于其他类型;半月板囊肿分型与半月板撕裂类型无统计学相关,各型半月板囊肿均以水平撕裂最多见.本组半月板囊肿按年龄分为≤19岁、20～50岁、≥51岁3组,年龄与半月板囊肿分型无统计学相关,在各年龄阶段,半月板旁型半月板囊肿最多见.结论 半月板囊肿多发生于外侧半月板,外侧半月板囊肿多见于前角、体部,内侧多见于后角,常合并半月板撕裂;滑膜型半月板囊肿合并半月板撕裂比率明显低于其他类型;各型半月板囊肿均以水平撕裂最多见;在各年龄阶段,半月板旁型半月板囊肿最多见.     

纵隔囊肿的CT诊断与鉴别诊断

目的提高纵隔囊肿的诊断与鉴别诊断水平。方法收集经手术病理证实的纵隔囊肿36例,分析其CT表现。结果所有病例CT表现均为边缘清晰、囊壁菲薄、内为不强化的水样密度肿块。其中神经肠源性囊肿1例、支气管囊肿12例、食管囊肿2例、心包囊肿5例、皮样囊肿7例、淋巴管囊肿4例、胸腺囊肿4例、非特异性囊肿1例。结论根据CT平扫和增强扫描上特征性表现,可较正确地作出纵隔囊肿的诊断,并与其它囊性病变鉴别。