膝关节病变的超声检查

通过对24例正常人、18例骨性关节炎（OA）及14例类风湿性关节炎（RA）患者双侧膝关节的超声探查发现：（1）OA及RA组髌上囊积液的比例分别为41．7％及64．3％；（2）RA组髌上囊的平均滑膜厚度明显大于正常组及OA组；（3）两个病变组膝关节股骨内髁处软骨厚度较正常组相比明显变薄，并有不同程度的超声异常表现；（4）OA组膝关节股骨内髁处软骨及软骨下骨质破坏的比例显著高于外髁，而RA组则无此现象。结果提示二维超声检查在膝关节病变的诊断及鉴别诊断方面具有良好的临床应用价值。     

超声在膝关节病变中的诊断价值

目的：应用超声高频探头检查类风湿性关节炎及骨性关节炎膝关节病变。方法：应用Aloka-630型超声诊断仪，探头频率7．5MHz，检查50例膝关节病变患。结果：类风湿性膝关节炎以滑膜增生为主；骨性关节炎以软骨及骨质破坏为主。结论：超声可清晰观察关节周围软骨、关节腔、滑膜及其他软组织病变，为临床诊断类风湿性关节炎及骨性关节炎进一步提供诊断依据。     

膝关节骨性关节炎的治疗进展

膝关节骨性关节炎（osteoarthritis,OA）又称膝关节增生性关节炎、退行性关节炎、退行性骨关节病等,是一种以关节软骨变性或丢失及关节边缘和软骨下骨质再生为特征的慢性关节炎症。该病始发部位在软骨,以老年人群最为常见,男女均可发病。60岁以上人群50％X线片有骨性关节炎的表现,其中35％～50％有临床表现;75岁以上者80％有骨性关节炎症状。随着人类寿命的延长,     

剥脱性骨软骨炎的研究现状与进展

剥脱性骨软骨炎（OCD）是指由各种原因导致的局部关节软骨及其软骨下骨质与母骨分离为特征的一类关节疾病．是引起青少年和成人关节症状的原因之一。据国外放射平片检查统计OCD的发病率为0．01％～0．06％．可发生于全身任何关节，但以膝关节最为常见，占OCD病例的75％。好发年龄10～加岁，其中发病高峰年龄在10～15岁，男女比例是2：1。本文以膝关节为主进行叙述。膝关节OCD最常发生典型部位（70％～80％）在股骨内侧髁外侧面后部，15％～20％发生在股骨外侧髁，发生在髌骨不常见（5％-10％），     

膝关节滑膜皱襞与股骨关节面软骨损伤

目的研究年龄、病程与滑膜皱襞病变和相应软骨面损伤之间的关系。方法回顾有滑膜皱襞的58个膝关节，对患者的年龄、病程与滑膜皱襞病变程度和软骨损伤程度之间进行相关性分析。结果58个膝关节中有68个滑膜皱襞，其中病理性滑膜皱襞54个（79．4％），造成相对应软骨面损伤的45个（66．2％）。年龄与滑膜皱襞病变程度之间，年龄与软骨损伤程度之间，病程与滑膜皱襞病变程度之间，病程与软骨损伤程度之间，均无显著性相关。滑膜皱襞病变程度和软骨损伤程度之间呈显著性正相关（r=0．769，P=0．000）。结论病理性滑膜皱襞可导致与其相对应的软骨面损伤，软骨损伤程度与滑膜皱襞病变的严重程度呈正相关。膝关节创伤以及关节反复屈伸的机械刺激是导致滑膜皱襞病变及相应软骨面损伤的主要原因。     

免荷膝关节矫形器干预对膝关节骨性关节炎疼痛及行走能力的影响

正骨性关节炎是关节软骨退变引起的一类关节疾患。最早出现症状是膝关节内侧腔(股骨内髁和胫骨内侧平台部),这种病理变化是由于膝关节的应力分布不均衡所造成的,久而久之,也会出现韧带、关节囊纤维层和滑膜层张力不均衡,关节面上的软骨逐渐变性、坏死、缺损。随着退变日益加重,继而出现关节间隙狭窄,半月板磨损,导致关节失稳,局部炎症引发疼痛,并继发产生关节的生物力学问题。本研究采用矫形器干预膝关节骨性关节炎患者,治疗其     

灸法治疗膝关节炎

膝关节炎是以膝关节骨及软骨、滑膜为主要改变的疾病，临床上中老年发病较普遍，尤以50-60岁为最多见，发病率女性超过男性，特别是女性体胖者，且随着病情的发展症状逐渐加重。膝关节骨性关节炎，是由于关节软骨，关节结构的退行性变以及继发于退行性变而导致的软骨骨的破坏或增生性变化，所引起的一系列疾病，疾病的根本原因是关节软骨的退化和损伤。     

高频超声在类风湿性关节炎膝关节病变中的应用

目的：应用高频超声观察髌上囊、滑膜、股骨髁软骨及软骨下皮质的情况,评价超声对类风湿性关节炎（RA）膝关节疾病的辅助诊断价值。方法：采用高频超声对RA组与对照组的膝关节髌上囊液体厚度、滑膜及股骨髁软骨厚度及软骨下骨皮质的回声情况进行对比观察。结论：高频超声通过观察关节积液、滑膜、软骨及软骨下骨皮质的病变为临床辅助诊段RA及其疗效评价、鉴别诊段提供依据。     

膝关节骨性关节炎的影像学和关节镜下分型诊断与治疗

目的探讨膝关节骨性关节炎的影像学和关节镜下的分型特点及各型关节镜下的治疗原则。方法对398例（448膝）膝关节骨性关节炎患者进行影像学和关节镜下分型，根据病变累及部位分为四型：Ⅰ型髌股关节型，Ⅱ型胫股关节型，Ⅲ型髁间型，Ⅳ型混合型。根据各型特点进行有选择性、有限化的关节镜下清理术，手术包括取出游离体、修整退变剥脱的软骨、清除磨损的半月板、髁间窝成形和清除增生肥厚的滑膜组织。结果随访230例，平均15个月（10～24个月），大多数患者临床症状减轻，关节功能改善。Lyshom评分，术后平均提高37分。结论关节镜下有选择性、有限化治疗膝关节骨性关节炎可以改善膝关节功能，延缓病程。     

关节镜下清理术治疗膝关节骨性关节炎

作者应用关节镜下清理术治疗膝关节骨性关节炎１４７例。本文介绍了膝关节骨性关节炎症状、Ｘ线表现、关节镜所见特点，并讨论了关节镜清理术手术指征、手术方法、影响疗效因素。认为关节镜下清理术治疗膝关节骨性关节炎可以同时消除引起症状的五大因素：软骨损害、半月板退化撕裂、滑膜炎症、关节渗液、骨内压力增高。有效率８７％。     

Relationship of medial plica and medial femoral condyle during flexion

BACKGROUND: The goal of this study was to investigate the kinematic relationship between medial plica and medial femoral condyle during knee motion. METHODS: I prospectively selected 30 knees which had different size of medial plica from patients underwent arthroscopic surgery over a one-year-period. I located the inner margins of these plicae by inserting needles percutaneously under direct vision during arthroscopic examination. The topographic changes of the margins of these plicae during knee motion were recorded by fluoroscopy and analyzed. FINDINGS: Three types of medial plicae were defined by their size. In all types of the medial plicae, shifting (rubbing, sliding) medially was found when the knee was moved from extension to flexion. They remained in contact with the medial femoral condyles during the whole range of motion. INTERPRETATION: This observation disclosed the kinematic relationship of the medial plica with the medial femoral condyle during knee motion in vivo. This pattern of medial-lateral motion may generate some shearing force acting on the cartilage of the medial femoral condyle. The conclusion of this study may draw more attention to the role of medial plica in the pathogenesis of degeneration of the cartilage on the medial femoral condyle of the knee joint.     

动态超声联合3.0T MRI诊断膝关节滑膜皱襞及其分型

目的 探讨动态超声联合3.0T MRI诊断膝关节滑膜皱襞及其分型的价值。方法 回顾性分析100例疑诊膝关节滑膜皱襞患者动态超声及3.0T MRI资料,以关节镜检查结果为标准,比较2种影像学方法单独及联合诊断膝关节滑膜皱襞的效能,对比其单独及联合测量的滑膜皱襞长度和厚度与关节镜结果的差异,分析其判断滑膜皱襞位置及分型与关节镜的一致性。结果 共检出70例膝关节滑膜皱襞,其中11例位于髌上、15例位于髌下、30例位于髌内侧、14例位于髌外侧,包括A型9例、B型35例、C型23例及D型3例。单一动态超声与3.0T MRI诊断膝关节滑膜皱襞的敏感度差异无统计学意义（P>0.05）,均低于二者联合（P均<0.05）。单一动态超声及3.0T MRI所测膝关节滑膜皱襞长度及厚度均低于二者联合及关节镜测量结果（P均<0.05）,二者联合与关节镜测量结果差异均无统计学意义（P均>0.05）。单一动态超声、3.0T MRI及二者联合评估膝关节滑膜皱襞位置（Kappa=0.755、0.826、0.897）及分型（Kappa=0.721、0.744、0.860）均与关节镜结果高度一致。结论 动态超声联合3.0T MRI对诊断膝关节滑膜皱襞及判断其分型具有较高价值。     

Atypische Plica mediopatellaris: Arthroskopische Differenzialdiagnose zur Innenmeniskuseinklemmung

Blockade and impression of the articular cartilage can be caused by hypertrophy of the synovial plicae of the knee. The plica mediopatellaris (medial shelf) is the most importand synovial fold in such pathology. In regular anatomy the distal part of the plica mediopatellaris passes to the fat pad (Hoffa). In this area exist in same cases a communication between plica suprapatellaris and plica infrapatellaris. In this article is demonstrated a case in wich the distal part of the plica mediopatellaris insert above the medial meniscus without any contact to the fat pad. The 27 years old sportsmen suffered on a acute blockade coursed by medial meniscal tear after clinical examination. During arthroscopic procedure the atypical plica was resected completely. This case history make clar that synovial plicae can occur in atypical morphology. Diligent arthroscopic diagnosis is necessary to clear the situation.     

Relationship between medial plica and medial femoral condyle—a three-dimensional dynamic finite element model

BackgroundMany researches reported that the pathologic medial plica impinges on the facing medial femoral condyle during knee motion and leads to erosive changes of the articular cartilage. The purpose of this study was to construct a simplified three-dimensional dynamic finite element human knee model to evaluate the dynamics behaviour between different types of medial plicae with the facing medial femoral condyles during knee motion.MethodsA three-dimensional dynamic finite element model composed of femur, tibia, covering cartilage and medial plica was developed. The kinematics of this simulation model was verified by previous findings during arthroscopic examination. The validated model was used to investigate and compare the magnitudes of the cyclic pressures acting on the cartilage of the medial femoral condyles by three different types of medial plicae with various Young’s moduli.FindingsAll types of plicae remained in contact with the medial femoral condyles and shifted medially when the knees moved from extension to flexion. The contact pressures were positively correlated with the Young’s moduli of the medial plicae. During the whole range of motion, the maximum contact pressures of all simulation scenarios occurred when the knees moved beyond 50° of flexion. When the Young’s moduli of medial plicae were set greater than 60 MPa, all types of medial plicae would elicit contact pressures greater than 10 MPa on the medial femoral condyles.InterpretationThe close relationship and possible high contact pressure between fibrotic medial plica and medial femoral condyle during knee motion might be a cause of cartilage damage on the medial femoral condyle and warrants further investigation.     

Medial synovial plica

Background. The purpose of this paper is to describe the frequency, pathophysiology and clinical sequelae of synovial plica of the knee. This structure is a remnant of tissue pouches found in the early stages of fetal growth. Symptomatic plica syndrome develops when the medial plica is irritated by injuries, an inflammatory state, or chronic overuse. Material and methods. We performed a retrospective analysis of the operative reports from 912 arthroscopies of the knee performed in the Orthopedic and Traumatology Department of Biziel Hospital in Bydgoszcz in the years 2002 and 2003. Results. Hypertrophic mediopatellar plica was found in 199 cases (21.8%). In 118 knees (12.9%) there were no more injuries except plica and associated chondromalacia of the patella and medial femoral condyle. Conclusions. On the base of this study we concluded that plica syndrome is an important clinical problem involving young people, especially women.     

关节镜下滑膜皱襞切除术治疗滑膜皱襞综合征52例临床分析

目的 探讨关节镜下滑膜皱襞切除术治疗滑膜皱襞综合征的临床效果。方法 对术前考虑或经超声诊断为滑膜皱襞综合症的52例患膝施行关节镜探查，并于镜下切除滑膜皱襞。结果 手术成功率100％，术后经18个月～4年随访，无1例症状复发。结论 关节镜下滑膜皱襞切除术治疗滑膜皱襞综合征是一种安全有效的方法。     

电针干预膝骨关节炎过程中转化生长因子β的调控作用

背景:电针治疗膝骨关节炎具有良好的中枢和外周镇痛作用.研究显示转化生长因子β在膝骨关节炎发生中具有重要作用.目的:从转化生长因子β调控角度,认识电针治疗膝骨关节炎的可能作用机制.方法:健康3月龄雄性SD大鼠,随机分为正常组、模型组、电针组和药物组.通过结扎大鼠股静脉并强迫运动的方法,建立膝骨关节炎动物模型.造模1个月后,电针组刺激内膝眼(EX-LE4)和犊鼻(ST 35)穴位,深0.1寸,脉冲2 Hz刺激20 min,1次/d,药物组为关节腔内注射药物透明质酸钠,0.1 mL/次,1次/周.治疗2周后,采集各组动物膝关节滑膜组织,观察转化生长因子β1、转化生长因子β1受体Ⅰ、转化生长因子β受体Ⅱ的表达.结果与结论:膝关节骨关节炎动物膝关节滑膜中转化生长因子β1水平增加(P < 0.05),经电针或透明质酸钠治疗后,膝关节滑膜中转化生长因子β1水平降低(P < 0.05),且转化生长因子β1受体Ⅰ,Ⅱ含量出现显著降低(P < 0.05).提示电针治疗膝骨关节炎是通过下调转化生长因子β1的含量来改善骨关节炎症状的,受体含量的减少有助于膝骨关节炎的恢复.     

Des donn??es fondamentales ?? la pratique clinique dans la r????ducation de la gonarthrose

Osteoarthritis is a whole joint disease involving cartilage, synovial tissue, sub-chondral bone, ligaments, muscles, and tendons. Non-pharmacological and pharmacological treatments for knee osteoarthritis target specifically these different tissue structures. Mechanical stress is the main actor in non-pharmacological treatment modalities. Muscle strengthening is able to decrease overload on symptomatic joint compartment, increase the stability of the knee, and probably decrease local inflammation.     

CT对膝关节周围滑膜囊积液的定位诊断价值

目的探讨CT对膝关节周围滑膜囊积液的定位诊断价值。方法对15例膝关节囊和/或周围滑膜囊积液进行分析。结果膝关节CT能很好地显示膝关节周围的肌肉、肌腱及骨骼等解剖结构,可准确定位周围滑膜囊积液。结论膝关节CT对膝关节周围滑膜囊积液的定位诊断具有重要的价值。     

下肢全长负重位X线检查在膝关节炎内外翻畸形中的临床价值

目的:探讨膝关节炎患者下肢全长负重位X线片对膝内、外翻畸形诊断的临床价值。方法:选取32例临床诊断为膝关节炎51膝分别拍摄下肢全长负重X线片,测量下肢力线和机械轴偏距(mechanical axis offset distance,MAD),解剖学股胫骨角(anatomical femor-tibial angle,aFTA),股骨远端力学外侧角(mechanical lateral distal femoral angle,mLDFA),胫骨近端力学内侧角(mechanical medial proximal tibial angle,mMPTA),对图像数据进行分析,对膝关节炎进行X线K/L分级,通过SPSS 17.0统计对下肢力线各参数与关节炎的相关性进行分析。结果:①膝关节下肢全长负重位X线片显示,关节有不同程度骨质增生,关节间隙变窄。②51膝骨关节炎中确诊膝内翻畸形38膝(74.51.%)和膝外翻畸形8膝(10.42%),5膝均无内外翻畸形。③膝关节炎X线K/L分级显示,0级:5膝(9.8%),I级:12膝(23.5%),II级:22膝(43.1%);III级:9膝(17.6%);IV级:3膝(59%)。④膝内翻组中股骨内翻7膝(18.42%),胫骨内翻18膝(47.36%),股骨、胫骨均内翻13膝(34.21%);膝外翻组中股骨外翻6膝,股骨、胫骨均外翻2膝。⑤在膝内翻组中,aFTA与骨关节炎X线K/L分级呈正相关(B值=0.132,t=2.648,P=0.012,P<0.05)。结论:下肢全长负重X线显示下肢结构清晰、完整,通过测量下肢力线参数评估,可全面诊断膝关节炎的内翻畸形或外翻畸形,膝内翻中以胫骨内翻显著,膝外翻中则以股骨外翻显著。因此,膝关节骨性关节炎的下肢全长负重X线检查具有较高的临床价值。