超声引导下髋关节药物注射在关节镜盂唇修复术后康复中的应用

目的: 探讨超声引导下髋关节药物注射在髋关节镜盂唇修复术后促进康复中的临床应用。方法: 纳入2015年6月至2017年5月于北京大学第三医院行髋关节镜盂唇修复术,术后1~6个月[平均(2.3±0.6)个月]仍有髋部疼痛导致康复期康复训练受限,但影像学检查显示盂唇愈合良好的36例患者,其中2例患者为双侧,共计38侧髋关节,行超声引导下髋关节疼痛阻滞治疗。对注射治疗前及治疗后满4周时患者髋部疼痛程度进行评分,应用SPSS 21.0统计学软件进行数据分析,同时随访患者髋关节功能状况,计算髋关节药物注射治疗的有效率[有效率=(“优良”+“好转”)例数/总例数×100%]。髋部疼痛程度评估采用视觉模拟评分法(visual analogue score, VAS)评估,疼痛程度分为0~10分,0分为无疼痛感,10分为难以忍受的剧烈疼痛。髋关节功能状况通过髋关节活动度进行评估。疗效“优良”指髋部无疼痛或偶有轻微疼痛,Patrick试验转阴性,运动功能不受限;“好转”指疼痛明显减轻,运动功能稍受限;“无效”指治疗前后疼痛和运动功能无明显改善,Patrick试验阳性。结果: 在接受髋关节药物注射治疗前,患者髋部疼痛程度VAS评分为(5.46±1.46)分,注射治疗后满4周时VAS评分为(2.01±0.53)分,VAS值明显减低,差异有统计学意义(P<0.05);药物注射治疗后,髋关节活动度有明显提高,治疗有效率为84.2%。结论: 对髋关节镜盂唇修复术后仍存在疼痛、功能受限的患者,行超声引导下髋关节药物注射可有效减轻髋部疼痛,改善髋关节活动度,促进髋关节功能重建。     

Non-contrast MR imaging of the glenohumeral joint. Part I. Normal anatomy

MR imaging of the shoulder without contrast is frequently used for evaluation of glenohumeral instability in spite of the popularity of MR arthrography. With proper imaging technique, familiarity with normal anatomy and variants as well as knowledge of the expected pathologic findings high diagnostic accuracy may be achieved.     

MR-based Parameters as a Supplement to Radiographs in Managing Developmental Hip Dysplasia

Background

Some dysplastic hips with favorable radiographic parameters fail to develop normally, suggesting that we should consider cartilaginous or soft tissue structures for further information regarding the condition of the hip. The purpose of this study was to provide a clear definition of concentric reduction in developmental dysplasia of the hip (DDH) based on magnetic resonance imaging (MRI), and to determine how radiographic and MR-based parameters could be used together to treat dysplastic hips.

Methods

We studied range of motion (ROM)-MRI of 25 patients with unilateral hip dysplasia (mean age at the time of MR imaging, 44.1 months). Each ROM-MRI consisted of a set of bilateral hip scans in the following positions: neutral; abduction; abduction- internal rotation; abduction-internal rotation-flexion; and adduction. Before MR scanning, the 25 patients received the following primary treatments: closed reduction (n = 15; at a mean age of 14.5 months); and open reduction (n = 10; at a mean age of 10.0 months). The following new parameters appear to be useful in treating DDH: 1) the labral angle, the angle the labrum makes with the acetabulum; 2) the uncorrected labral deformity (ULD), the "residual deformity" (deflection of the labrum) when the affected labrum is freed from pressure in abduction; and 3) the zone of compressive force (ZCF), the region of the acetabulum through which the body weight acts on the femoral head.

Results

A concentrically-reduced hip is one in which the labrum points downward in the neutral position, at the same angle as that of the normal side; and in which the ZCF is zone 3, the inner acetabular zone as defined herein. The ULD and the ZCF may be determined precisely as we have done, or the physician may simply observe the changes in the orientation of the labrum and compare the changes qualitatively to the unaffected side, and likewise for the medial joint space.

Conclusions

Detailed analysis of the labrum as permitted by ROM-MRI, together with acetabular index and other parameters measured from radiographs, provides important information for physicians treating childhood hip dysplasia.     

The pattern of distribution of PGP 9.5 and TNF-alpha immunoreactive sensory nerve fibers in the labrum and synovium of the human hip joint

To date, there has been no report clarifying the existence of sensory nerve fibers as the origin of the hip joint pain of osteoarthritis. We examined the existence of sensory nerve fibers in osteoarthritis (OA), osteonecrosis of the femoral head (ONFH), and femoral neck fracture of the human hip joint. Ten labra of 10 human hip joints were harvested during a total hip arthroplasty. Each labrum was separated into 12 sections and we used three sections for analysis, which included 2 weight-bearing and 1 non-weight-bearing portion. Protein gene product 9.5 (PGP 9.5) immunoreactive sensory nerve fibers were found in the labrum and synovium harvested from the weight-bearing portion in the OA group. Some of these sensory nerve fibers were also positive for tumour necrosis factor alpha (TNF). The PGP 9.5 immunoreactive sensory nerve fibers existed in the labrum tissue and inflammatory TNF positive cells were observed in the hyperplastic synovium. On the other hand, we could not demonstrate PGP 9.5 or TNF immunoreactive sensory nerve fibers and cells in any of the ONFH group or the non-weight-bearing portion in the OA group. These data suggest that the pain of ONFH and OA of the hip joint have different pathogenetic mechanisms and that the invasion of sensory nerve fibers containing TNF may be involved in the pathogenesis of pain in the human hip joint affected by OA.     

Acetabular labrum entrapment following traumatic posterior dislocation of the hip

 In traumatic dislocation of the hip with or without a fracture of the acetabular rim, complete anatomical reduction might be prevented by a bone fragment or infrequently by a soft tissue block, such as a torn acetabular labrum, ruptured capsule, or round ligament. We report a rare case of a tear in the acetabular labrum that prevented complete reduction of the dislocated hip. A 26-year-old man suffered posterior dislocation of the right hip, which was reduced under general anesthesia. The postreduction radiograph showed that the reduction was not complete, and a thin bony fragment was observed in the joint space in the weight-bearing area. Open reduction was performed 11 days later. We found a free bone fragment in the joint space, which was removed. The postoperative radiograph still did not show complete reduction of the hip. A large defect in the contrast medium was shown in the widened joint space by arthrography, which revealed the existence of the soft tissue interposition. We then performed a second operation and learned that the acetabular labrum was widely detached from the anterior to the posterior acetabular rim and was lying deep within the acetabulum. This detached portion of the labrum was excised, and the hip was reduced. The radiograph obtained during surgery then showed complete, concentric reduction. We missed the diagnosis clinically and radiologically at the first operation, proving how important it is to obtain an accurate radiological diagnosis in the operating room. Received: May 24, 2002 / Accepted: October 7, 2002 Offprint requests to: Y.T. Kim