椎小关节病的CT诊断：附402例分析

笔者对１０１７例肩背和／或腰腿痛患者的临床、Ｘ线及ＣＴ资料进行了回顾性分析。ＣＴ显示椎小关节异常４０２例，Ｘ线显示１８３例。ＣＴ对本病的显示率比Ｘ线高１２倍。ＣＴ能有效地显示关节突增生肥大、骨赘形成、关节间隙变窄、骨性关节面改变、关节脱位及半脱位、侧隐窝或椎间孔狭窄、关节囊钙化及关节“真空”征等。后二者Ｘ线检查难以显示。ＣＴ易于显示椎小关节病及其并存症，对肩背腰腿痛患者的合理施治有重要意义。     

Rupioid Psoriasis Associated with Arthropathy

We reported a rare case of rupioid psoriasis associated with arthropathy. A 28-year-old male had suffered from severe arthritis for 6 months and had limpet-like, cone-shaped skin lesions on the extremities for 3 months. The histopathology revealed remarkable Munro's and Kogoj microabscesses, intense dermal edema, and moderate inflammatory cell infiltration. The radiological examination showed bilateral sacroilitis. The skin lesions and arthritis responded dramatically in three weeks to i.m. methotrexate combined with topical steroids and emollients and occlusive dressing technique. There was no recurrence of such skin lesions during the two year follow-up period.     

A retrospective study on chemical and radioactive synovectomy in severe haemophilia patients with recurrent haemarthrosis

Between 1970 and 1994, 116 chemical and 90 radioactive synovectomies were performed in 107 patients with severe haemophilia and two with type 3 von Willebrand's disease. The products used were osmic acid (OA) in 100 cases, 90-Yttrium in 35 cases, 186-Rhenium in 48, 169-Erbium in two, hexacetonide triamcinolone in 16 and radioactive gold in five cases. The use of radioactive colloids is not allowed in France in patients under 15 years of age. Twenty-nine patients had more than one synovectomy per joint. All patients were evaluated for 6 months post-synovectomy, using both a clinical and a radiological score. Six months after synovectomy, a good or excellent result was obtained for 81% of the joints treated with isotopes, compared with 44% of those treated with OA, P<0.001. This superiority of isotopes over osmic acid was still observed after 6 months for the 89 joints that were re-evaluated, with follow-up ranging from 1 to 9 years. It was possible to calculate a radiological score in 84 cases. With OA the best results were from the joints with the lowest scores pre-synovectomy (<7). No correlation could be established between the clinical and the radiological scores, due to the small size of the sample. In summary: (1) chemical and radioactive synovectomy are simple and safe procedures for haemophilic arthropathy, (2) in our series, after 6 months the efficacy of isotopic synovectomy was greater than that of chemical synovectomy, and this benefit seems to persist after 6 months, and up to 9 years in the group of patients with longer-term follow-up.     

Effects of haemophilic arthropathy on health-related quality of life and socio-economic parameters

Summary. Although prophylactic treatment is advised for all children with severe haemophilia, the optimal regimen is still under discussion. Should all joint bleeds be prevented, or can a limited amount of arthropathy be tolerated in adulthood without loss of quality of life? To answer this question, the effect of haemophilic arthropathy on health‐related quality of life (HRQoL) needs to be quantified. In a retrospective study, the effect of arthropathy on HRQoL and socio‐economic parameters was assessed in a single‐centre cohort of 96 patients with severe and moderate haemophilia with a minimum age of 13 years. Arthropathy was measured by the radiological Pettersson score of the elbows, knees and ankles (maximum: 78 points). HRQoL was assessed by the Short Form 36 (SF36), measuring eight domains of health. Labourforce participation and medical consumption were assessed using a separate questionnaire. Patients were studied at a mean age of 28.6 years (range: 13–54), the mean time between evaluation and the last Pettersson score was 0.4 years (SD: 1.1). The overall median Pettersson score was 13 (range: 0–78). There was a trend towards lower quality of life with increasing Pettersson scores and age, especially in the physical domains of the SF36. An age‐adjusted analysis showed that arthropathy had a small but significant effect on HRQoL in the domain of ‘physical function’ of the SF36, but not on its other domains, or on labourforce participation and medical consumption. Thus suggesting that the SF36 can be used to assess the effects of haemophilic arthropathy, especially in the domain of ‘physical function’.     

Effect of late prophylaxis in hemophilia on joint status: a randomized trial

Essentials

• High‐quality data are lacking on use of prophylaxis in adults with hemophilia and arthropathy.
• SPINART was a 3‐year randomized clinical trial of late/tertiary prophylaxis vs on‐demand therapy.
• Prophylaxis improved function, quality of life, activity and pain but not joint structure by MRI.
• Prophylaxis improves function but must start before joint bleeding onset to prevent arthropathy.

     

Prophylactic versus on-demand treatment strategies for severe haemophilia: a comparison of costs and long-term outcome

A multicentre study was performed to compare clotting factor use and outcome between on-demand and prophylactic treatment strategies for patients with severe haemophilia. Data on treatment and outcome of 49 Dutch patients with severe haemophilia, born 1970-80, primarily treated with prophylaxis, were compared with those of 106 French patients, who were primarily treated on demand. Dutch patients received intermediate dose prophylaxis, for a median duration of 12.7 years. Patients primarily treated with prophylaxis had fewer joint bleeds per year (median 2.8 vs. 11.5), a higher proportion of patients without joint bleeds (29% vs. 9%), lower clinical scores (median 2.0 vs. 8.0), and less arthropathy as measured by the Pettersson score (median 7 points vs. 16 points). Mean annual clotting factor use was equal at 1,488 +/- 783 IU kg-1 year-1 (mean +/- standard deviation) for patients primarily treated with prophylaxis and 1,612 +/- 1,442 IU kg-1 year-1 for patients primarily treated on demand. These findings suggest that, compared with a primarily on-demand treatment strategy, a primarily prophylactic treatment strategy leads to better outcome at equal treatment costs in young adults with severe haemophilia.     

半限制性假体治疗 Charcot 膝关节病的疗效分析

目的：探讨半限制性假体全膝关节置换( total knee arthroplasty,TKA )在膝关节 Charcot 关节病中的应用及近期临床效果。方法2003年7月至2013年6月,对行 TKA 的12例 Charcot 关节病患者(12膝)进行回顾分析。12例中,男5例,女7例;年龄30～70岁,平均48岁。所有患者均使用半限制性假体,其中7膝加用延长杆。本组12例术后1、3、6、12个月以及以后每年随访1次,12例均获14个月～11年随访,平均6.5年。12例每次随访,均摄患肢膝关节正侧位 X 线片、并行 HSS、KSS 评分、膝关节活动度、关节稳定性、假体固定情况(有无假体松动)等评价。结果1例术后2年出现感染、假体松动,行分期手术。一期清创,抗生素骨水泥临时假体植入,待感染控制后,行二期翻修术,术后恢复较好。其余病例术后疼痛完全消失,膝关节畸形矫正,稳定性及功能均良好,无感染、假体松动、深静脉血栓等并发症。术后 X 线片显示假体位置及下肢力线恢复良好。末次随访时,膝关节 HSS 评分平均87.7(82～96)分,较术前平均为51.5(32～72)分,差异有统计学意义(P＜0.01)。膝关节 KSS 临床评分：平均为87.5(80～95)分,较术前平均为57.9(35～70)分,差异有统计学意义(P＜0.01)。膝关节 KSS 功能评分平均为86.9(80～95)分,较术前的平均为56.8(30～70)分,差异有统计学意义(P＜0.01)。膝关节活动度( ROM )平均115°(110～130)°,较术前的平均为96.5°(85～110)°,差异有统计学意义(P＜0.01)。随访时 HSS 评分、KSS 评分和 ROM 与术前比较,差异均有统计学意义(P＜0.01)。患者对功能及关节的稳定性满意。结论半限制性膝关节假体 TKA 是治疗膝关节 Charcot 关节病的有效方法,术中采取适度的软组织松解及正确的截骨、合理的骨缺损处理、选择适当的假体和术后康复,Charcot 关节病患者可以通过 TKA 获得良好的近期结果,远期效果有待于随访观察。     

Progressive pseudorheumatoid chondrodysplasia: a hereditary disorder simulating rheumatoid arthritis

Progressive pseudorheumatoid chondrodysplasia is a rare hereditary disorder. This autosomal recessive condition is characterised by progressive arthropathy and platyspondyly. The symptoms are similar to those of rheumatoid arthritis but synovitis is absent. In this study a patient with inherited progressive pseudorheumatoid chondrodysplasia is presented.     

A permeability-enhancing factor produced by tumor

Summary The intra-articular injection of ascites fluid or of extracts derived from malignant tumors was shown to induce exudative joint lesions. The intraarticular injection of normal plasma did not have this effect. It is suggested that tumor secretes a permeability-enhancing agent. This substance promotes the extravasation of humoral or cellular elements into the joint spaces. A similar mechanism may underlie the development of pulmonary arthropathy or the formation of malignant effusions.     

A new magnetic resonance imaging scoring method for assessment of haemophilic arthropathy

In a European multicentre study, 39 ankles in 28 haemophilic boys were investigated by magnetic resonance imaging (MRI). A new MRI score was developed in the format A(e:s:h) for evaluating haemophilic arthropathy. This scheme provides high resolution and allows separation of different pathological components. The factor A is calculated as the sum of scores for subchondral cysts (maximum value 6), irregularity/erosion of subchondral cortex (maximum 4) and chondral destruction (maximum 6); e, s and h, respectively, represent effusion/haemarthrosis, synovial hypertrophy and haemosiderin deposition, and they are separately evaluated on a scale of 0-4. Working independently, two radiologists scored the 39 ankles twice using both this new 'European' scoring method and a previously published 'Denver' scoring scheme. Final classification was achieved by consensus. The reproducibility of the readings was assessed, and for both scoring methods the results indicated good or moderate intraobserver agreement, and good, moderate or fair interobserver agreement. These findings suggest that MRI can be useful for semiquantitative evaluation of haemophilic arthropathy, providing the examination is performed according to an appropriate protocol, and the images are evaluated by specially trained radiologists.