32P colloid radiosynovectomy in treatment of chronic haemophilic synovitis: Iran experience

Repeated intra-articular bleeding with subsequent development of chronic synovitis and cartilage changes, leading to haemophilic arthropathy, is one the most debilitating problems in haemophilic patients. Radiosynovectomy is a familiar therapeutic choice in management of chronic synovitis in haemophilia. We report the treatments results of synoviorthesis with (32)P chromic phosphate with emphasis on clinical aspects. Between 2002 and 2006 we performed 66 procedures in 53 patients. Seven patients were excluded. The remaining 46 patients were followed for an average of 31 months. The mean age of patients at the time of injection was 15.9 years (range: 6-28). There were three repeat injections. According to Fernandez-pallazi and Cavilgia clinical classification (Table 1) [23], nine joints were Stage II and 46 were Stage III. In latest follow-up, 77% of patients reported at least a 50% decrease in bleeding frequency after treatment (P < 0.0001). The need for antihaemophilic factor consumption dropped by about 74% postradiosynovectomy (P < 0.0001). In most of the injected joints, the range of motion remained stable or improved. A trend was found for the number of haemarthrosis to increase after a period of considerable improvement. Synoviorthesis using (32)P effectively reduces the intra-articular bleeding rate and factor concentrate use. Durability of the response seems to be unpredictable, perhaps attributable to the late intervention. An early radiosynovectomy might be more helpful in terms of stability of response to treatment.     

The Usefulness of Magnetic Resonance Imaging in the Diagnosis of Anterolateral Impingement of the Ankle

The purpose of this study is to assess the sensitivity and specificity of magnetic resonance imaging (MRI) in the diagnosis of anterolateral impingement of the ankle and to assess the most helpful sequence in making the diagnosis. Twenty-four patients who had undergone ankle arthroscopy were chosen. Twelve patients had arthroscopically documented anterolateral impingement, and 12 patients with no impingement on arthroscopy served as controls. Two musculoskeletal radiologists and an orthopedic surgeon, blinded to the operative diagnosis, retrospectively reviewed selective MRI images in the sagittal, axial, and coronal planes. The sensitivities and specificities were calculated for all 3 reviewers. The Kendall coefficient of concordance was calculated for overall agreement among reviewers. Sensitivities varied from 0.75 to 0.83, whereas specificities varied from 0.75 to 1.00. Using the Fisher exact test of contingency, the sensitivities and specificities showed that all reviewers' interpretations were statistically significant with P = .039, .001, and .012, respectively. The axial images were felt to be most helpful in making the diagnosis. The physicians felt that the sagittal images were helpful in 67%, 83%, and 100%, respectively. MRI is a useful tool that can aid the clinician in the diagnosis of anterolateral impingement of the ankle. T1 sagittal images demonstrating displacement of the normal fat signal anterior to the fibula by scar can be useful and help to confirm the diagnosis.     

TDP局部照射用于治疗儿童髋关节一过性滑膜炎的疗效观察

目的:探讨加速儿童髋关节一过性滑膜炎疾病的愈合.方法:随机性分析2005年1月～2006年4月共100例髋关节一过性滑膜炎患儿的治疗效果,把病人随机分为治疗组及对照组.治疗组按常规方法治疗加TDP灯局部照射,对照组仅按常规方法治疗.结果:治疗1周后,治疗组B超检查增厚滑膜厚度变化差值、关节腔间隙宽度变化值、关节腔积液好转率、"4"字试验阴性率均明显优于对照组(P＜0.05).结论:TDP灯用于治疗儿童髋关节一过性滑膜炎能加速疾病愈合,提高治疗效果.     

关节镜下滑膜切除术治疗膝滑膜结核的临床分析

目的：探讨关节镜下滑膜切除术治疗膝滑膜结核的疗效。方法：对我院1990年1月至2003年7月的23例膝关节滑膜结核的患者在关节镜下行滑膜切除术并取组织送病理检查。结果：术后经随访16—36个月，患者功能恢复良好，症状消失，优良率达到96．3％。结论：关节镜下滑膜切除术治疗膝关节滑膜结核是一种安全有效的治疗方法。     

关节镜下膝关节结核性滑膜炎的治疗(附10例报告)

目的探讨关节镜下结核性滑膜炎的特点和滑膜切除术的效果. 方法选择10例结核性滑膜炎,行关节镜下滑膜切除手术和活检.术后配合关节腔注射异烟肼和全身抗结核治疗. 结果所有病人随访6月～3年,术后第2天行CPM关节功能锻炼,9例膝关节屈曲从手术前90°±5°平均提高到120°±14°,伸直受限从手术前20°±3°提高到5°±1°,手术前后比较差异有显著性(t值分别为6.9、 6.3,P<0.01),JOA评分术前(44±8)分,术后(82±10)分(t=8.47,P<0.01),所有病人2个月后关节肿胀减轻,随访期间内无病变复发. 结论关节镜下切除滑膜和清理结核性肉芽组织,改善软骨营养,结合药物治疗可有效控制病情,改善关节功能.     

Prevention of haemophilic synovitis: prophylaxis

Summary.  It has been proven that early prophylactic therapy can prevent bleeding and arthropathy. Numerous retrospective non-randomized cohort studies have demonstrated that prophylaxis, if started early in life, is associated with a considerable reduction of the mean number of joint bleeds and the rate of joint deterioration. It is quite extraordinary that despite the considerable evidence base it has been considered necessary by investigators to pursue the ideal of the controlled randomized trial and expose children to the risk of cerebral bleed. This questionable ethical approach is driven by the reluctance of the 'willingness to pay' but it is important that patients are not subjected to unnecessary investigation at either the behest of the Cochrane Database or those who control the financing of haemophilia care.     

色素绒毛结节性滑膜炎28例报道

目的探讨色素绒毛结节性滑膜炎(PVS)的临床病理特点、治疗和预后的关系。方法本组PVS28例,男13例,女15例,年龄12～53岁。膝关节15例,手指7例,足背4例,颞颌及骶髂关节各1例,多肢体1例。局限型19例,弥漫型9例。伴外伤史3例,骨破坏4例,恶变2例,半月板破裂1例,滑膜血管瘤1例。均行滑膜切除,早期操练,3例加放疗。28例均经病理证实。结果22例随访2～18年,13例功能良好;9例复发5例功能欠佳,2例截指(趾),2例死亡。放疗3例均复发。结论PVS临床病理均有肿瘤的特征,可恶变和转移,易复发,最佳治疗是彻底的滑膜切除而不是放疗。     

玻璃酸钠与Kenacort-A联合治疗膝骨关节炎合并滑膜炎临床观察

目的探讨玻璃酸钠(SH)联合肾上腺皮质激素类药Kenacort-A关节腔内注射治疗膝骨关节炎(OA)合并滑膜炎(SY)的临床疗效。方法选膝OA合并SY患者205例,随机分为单纯用药组(100例)和联合用药组(105例),单纯用药组给予SH关节腔内注射,联合用药组给予AH+Kenacor-A关节腔内注射。结果联合用药组的起效时间及疗效明显优于单纯用药组。结论SH联合Kenacort-A治疗膝OA合并SY,疗效快,可提高临床治疗效果。