肌骨超声在中老年退行性膝关节病变的临床应用价值

目的探讨肌骨超声对中老年退行性膝关节病变的临床诊断价值。方法选取我院临床诊断为退行性膝关节病变患者60例(87个膝关节),男32例,女28例;年龄55～78岁,平均(61.5±6.5)岁。所有患者患侧膝关节均行US、MRI检查及关节镜手术。通过膝关节US和MRI检查结果与关节镜手术后诊断进行比较,分析肌骨超声(ultrasound,US)诊断退行性膝关节病变的临床价值。结果肌骨US可以清晰地显示关节软骨病变、滑膜增厚及关节积液,并且可以观察增生滑膜内的血流信号丰富程度,其与MRI的诊断符合率比较,差异无统计学意义(P0.05)。但是对于诊断肌腱、半月板及韧带的损伤,MRI明显优于肌骨US,二者比较差异有统计学意义(P0.05)。结论肌骨US对退行性膝关节早期病变的诊断价值与MRI相同,可作为中老年膝关节病的常规检查,值得临床推广应用。     

关节镜检查和镜下手术诊治膝关节内良性肿瘤

[目的]提高对膝关节内良性肿瘤诊断的认识和探讨镜下手术适应证的选择。[方法]回顾总结1996年以来关节镜检查确诊并同时进行镜下手术治疗的13例膝关节内良性肿瘤的患者，其中男9例，女4例；年龄7—49岁，平均38．2岁。滑膜血管瘤3例，腱鞘巨细胞瘤2例，十字韧带腱鞘囊肿或滑膜囊肿4例，软组织内软骨瘤1例，十字韧带内韧带状瘤2例，十字韧带内硬纤维瘤1例。经过至少半年以上随访，进行疗效观察。【结果】全部病例均在膝关节镜检查后确诊，并经过病理证实。镜检后同时行关节镜下手术治疗，随访11个月-6年，术后较之术前临床症状明显改善，无复发。疗效评定：优46％，良39％，可15％。[结论]膝关节内良性肿瘤少见，单凭临床诊断较为困难。极易漏诊。对于临床上不确切的膝关节紊乱病人，MRI有助于鉴别诊断，关节镜检查和镜下手术是确诊和治疗的主要手段。     

MRI对半月板及软骨损伤的临床诊断研究

目的研究分析并评价MRI、CT在膝关节半月板及关节软骨损伤的临床诊断作用价值。方法选取2016年1月至2016年12月本院收治的外伤所致膝关节半月板及关节软骨损伤患者94例,临床医师对所有患者分别行膝关节镜、MRI、CT扫描检查。结果经膝关节镜确诊为半月板损伤共94个,诊断准确率均为100%;MRI检查后Ⅱ、Ⅲ级诊断准确率均高于CT检查诊断准确率(P0.05);MRI、CT检查膝关节半月板后的诊断准确率均低于膝关节镜检查(P0.05)。经膝关节镜确诊为关节软骨损伤共92个,诊断准确率均为100%;MRI检查后Ⅱ~Ⅳ期诊断准确率均显著高于CT检查诊断准确率(P0.05);MRI、CT检查膝关节关节软骨损伤后的诊断准确率均低于膝关节镜检查(P0.05)。结论 MRI检查对Ⅱ、Ⅲ级半月板和Ⅱ~Ⅳ期关节软骨的诊断准确率均高于CT检查,但上述两种影像检查方法对半月板、关节软骨的诊断准确率均低于膝关节镜,由于MRI及CT检查较关节镜检查方便,适合临床医师根据具体情况选择应用。     

关节镜在膝关节单间室置换术中的应用探讨

[目的]探讨关节镜在膝关节骨性关节炎单室置换手术中的应用价值与作用.[方法]对21例(30个膝关节)内侧单室置换患者的临床症状、术前影像学、临床理学检查与术中关节镜检情况和最终手术方法的选择进行比较,从而分析关节镜在膝关节单间室置换中的作用与价值.[结果]所有患者镜检显示病变主要位于内侧室,股骨髁和胫骨平台软骨呈Outbrige Ⅲ度～Ⅳ度退变.26/30(87%)患者存在不同程度的内侧半月板损伤,4/30(13.3%)合并外侧半月板退变裂,骨性关节炎的病变均以前内室为主,19/30(63%)合并Ⅰ度～Ⅳ度局限或广泛的髌骨软骨退变,外侧室正常或局限性软骨退变＜Ⅱ度.镜下所见与术前临床体检和影像学检查基本相符.所有患者均实行了微创Oxford Ⅲ假体内侧单室置换术,没有因镜检结果而改变手术方式.[结论](1)关节镜在膝关节单间室置换中应用的主要目的在于处理关节内的其他病变而非确定手术适应证;(2)对于合并外侧半月板损伤和其他间室轻度骨性关节炎的患者,关节镜仍是一种有效的辅助治疗手段.     

下肢腱鞘巨细胞瘤的MRI诊断及临床应用

目的:分析腱鞘巨细胞瘤的MRI表现,探讨其MRI的诊断价值。方法:回顾性分析经手术病理证实的腱鞘巨细胞瘤20例的MRI检查资料。男8例,女12例;年龄15～61岁,平均35.5岁。所有病例行MRI检查。结果:病变位于膝关节16例,足趾关节和踝关节各2例。其中局限性19例,弥漫性1例,MRI均表现为下肢骨关节旁软组织肿块,肿瘤与骨骼肌相比,T1WI上15例接近于骨骼肌信号,5例稍低于骨骼肌信号;在T2WI上4例介于骨骼肌与皮下脂肪信号之间,13例接近于骨骼肌信号,3例稍低于骨骼肌信号。16例行T1WI增强扫描,5例呈均匀强化,11例呈不均匀强化。4例伴邻近骨质破坏。结论:MRI能明确显示下肢关节旁腱鞘巨细胞瘤病变的部位、形态及内部信号特征,对临床诊断、指导临床治疗和随访具有重要价值。     

低磁场MRI在膝关节软骨损伤中的价值

目的分析关节软骨损伤的低磁场MRI、CT和常规X线平片（CR）表现,评价低磁场MRI在关节软骨损伤检查、诊断中的临床应用价值。方法分析5例有膝关节损伤病史,且经膝关节镜手术证实为关节软骨损伤患者的膝关节MRI、CT和CR所见,着重观察关节软骨和软骨游离体,并与关节镜手术结果对照分析。结果 5例关节软骨骨折在MRI上均有表现异常,其中软骨信号异常3例,软骨凹陷2例,软骨连续性中断2例,软骨缺损1例,软骨缺损伴关节内游离软骨体1例。5例均有关节腔、囊积液,2例见轻微骨挫伤。CT仅1例见局部骨皮质毛糙,但均可见不同程度关节囊肿胀;CR除见局部关节周围软组织稍肿胀外,均无异常改变。结论低磁场MRI在关节软骨损伤检查诊断中同样具有很大优势,对急性关节软骨损伤显示准确,可准确评价急性膝关节损伤的范围、程度,决定治疗方案。     

膝关节运动性骨挫伤的MRI影像学特征分析

目的 分析膝关节运动性骨挫伤的磁共振（MRI）影像学特征。方法 研究对象为膝关节运动性骨挫伤患者80例，选取时间为2020年8月至2021年8月，所有患者均经CT和MRI检查，根据MRI图像表现分析患者膝关节损伤部位和数量，以关节镜检查为金标准，对比MRI检查和CT检查膝关节运动性骨挫伤的敏感性、特异性、准确性。结果 MRI检查检出膝关节运动性骨挫伤77例，包括102处骨挫伤，其中单发性41例（51.25%），多发性36例（45.00%），在多发性患者中骨挫伤好发部位为股骨外侧踝52处（50.98%）；关节周围组织损伤伴随症状者20处，好发部位为韧带损伤13处（12.75%）。MRI检查对骨挫伤分型检出率均高于CT对照组，差异具有统计学意义（P<0.05）。MRI检查诊断膝关节运动性骨挫伤的敏感性为97.30%、特异性为83.33%、准确度为90.00%,CT检查诊断膝关节运动性骨挫伤的敏感性为68.92%、特异性为66.67%、准确度为68.75%,MRI检查诊断膝关节运动性骨挫伤一致性更高。结论 MRI可准确显示膝关节运动性骨挫伤病灶定位及范围大小，诊断敏感性和特异性均高于C...     

MRI在膝关节隐匿性骨折诊断中的临床应用

目的探讨MRI在膝关节隐匿性骨折诊断中的临床应用价值。方法回顾性分析2017年2月至2019年10月本院收治的膝关节疑似隐匿性骨折的患者86例的临床资料。所有患者均接受X线、螺旋CT和MRI检查。结果 86例受检患者最终共计81例患者查出阳性。93侧受检关节共计86侧关节经关节镜等检查查出膝关节隐匿性骨折。MRI对关节腔积液的检出率显著高于螺旋CT,而螺旋CT对胫骨平台骨折的检出率显著高于MRI,差异具备统计学意义,P0.05。MRI的检出率和准确率均高于螺旋CT。差异具备统计学意义,P0.05。MRI诊断膝关节隐匿性骨折的敏感度95.35%(82/86),而螺旋CT诊断膝关节隐匿性骨折的敏感度80.23%(69/86),两者比较差异具备统计学差异,P0.05。结论 CT和MRI在诊断膝关节隐匿性骨折中各有其优劣,但MRI对隐匿性膝关节骨折的诊断效能较高,同时能够发现膝关节骨折中的韧带损伤、关节腔积液和半月板损伤,值得临床推广使用。     

关节镜与MRI诊断膝关节韧带损伤的对照研究

目的对比关节镜与MRI检查膝关节韧带损伤的精准率,评价临床应用效果。方法选取膝关节韧带损伤患者52例,进行关节镜及手术前先采用MRI诊断技术进行检查,检查后的7d~6个月内进行关节镜检查或手术,将两次诊断的结果进行对比。结果 MRI诊断与关节镜及手术损伤程度的符合率:前交叉韧带为93.5%,后交叉韧带为100%,外侧副韧带为90.6%,内侧副韧带为88.5%,关节镜及手术对比诊断的符合率为93.1%。结论膝关节韧带损伤的诊断检查采用MRI诊断技术,具有精准率高、无创、安全、方便等优势,临床应用效果满意。     

膝关节镜术后再次手术的原因

目的探讨膝关节镜术后再次手术的原因。方法对25例膝关节镜术后再次手术者行膝关节镜术16例,开放性滑膜切除术7例,全膝关节置换术2例。分析其再手术原因。结果软骨剥脱、滑膜病变残留或滑膜炎复发、漏诊半月板或交叉韧带损伤以及关节游离体是再手术中见到的主要病变。随访6个月-2年,16例膝关节镜术后机械性交锁症状均消失,7例行滑膜切除、2例人工全膝关节置换术者术后肿胀疼痛均消失。结论误漏诊、术前查体不细、适应证选择及手术处理不当是膝关节镜术后再次手术的主要原因。提高术前诊断水平、术中关节镜操作技术是减少再手术的关键。     

Monoarthrite secondaire à une métastase articulaire : à propos de deux cas et revue de la littérature

Synovial metastasis of neoplasms are uncommon. We report two cases of monoarthritis of the knee due to articular metastasis. The diagnosis was performed by cytologic evaluation of the synovial fluid. The first case was an epidermoid carcinoma of the ureter with a metastasis to the left knee joint. The second was a chronic monoarthritis of the left knee unresponsive to classical treatment and found to have bony metastases of the distal femur from lung adenocarcinoma. Only 28 cases of synovial metastasis of solid tumor have been reported in the literature. The knee joint is the most commonly affected. Lung is the main localization of the primary neoplasm (12 cases) and histologic type is preferentially adenocarcinoma (12 cases). Articular metastasis has usually a poor prognosis with an average survival lower than 5 months.     

Arthroskopisch unterstütztes Frakturmanagement am Kniegelenk

Minimally invasive and arthroscopic procedures have become an integral part of orthopedics and arthroscopy of the knee in particular has extensively evolved during recent years. Therefore, the purpose of this article is to show the indications and possibilities and also the limitations of arthroscopy-assisted fracture fixation of the knee joint. Based on the literature and our own experiences we consider the following indications for arthroscopy-assisted fracture fixation in the knee to be appropriate: 1) simple fractures of the tibial plateau, depression fractures of the tibial plateau and simple fractures of the patella, 2) arthroscopic control of reconstruction of the articular surface in complex fractures, 3) bony avulsions of the posterior or anterior cruciate ligament, 4) osteochondral flakes, 5) therapy of concomitant intra-articular lesions in fractures of the knee joint and 6) arthroscopy in posttraumatic situations. The various indications are discussed in relation to the current literature and on the basis of case reports. Arthroscopy is not only an assisting and helpful instrument in the therapy of fractures of the knee joint but in some cases it is also indispensable to guarantee optimal fracture management.     

Calcified Loose Bodies Trapped in the Lateral Synovial Recess of the Knee

Calcified loose bodies originate in the knee joint for a variety of reasons and are removed when symptomatic. We present the case of a 56-year-old man who had multiple calcified bodies located in a sac beneath the iliotibial band known as the lateral synovial recess of the knee. Despite the fact that these loose bodies likely arose from the joint, they were unable to be visualized during arthroscopy and required a separate lateral incision for removal.     

跟骨关节内骨折的CT分型与手术内固定的改进

目的通过对跟骨关节内骨折的病理解剖学研究,探讨其CT分型与疗法的改进。方法对26例31侧跟骨关节内骨折的病人进行CT扫描,并结合术中病理改变,提出跟骨骨折CT影像分型方法,根据CT分型应用自行设计的近“山”字形跟骨钢板进行手术治疗,术后不用任何形式的外固定,早期功能练习。结果平均愈合时间为8周,手术优良率为90.32%。结论(1)此CT分型对跟骨后关节面塌陷和粉碎程度的判定有积极意义,对术中是否植骨和是否使用关节镜监控跟骨后关节面的复位质量及预后有重要的判断价值;(2)此钢板对跟骨骨折起到坚强的固定作用,使距下关节早期活动,减少合并症的发生。     

Ankle arthroscopy

Arthroscopic assessment of the ankle joint can be an important diagnostic aid for intra-articular pathologic conditions. The major portals of entry are anteromedial and anterolateral. In one patient with loose bodies of the ankle, the authors successfully localized the loose bodies and determined the status of the articular surface by arthroscopy. In a second patient with pain and a roentgenogram suggestive of an osteochondral fracture, arthroscopic evaluation determined that the articular surface was intact, and the patient was successfully treated non-surgically. Precise indications for arthroscopy of the ankle have not yet been determined, but its role will certainly be less extensive in the ankle than in the knee.     

Arthroscopic extraction of a stainless steel foreign body imbedded in the tibial plateau

We present a case of foreign body synovitis in the knee joint caused by a fragment of stainless steel imbedded in the tibial plateau for 10 years, which was extracted successfully using an arthroscope. The cause of synovitis was the long-standing release of small stainless steel particles resulting from the abrasion of the steel against the opposing lateral femoral condyle. For an articular foreign body, arthroscopy is by far the best treatment. Arthroscopy allows the surgeon to localize as well as to extract even the smallest foreign body fragment, and also provides for washing out of the joint cavity.Arthroscopy 1998 Jan-Feb;14(1):103-5     

膝部骨内高压症关节内组织学观察

为探讨膝部骨内高压症的起因。方法：对２２例膝部骨内高压症病人的膝内组织进行关节镜、光镜和扫描电镜观察。结果：发现滑膜、软骨等有肥大、萎缩和混合３型改变。结论：认为膝部骨内高压症起因于膝部骨内微循环瘀滞的同时，尚不应完全排除由膝关节腔内压增高的结果     

膝关节游离体的关节镜诊治

目的　探讨膝关节游离体的关节镜诊断及镜下摘除技巧。方法　 2 9例中 ,根据临床及X线片诊断游离体者 13例 ,骨性关节炎 12例 ,膝关节结构紊乱 4例 ,均经关节镜确诊为游离体并行镜下摘除。结果　经关节镜手术证实 ,与X线检查符合者7例 ,不符合 2 2例 ,均通过关节镜补充诊断 ,镜下单膝关节取出游离体最多 14枚 ,最少 1枚。术后随访时间平均 15个月 ,优良率 93 10 %。结论　关节镜诊治膝关节游离体是一种直观准确、创伤小、恢复快的好方法 ,只要注意操作技巧 ,多能获得良好效果     

膝关节腔内注射皮质类固醇对骨髓腔内压的影响

３０只健康新西兰白兔，随机分为Ａ，Ｂ两组，每组１５只，Ａ组右膝关节内注射醋酸强的松龙７．５ｍｇ／ｋｇ，每周１次；Ｂ组右膝关节内注射生理盐水０．３７５ｍｌ／ｋｇ，每周１次，每组分别于第３，５，７，９，１１周的第１天，各取３只动物，在氯胺酮麻醉下，行双侧胫骨上端，股骨下端和膝关节腔穿刺，并测定腔内压力。     

Arthroscopy following pediatric injuries of the knee joint--a helpful or superfluous diagnostic procedure?

Between 1983 and 1987, 1082 arthroscopies were carried out on the knee joint. This included 48 cases of children between the age of seven and fifteen with knee injuries. In 21 cases the clinical diagnosis was confirmed. In 5 cases the clinically indications for an operation could not be confirmed. In 9 cases of arthroscopy, it was demonstrated that an operation was necessary, although this was not clinically diagnosed. Finally in 15 cases, specific conservative therapy could be planned on the basis of the medical evidence. From 35 cases of haemarthrosis, 27 proved to have injuries requiring therapy, 12 of which were not obvious during clinical examination. The results underline advantages of arthroscopy for childhood knee joint injuries, in allowing a definite diagnosis and varying therapeutic measures.