老年与青中年类风湿关节炎临床和实验室对比分析

目的:对比分析老年与青中年类风湿关节炎临床表现和实验室指标.方法:回顾性对比分析我院2006年1月-2009年12月门诊及住院的43例老年类风湿关节炎(EORA)和89例青中年类风湿关节炎(YORA)的临床表现及实验室指标.结果:EORA组和YORA组性别比(女/男)分别为1.39和2.71(p＜0.05).EORA组和YORA组急性起病分别占60.5%和24.7%(p＜0.05).EORA组患者肩关节受累比例明显高于YORA组(p＜0.05),但肘关节、掌指关节、指间关节、踝关节和跖趾关节受累比例明显低于YORA组(p＜0.05).EORA组患者体重下降和肌痛较YORA组常见(p＜0.05).EORA组患者ESR和CRP水平明显高于YORA组(p＜0.05),但RF和ANA阳性率明显低于YORA组(p＜0.05).结论:EORA患者和YORA患者在临床表现及实验室检查存在一些明显差异.这提示年龄可能会影响类风湿关节炎疾病的表现形式.     

丝裂霉素C预防肌腱粘连的实验研究

目的:探讨丝裂霉素C(mitomycin C,MMC)对肌腱粘连的影响.方法:SD大鼠80只,右足为丝裂霉素C组,左足为生理盐水组.以屈趾肌腱为试验对象,切断后采用改良Kessler法缝合.右足吻合处用0.4mg/ml MMC脑棉片湿敷5分钟,生理盐水反复冲洗3次;左足生理盐水脑棉片湿敷5分钟,生理盐水反复冲洗3次.术后1、2、4、8周处死动物,收集2组屈趾肌腱分别进行大体观察、组织学观察和羟脯氨酸含量测定.结果:丝裂霉素C组肌腱粘连程度较生理盐水组明显减轻,有统计学意义(P＜0.05),羟脯氨酸含量在术后2、4、8周较生理盐水组增高.结论:丝裂霉素C有防止肌腱粘连的作用.     

人体足底韧带松解后足部的形态改变及应力分布的实验研究

较多足部畸形同足弓塌陷或不稳定有关,尤其是足纵弓塌陷.关于跖腱膜松解对足弓高度的影响已有许多研究,但对跖腱膜松解后足部的应力分布尚不清楚.本研究旨在探讨足底韧带损伤后对足弓生物力学的影响.通过CT图像数据建立人体足踝部三维有限元模型,包括足踝部骨骼、主要关节、关键韧带结构及足底软组织.在模型上模拟跖腱膜和其他跖侧韧带松...     

蚁龙胶囊治疗痛风探讨

痛风症 (中医学认为湿热痹证 ) ,按现代医学认为是一种代谢性疾病。临床上表现为急、慢性痛风关节炎样伴反复急性发作。受累关节以拇趾及跖趾关节最为普遍。而血尿酸则为诊断痛风的重要依据之一。我们在临床上用蚁龙胶囊结合中医中药 ,治愈 3例痛风症 ,随访一年 ,均未复发。现将 1例报告如下。1　临床资料　　患者 ,男 ,5 8岁 ,农民 ,8年前因足跖扭伤未愈 ,即下水劳动及洗冷水 ,湿浸筋骨 ,导致趾、跖、踝关节剧疼 ,继则痛处红肿发热 ,行走困难。曾在当地治疗 ,效果不显著。事后每年均有类似发作 ,多因过度疲劳或节气交替 ,尤其是春、夏之交 …     

丝素蛋白布洛芬复合凝胶预防肌腱粘连的作用研究

目的:探讨丝素蛋白布洛芬复合凝胶对肌腱粘连的预防作用及愈合后肌腱功能的影响。方法:选取体重2.5 Kg-3.5 Kg成年雄性来亨(Leghorn)鸡90只,随机分成3组,每组30只。将左足第三趾趾深屈肌腱横断后,采用改良Kessler缝合法缝合肌腱,A组动物直接缝合,B组动物在肌腱横断处周围注入丝素蛋白凝胶,然后逐层缝合,C组动物在肌腱横断处周围注入丝素蛋白布洛芬复合凝胶。在术后1、3、6周处死并取材分别进行大体实验观察、组织学观察和生物力学测定,在术后6周进行关节活动度评定。结果:术后1、3、6周,创口无感染流脓,创口愈合较好,C组肌腱粘连程度评分和肌腱功能评价显著优于B组和A组。C组细胞炎性反应较少,与周围组织粘连程度较轻,纤维组织排列较规则;B组有细胞炎性浸润反应,且与周围组织程中度粘连,纤维组织排列不规则;A组细胞炎性反应明显,与周围组织粘连较重,分界不清,纤维组织排列杂乱无序。术后3、6周,各时间点肌腱滑动距离C组最远,B组好于A组,两两比较,C组与A、B两组之间有明显差异(P0.05)。术后3周、6周C组肌腱主动屈曲功优于B组,A组最差,两两比较,肌腱主动屈曲功比值存在差异具有统计学意义(P0.05)。肌腱术后功能测定比较,C组趾关节活动度明显优于B组,A组最差,术后各组肌腱趾关节活动度组间差异具有统计学意义(P0.05)。结论:丝素蛋白布洛芬复合凝胶可以有效防止肌腱粘连,且不影响术后肌腱的功能。     

PEDF 在类风湿关节炎滑膜组织中的表达及临床意义

目的:研究类风湿关节炎患者滑膜组织中色素上皮衍生因子(Piment epithelial-derived factor,PEDF)的表达情况。方法:采用免疫组化法,检测30例类风湿关节炎活动期膝关节滑膜组织中PEDF蛋白表达,以16例退行性关节炎患者、16例正常人及该30例患者治疗后(稳定期)关节滑膜组织中PEDF蛋白作对照,进行对比分析。结果:PEDF在类风湿关节炎患者明显低于正常人、退行性关节炎患者滑膜组织中的表达,在活动期滑膜组织中的表达明显低于稳定期,组间比较,差异均有统计学意义(P均<0.05)。结论:PEDF与类风湿关节炎的疾病过程密切相关,针对色素上皮衍生因子的靶点治疗有望成为类风湿关节炎治疗的新的方向及策略。     

慢性淋巴细胞性甲状腺炎合并甲状腺结节的临床分析

目的:研究分析中国东北地区慢性淋巴细胞性甲状腺炎(CLT)合并甲状腺结节的诊断和治疗方式.方法:回顾性分析2009年9月--2010年12月收治经病理证实的CLT合并甲状腺结节的共151病例,依据不同的病理类型分组,就临床特点、诊断和治疗进行比较.结果:CLT合并甲状腺乳头状癌组共58例,女性51例,男性7例,平均年龄37.5±4岁,平均病程18个月,28例为腺体内单发结节,病灶平均直径为0.9± 0.56 cm,36例病灶直径小于1.0 cm,42例见结节内伴钙化.CLT合并良性结节组98例,女性患者93例,男性患者5例,平均年龄48.1±9岁,平均病程72个月,34例为腺体内单发结节,病灶平均直径1.8± 0.42 cm,35例病灶直径小于1.0 cm,10例见结节内伴钙化.两组在发病年龄、病程、结节个数及钙化方面的差异均有统计学意义.结论:CLT合并甲状腺癌微小癌多见,淋巴结转移率低,彩超提示单发结节或者结节合并钙化的病例,应行手术治疗.     

巨大痛风石手术切除一例及文献复习

目的:探讨晚期巨大痛风石结节的临床表现及手术治疗效果.方法:回顾性分析一例典型病例患者的临床资料、手术方法的选择以及病理学表现.结果:该患者为晚期通风症患者,发展为痛风石.表现为痛风石结节增生,破坏肌腱以及骨组织.各项辅助检查以及手术后病理结果均支持痛风病的诊断.通过手术切除第一跖趾关节旁巨大痛风石,疗效满意.结论:痛风是一种因嘌呤代谢紊乱所致的疾病,本例患者经过各种保守对症治疗均无效.接收此患者后,通过文献复习分析以及临床检查确诊,本病例痛风病变已发展至晚期巨大痛风石结节.只有通过手术治疗才能彻底治愈.手术后证明对晚期巨大痛风石结节同时伴有骨关节破损的痛风石患者行手术治疗是完全可行,且疗效显著.     

大豆多肽Lunasin对类风湿关节炎大鼠T细胞免疫指标的影响

目的：探讨Lunasin对实验性类风湿关节炎（RA）大鼠免疫功能的影响。方法： Wistar雄性大鼠50只,按体重随机分为（n=10）：对照组、模型组和3个Lunasin处理组（0.1,0.2,0.4 mg/kg灌胃）。利用弗氏完全佐剂（FCA）局部注入大鼠足跖皮内,建立RA模型,治疗组Lunasin灌胃每天1次,对照组和模型组灌胃等量生理盐水;于实验第21天,检测足跖厚度、滑膜液T淋巴细胞活化情况和滑液中白介素-12（IL-12）、肿瘤坏死因子β（TNF-β）和I L-4、IL-10的分泌情况。结果：Lunasin可降低T淋巴细胞活化标志物CD69⁺和CD25⁺的表达,减少滑膜液中IL-12、TNF-β的分泌,增加IL-4、IL-10的分泌。结论：Lunasin能够抑制类风湿关节炎滑膜液中T细胞的活化并能反转Th1/Th2型细胞因子的分泌,调节类风湿关节炎免疫微环境。     

皖南汉族的跖纹研究

本文分析了安徽皖南地区520例(男女各260人)汉族健康人的跖纹样本。追踪了跖纹A、B、C、D、E和P线止区,发现A、B、C、D线多止于1区;E 线主要走向13区;p三叉缺失较多,P远侧射线止区较高,而腓侧射线止区较低。母趾球纹为L>W>A。各趾间区真实花纹依次用为Ⅲ>Ⅱ>Ⅳ。足小鱼际远侧真实花纹较多,其他跖区较少。在性别、民族和人种间进行了比较,并对差异的原因进行了讨论。     

Evidence of isometric function of the flexor hallucis longus muscle in normal gait

Studying mechanics of the muscles spanning multiple joints provides insights into intersegmental dynamics and movement coordination. Multiarticular muscles are thought to function at "near-isometric" lengths to transfer mechanical energy between the adjacent body segments. Flexor hallucis longus (FHL) is a multiarticular flexor of the great toe; however, its potential isometric function has received little attention. We used a robotic loading apparatus to investigate FHL mechanics during simulated walking in cadaver feet, and hypothesized that physiological force transmission across the foot can occur with isometric FHL function. The extrinsic foot tendons, stripped of the muscle fibers, were connected to computer-controlled linear actuators. The FHL activity was controlled using force-feedback (FC) based upon electromyographic data from healthy subjects, and subsequently, isometric positional feedback (PC), maintaining the FHL myotendinous junction stationary during simulated walking. Tendon forces and excursions were recorded, as were the strains within the first metatarsal. Forces in the metatarsal and metatarsophalangeal joint were derived from these strains. The FHL tendon excursion under FC was 6.57+/-3.13mm. The forces generated in the FHL tendon, metatarsal and metatarsophalangeal joint with the FHL under isometric PC were not significantly different in pattern from FC. These observations provide evidence that physiological forces could be generated along the great toe with isometric FHL function. A length servo mechanism such as the stretch reflex could likely control the isometric FHL function during in vivo locomotion; this could have interesting implications regarding the conditions of impaired stretch reflex such as spastic paresis and peripheral neuropathies.     

The Feet of Overweight and Obese Young Children: Are They Flat or Fat?

Objective: The purpose of this study was to determine whether the flat feet displayed by young obese and overweight children are attributable to the presence of a thicker midfoot plantar fat pad or a lowering of the longitudinal arch relative to that in non‐overweight children. Research Methods and Procedures: Foot anthropometry, an arch index derived from plantar footprints, and midfoot plantar fat pad thickness measured by ultrasound were obtained for 19 overweight/obese preschool children (mean age, 4.3 ± 0.9 years; mean height, 1.07 ± 0.1 m; mean BMI, 18.6 ± 1.2 kg/m²) and 19 non‐overweight children matched for age, height, and sex (mean age, 4.3 ± 0.7 years; mean height, 1.05 ± 0.1 m; mean BMI, 15.7 ± 0.7 kg/m²). Results: Independent t tests revealed no significant between‐subject group differences (p = 0.39) in the thickness of the midfoot plantar fat pad. However, the overweight/obese children had a significantly lower plantar arch height (0.9 ± 0.3 cm) than their non‐overweight counterparts (1.1 ± 0.2 cm; p = 0.04). Discussion: The lower plantar arch height found in the overweight/obese children suggests that the flatter feet characteristic of overweight/obese preschool children may be caused by structural changes in their foot anatomy. It is postulated that these structural changes, which may adversely affect the functional capacity of the medial longitudinal arch, might be exacerbated if excess weight bearing continues throughout childhood and into adulthood.     

超声联合手部滑膜炎与腱鞘炎判断RA患者的疾病活动度的可行性

摘要 目的：探究超声联合手部滑膜炎与腱鞘炎判断RA患者的疾病活动度的可行性。方法：选择2018年9月至2019年9月我院收治的103例RA患者,采用GS和PD超声检查患者手部关节和腱鞘,比较超声指标与DAS28-CRP的相关性以及超声检查手部滑膜炎与联合检查手部滑膜炎和腱鞘炎对病情诊断情况的差异。结果：关节GS总分、关节PD总分、腱鞘GS总分、腱鞘PD总分、联合GS总分、联合PD总分与DAS28-CRP均显著相关（P<0.05）。在基于DAS28-CRP的情况下,对比超声只检查手部滑膜炎与超声检查手部滑膜炎和腱鞘炎时发现：只存在腱鞘炎患者共有9名,即9名患者将被认为病情缓解,占所有患者的8.70 %。结论：超声联合手部滑膜炎与腱鞘炎可以更准确地评估患者疾病活动度,减少误诊或遗漏的概率,值得在临床推广使用。     

Ultrasonography,magnetic resonance imaging,radiography, and clinical assessment of inflammatory and destructive changes in fingers and toes of patients with psoriatic arthritis

The aim of the present study was to assess ultrasonography (US) for the detection of inflammatory and destructive changes in finger and toe joints, tendons, and entheses in patients with psoriasis-associated arthritis (PsA) by comparison with magnetic resonance imaging (MRI), projection radiography (x-ray), and clinical findings. Fifteen patients with PsA, 5 with rheumatoid arthritis (RA), and 5 healthy control persons were examined by means of US, contrast-enhanced MRI, x-ray, and clinical assessment. Each joint of the 2nd–5th finger (metacarpophalangeal joints, proximal interphalangeal [PIP] joints, and distal interphalangeal [DIP] joints) and 1st–5th metatarsophalangeal joints of both hands and feet were assessed with US for the presence of synovitis, bone erosions, bone proliferations, and capsular/extracapsular power Doppler signal (only in the PIP joints). The 2nd–5th flexor and extensor tendons of the fingers were assessed for the presence of insertional changes and tenosynovitis. One hand was assessed by means of MRI for the aforementioned changes. X-rays of both hands and feet were assessed for bone erosions and proliferations. US was repeated in 8 persons by another ultrasonographer. US and MRI were more sensitive to inflammatory and destructive changes than x-ray and clinical examination, and US showed a good interobserver agreement for bone changes (median 96% absolute agreement) and lower interobserver agreement for inflammatory changes (median 92% absolute agreement). A high absolute agreement (85% to 100%) for all destructive changes and a more moderate absolute agreement (73% to 100%) for the inflammatory pathologies were found between US and MRI. US detected a higher frequency of DIP joint changes in the PsA patients compared with RA patients. In particular, bone changes were found exclusively in PsA DIP joints. Furthermore, bone proliferations were more common and tenosynovitis was less frequent in PsA than RA. For other pathologies, no disease-specific pattern was observed. US and MRI have major potential for improved examination of joints, tendons, and entheses in fingers and toes of patients with PsA.     

Flap irritation phenomenon (FLIP): etiology of chronic tenosynovitis after finger pulley rupture

After a pulley rupture, most climbers regain the full function of their previously uninjured fingers. However, in some cases of pulley rupture, a persistent inflammation of the tendon sheath is observed. In this study, 16 cadaver fingers were loaded until pulley rupture and then studied for the rupturing mechanism. In addition, two patients with this pathology were investigated using ultrasound and MRI, and received surgery. In 13 fingers, a rupture of one or several pulleys occurred and almost always at the medial or lateral insertion. In one finger, a capsizing of the pulley underneath the intact tendon sheath was observed, leading to an avulsion between tendon and tendon sheath. A similar pathology was observed in the ultrasound imaging, in MRI, and during surgery in two patients with prolonged recovery after minor pulley rupture. In cases of prolonged tenosynovitis after minor pulley rupture, a capsizing of the pulley stump is probably the cause for constant friction leading to inflammation. In those cases, a surgical removal of the remaining pulley stump and sometimes a pulley repair may be necessary.     

Strain and elongation of the human gastrocnemius tendon and aponeurosis during maximal plantarflexion effort

Regarding the strain and elongation distribution along the tendon and aponeurosis the literature is reporting different findings. Therefore, the purpose of this study was to examine in vivo the elongation and the strain of the human gastrocnemius medialis tendon and aponeurosis simultaneously at the same trial during maximal voluntary plantarflexion efforts. Twelve subjects participated in the study. The subjects performed isometric maximal voluntary contractions of their left leg on a Biodex-dynamometer. The kinematics of the leg were recorded using the Vicon 624 system with 8 cameras operating at 120 Hz. Two ultrasound probes were used to visualise the tendon (myotendinous junction region) and the distal aponeurosis of the gastrocnemius medialis respectively. The main findings were: (a) the absolute elongation of the gastrocnemius medialis tendon was different to that of the aponeurosis, (b) the strain of the gastrocnemius medialis tendon did not differ from the strain of the aponeurosis, (c) during the "isometric" plantarflexion the ankle angle exhibited significant changes, and (d) the non-rigidity of the dynamometer arm-foot system and the coactivity of the tibialis anterior both have a significant influence on the moment exerted at the ankle joint. Thus the strain of the human gastrocnemius medialis tendon and aponeurosis estimated in vivo using two-dimensional ultrasonography is uniform. To calculate the elongation of the whole tendon it is necessary to multiply the strain calculated for the examined part of the tendon by the total length of the tendon.     

Spontaneous serial fractures of metatarsal bones in female patient with rheumatoid arthritis on long-term steroid therapy

Low-dose oral steroid therapies are very effective in active rheumatoid arthritis (RA), reducing disease activity in acute crisis either while waiting for disease-modifying antirheumatic drugs (DMARDs) to take effect or if it was slow in response to DMARDs. However, long-term steroid therapies are associated with serious side effects, such as osteoporotic reduction of bone mass and frequent fractures. This paper reports a female patient who has suffered RA treated with low-dose oral steroid therapy in a long-term period. Suddenly, she developed severe pain and oedema of forefeet during home distance level walking, with no history of trauma. The diagnosis of spontaneous serial fractures of the 2nd to 4th metatarsal (MT) bone bilaterally was performed by feet radiography. Furthermore, in widening the diagnostic approaches the authors had performed diagnostic musculoskeletal ultrasound to exclude metatarsophalangeal joint effusion and exacerbation of RA. They also made a static analysis of feet on the electronic baropodometer system in order to register biomechanical changes in bipedal standing. One year after, the same diagnostic procedures were done, on which occasion the healing of fractures were verified, with better results in biomechanical static analysis of the feet but without complete regression of static disbalance. This could lead to further disturbances during level walking and daily activities. This paper reports a unique case of the RA patient on long-term low-dose steroid therapy with previously unreported sites of spontaneous metatarsal fractures of feet which causes further static disbalance; consequently the patient might experience problems in every-day life activities.     

Mechanical properties of the triceps surae tendon and aponeurosis in relation to intensity of sport activity

The purpose of the present study was to investigate whether the mechanical properties (i.e. force strain relationship) of the triceps surae tendon and aponeurosis relate to the performed sport activity in an intensity-dependent manner. This was done by comparing sprinters with endurance runners and subjects not active in sports. Sixty-six young male subjects (26+/-5 yr; 183+/-6 cm; 77.6+/-6.7 kg) participated in the study. Ten of these subjects were adults not active in sports, 28 were endurance runners and 28 sprinters. All subjects performed isometric maximal voluntary plantar flexion contractions (MVC) on a dynamometer. The distal aponeuroses of the gastrocnemius medialis (GM) was visualised by ultrasound during the MVC. The results showed that only the sprinters had higher normalised stiffness (relationship between tendon force and tendon strain) of the triceps surae tendon and aponeurosis and maximal calculated tendon forces than the endurance runners and the subjects not active in sports. Furthermore, including the data of all 66 examined participants tendon stiffness correlated significantly (r=0.817, P<0.001) with the maximal tendon force achieved during the MVC. It has been concluded that the mechanical properties of the triceps surae tendon and aponeurosis do not show a graded response to the intensity of the performed sport activity but rather remain at control level in a wide range of applied strains and that strain amplitude and/or frequency should exceed a given threshold in order to trigger additional adaptation effects. The results further indicate that subjects with higher muscle strength possibly increase the margin of tolerated mechanical loading of the tendon due to the greater stiffness of their triceps surae tendon and aponeurosis.     

In vivo moment generation and architecture of the human plantar flexors after different shortening–stretch cycles velocities

The purpose of this study was to examine the moment generation of the human plantar flexors and the architecture of the gastrocnemius medialis muscle during and after shortening–stretch cycles in vivo. Fourteen male subjects (30 ± 7 years, 177 ± 7 cm, 80 ± 9 kg) performed a series of electro-stimulated shortening–stretch plantar flexion contractions. The shortening–stretch cycles were performed at three constant angular velocities (25°/s, 50°/s, 100°/s), two amplitudes (15° and 25° ankle angle changes) and at two different stimulation frequencies (30 Hz and 85 Hz). The resultant ankle joint moments were calculated through inverse dynamics. Pennation angle and fascicle length of the m. gastrocnemius medialis at rest and during contractions were measured using ultrasonography. The corresponding ankle moments, kinematics and changes in muscle architecture were analysed at seven time intervals. A three-way analysis of variance (amplitude × velocity × stimulation frequency) and post-hoc test with Bonferroni correction were used to check the amplitude, velocity and stimulation level related effects on moment enhancement (α = 0.05). The results show an ankle joint moment enhancement after shortening–stretch cycles influenced by muscle architectural changes. We found 2–3% isometric ankle joint moment enhancement at steady state, 1.5–2.0 s after the shortening–stretch cycle. However, the observed alteration in muscle architecture after the imposed perturbation, could lead to an underestimation (1–3%) of joint moment enhancement due to the force–length relationship of the triceps surae. Furthermore, the enhancement observed was independent of the shortening–stretch amplitude, velocity and stimulation frequency.     

Regional Differences in Elements of Human Peroneus LongusTendons

Many studies have been performed on the structure, molecular composition, and biochemical properties of tendons. However, comparatively little research has been conducted on the content of various trace elements within tendons. Six elements were analyzed in four regions of the peroneus longus tendon: the tensional part of the tendon immediately proximal to the lateral malleolus (region A), the compressive region of the tendon in contact with the lateral malleolus (region B), the compressive region of the tendon in contact with the deep surface of the cuboid (region C), and the tensional part of the tendon between the cuboid and first metatarsal, to which the tendon is attached (region D). Regions B and C are wraparound regions. The calcium content was higher in region C (2.10?±?0.93 mg/g) than in both regions A (1.25?±?0.51 mg/g) and D (1.43?±?0.41 mg/g) (p?<?0.05), indicating that it is likely related to regional differences in cartilage degeneration. The phosphorus content was also higher in region C, possibly because of low alkaline phosphatase activity in this region. The sulfur content was higher in the wraparound regions (region B: 0.98?±?0.09 mg/g, region C: 1.24?±?0.19 mg/g) than in both regions A (0.83?±?0.11 mg/g) and D (0.83?±?0.1 mg/g) (p?<?0.01); sulfur content is thought to be influenced by tendon–bone compression. Finally, the magnesium content in the wraparound regions was also higher, which is probably related to a higher level of fibrocartilage. No significant relationships were found with regard to zinc or iron. Overall, the findings of the present study indicate that element contents are related to function and anatomical differences in tendons, and that they may even vary within the same tendon.