Condromatosis sinovial de cadera. Tratamiento artroscópico / Hip synovial chondromatosis. Arthroscopic treatment

Introducción: La condromatosis sinovial se define como una lesión metaplásica benigna, de baja incidencia en cadera. La técnica ideal de tratamiento genera controversia por la probable recurrencia y la progresión degenerativa descrita para técnicas tanto a cielo abierto como artroscópicas. El objetivo de este trabajo es reportar la técnica quirúrgica y los resultados a corto plazo en una serie de pacientes con condromatosis sinovial de cadera tratados por vía artroscópica. Materiales y Métodos: Entre abril de 2007 y mayo de 2011, 10 pacientes (9 mujeres y 1 hombre, edad promedio 38 años; rango 17-53) fueron operados por vía artroscópica a causa de una condromatosis sinovial de cadera. Se evaluaron la técnica quirúrgica, los resultados clínicos y radiológicos, y el grado de satisfacción con el procedimiento. La escala funcional de Harris modificada preoperatoria fue de 51 puntos (rango 49-54). La histología diferida confirmó el diagnóstico en todos los casos. El seguimiento prospectivo fue, en promedio, de 35 meses (rango 24-47). Resultados: En todos los casos, se realizó una técnica artroscópica convencional para extraer cuerpos libres y sinovectomía parcial anterolateral. En tres pacientes, se amplió la incisión de uno de los portales para extraer cuerpos de gran diámetro. La escala funcional de Harris modificada posoperatoria fue, en promedio, de 88 puntos (rango 85-91). No se observó progreso degenerativo articular radiológico en el último control. Todos los pacientes se mostraron satisfechos con el procedimiento. No se registraron complicaciones. Conclusiones: Los resultados a corto plazo favorables coinciden con los publicados. Los pacientes con condromatosis sinovial de cadera pueden ser tratados por vía artroscópica en forma segura y eficaz. Diseño del estudio: Estudio terapéutico Nivel de evidencia: IV...

Background: Synovial chondromatosis is defined as a benign metaplastic lesion, with a low incidence in hips. The ideal treatment technique is controversial due to the probable recurrence and degenerative progression described with both arthroscopic and open surgery. The aim of this study is to report the surgical technique and shortterm results in a series of patients with synovial chondromatosis treated with arthroscopic hip. Methods: From April 2007 to May 2011, 10 patients (9 women and a man; average age 38 years; range 17-53) underwent hip arthroscopy for synovial chondromatosis. Surgical technique, clinical and radiological results, and satisfaction with the procedure were evaluated. The preoperative modified Harris hip functional scale was 51 points (range 49-54). Delayed histology confirmed diagnosis in all cases. Prospective follow-up averaged 35 months (range 24-47). Results: The conventional arthroscopic technique to extract loose bodies and partial anterolateral synovectomy were performed in all patients. In three patients incision of one of the portals was extended to extract bodies of large diameter. The postoperative modified Harris hip functional scale averaged 88 points (range 85-91). No radiographic joint degenerative progress was seen at the last control. All patients were satisfied with the procedure. There were no complications. Conclusions: Favorable short-term results are consistent with those reported in the literature. Patients with synovial chondromatosis can be treated with hip arthroscopy safely and effectively. Design of the Study: Therapeutic. Level of Evidence: IV...

Posterior fixation and fusion for treatment of Os odontoideum complicated by atlantoaxial dislocation / 南方医科大学学报

<p><b>OBJECTIVE</b>To summarize the techniques and evaluate the therapeutic effect of posterior fixation and fusion in the treatment of Os odontoideum complicated by atlantoaxial dislocation.</p><p><b>METHODS</b>From March, 2007 to October, 2010, 10 patients with Os odontoideum (including 6 male and 4 female patients aged from 20 to 65 years, mean 39.8 years) were treated in our hospital. Before and after the operation, the patients underwent X ray, CT and MRI examinations to measure and evaluate the degree of dislocation and neural compression. After preoperative traction for 1-2 weeks, all the 10 patients showed deductible atlantoaxial dislocation. Through a posterior approach, Atlantoaxial pedicle screws fixation were performed in 9 cases, and C2/3 pedicle-Occiput screw fixation was performed in 1 case. All the patients wore cervical collars as external support for 3 months after the operation.</p><p><b>RESULTS</b>The mean operative time was 3 h in these patients with a mean intraoperative blood loss of 420 ml. The symptoms were relieved after the surgery in all the patients, who showed no neck pain or neurological defects. The patients were followed up for 6 to 52 months (mean 22 months), and bony fusion was observed in all the 10 cases within 6 to 8 months without such complications as internal fixation failure or redislocation of the atlas.</p><p><b>CONCLUSION</b>Patients with Os odontoideum complicated by atlantoaxial dislocation should undergo surgical stabilization to avoid severe neurological injury. Pedicle screw instrument in the atlas allows restoration of the spinal stability, short-segment fusion, and maximal preservation of the mobility of the neck.</p>

Expression of Caspase-8 and Bcl-2 in the cartilage loose bodies in patients with Kashin-Beck disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the role of Caspase-8 and Bcl-2 in the formation of loose bodies in Kashin-Beck disease (KBD).</p><p><b>METHODS</b>Specimens of cartilage loose bodies were collected from 50 adult patients with KBD, and the samples of articular cartilage were collected from 10 healthy adults to serve as control. Avidin-biotin alkaline phosphatase immunohistochemistry was employed to examine Bcl-2 and Caspase-8 positivities in the chondrocytes in the loose bodies.</p><p><b>RESULTS</b>In KBD loose bodies, the percentage of chondrocytes positive for Bcl-2 and Caspase-8 [(18.40∓8.78)% and (67.54∓12.29)%, respectively] were significantly higher than those of the control group [(12.25∓1.58)% and (24.70∓4.35)%, respectively]. Caspase-8 was found to promote chondrocyte apoptosis in the loose bodies, and this effect overrode the apoptosis-suppressing effect of Bcl-2. Bcl-2 and Caspase-8 positivities were found mainly in the deep hypertrophic chondrocytes in the cartilage or in cells adjacent to the bone tissues.</p><p><b>CONCLUSION</b>KBD loose bodies contain an increased percentage of apoptotic chondrocytes positive for Bcl-2 and Caspase-8. The apoptosis-inducing effect of Caspase-8 was a dominant feature in the cartilage pathology of KBD compared to the apoptosis-suppressing effect of Bcl-2.</p>

Artroscopia de la cadera en trauma: serie de casos y revisión de la literatura / Hip arthroscopy in trauma: case series: [review]

Las lesiones de la cadera pueden existir en forma aislada luego de un trauma o hacer parte de una enfermedad degenerativa. La lesión articular aguda es reconocida cada vez más como causa de dolor de la cadera luego de un trauma. Las lesiones condrales, del labrum y los fragmentos osteocondrales libres en la articulación después de un trauma mayor o menor son lesiones que se pueden manejar adecuadamente con la artroscopia de la cadera; debe sospecharse la presencia de enfermedad degenerativa previa si el trauma desencadenante es mínimo.

Histology of two rice bodies isolated from the stifle of an adult draught horse stallion

In the human and equine species, different kinds of free floating intra-articular particles are related to certain disorders. Osteochondral fragments formed during osteochondrosis dissecans are the most common finding in the equine species, whereas in humans rice bodies due to rheumatoid arthritis are more frequent. Herein we report a third type of floating body inside the stifle of an adult draught horse stallion, in macroscopic appearance similar to articular rice bodies known in humans. As revealed by histologic examination, the two particles consist of polypoid degenerated structures derived from synovial villi. Their formation was probably induced by ischemia.

Remocion artroscopica de fragmentos libres osteocondrales secuelar a fractura-luxacion posterior de cadera: reporte de tres casos / Arthroscopic resection of free osteochondral fragments due to posterior fracture-dislocation of the hip

Los cuerpos libres intraarticulares asociados a las luxaciones traumaticas de cadera con o sin fractura acetabular son frecuentes. Este tipo de lesiones tienen un alto riesgo de desarrollar artrosis postraumatica debido a la presencia residual de fragmentos osteocondrales intraarticulares. Presentamos 3 casos de fractura-luxacion de cadera en los que se realizo artroscopia de cadera, extrayendo los fragmentos libres residuales. En uno de ellos, se realizo ademas osteosintesis de la ceja posterior. Todos los pacientes tuvieron una evolucion excelente, de acuerdo al score de Harris modificado con un rango de movilidad completo a los seis meses. Ninguno de los pacientes presento imagenes radiologicas de degeneracion articular a un seguimiento promedio de 21 meses.

MR Findings of Traumatic Transient Lateral Dislocation of the Patellae

PURPOSE: To determine the magnetic resonance (MR) imaging characteristics of traumatic transient lateral dislocation of the patellae. MATERIALS AND METHODS: In eight patients (6 males, 2 females, mean age: 22.4 years) in whom transient lateral dislocation of the patella was diagnosed, the distinctive MR imaging findings reflecting known injury mechanism were retrospectively analyzed with regard to bone contusion, chondral defect, fracture, loose body, joint effusion, and the associated soft tissue abnormalities. RESULTS: All of eight patients had bone contusions in the lateral femoral condyle and medial facet of the patella, while in five, chondral defects were present in this latter region. In three patients, fractures of the on lateral femoral condyle (n=2) and medial facet of the patella (n=3) were noted, and in three others, loose bodies were noted. Joint effusion [simple effusion (n=4), lipohemarthrosis (n=3)] was observed in seven patients, and associated soft tissue injuries [to the medial patellar retinaculum (n=8), patellar tendon (n=2), and anterior cruciate ligament (n=1)] in eight. Patellar subluxation was found in seven. CONCLUSION: MR imaging is a useful technique for the diagnosis of traumatic lateral dislocation of the patella. The significant MR findings are bone contusion in the lateral femoral condyle and medial facet of the patella, chondral defect, fracture, joint effusion, injury to the medial patellar retinaculum, and patellar subluxation.

Luxaçäo traumática bilateral do quadril: relato de dois casos e revisäo bibliográfica / Bilateral traumatic luxation of the hip: report of two cases and review of literature

Os autores relatam dois caos de luxaçäo traumática bilateral do quadril que foram atendidos e tratados no Departamento de Ortopedia e Traumatologia da Santa Casa de Säo Paulo, "Pavilhäo Fernandinho Simonsen". Discutem esta rara lesäo traumática; fazem uma revisäo da literatura e enfatizam a importância de sua reduçäo precoce e o tratamento adequado das fraturas, quando associadas.

Remoçäo artroscópica de corpos livres endoarticulares do joelho: técnicas e resultados / Removal of loose bodies from the knee under arthroscopic control: techniques and results

Os autores, depois de descreverem a técnica, relatam os resultados de 85 intervençöes cirúrgicas de remoçäo artroscópica de corpos livres endoarticulares do joelho. As vantagens com a técnica a "céu fechado" consistem na individualizaçäo dos corpos livres radiotransparentes, näo visíveis ao exame radiológico pré-operatório, e na remoçäo de corpos livres situados em áreas de difícil acesso artrotômico