本文選題：膝關(guān)節(jié) + 滑膜形態(tài)�。� 參考：《重慶醫(yī)科大學(xué)》2011年碩士論文

【摘要】：目的:滑膜異常、關(guān)節(jié)積液是膝關(guān)節(jié)的常見(jiàn)病變。但由于膝關(guān)節(jié)結(jié)構(gòu)的復(fù)雜性,滑膜異常、關(guān)節(jié)積液表現(xiàn)不一,給臨床診治帶來(lái)困難。本課題擬通過(guò)膝關(guān)節(jié)各部滑膜的解剖,探究滑膜囊形成的解剖學(xué)基礎(chǔ),尋找患者膝關(guān)節(jié)病變的滑膜變化特征;通過(guò)對(duì)新鮮成人尸體正常膝關(guān)節(jié)腔內(nèi)注入不同量對(duì)比劑的標(biāo)本進(jìn)行MRI觀察,為臨床確診膝關(guān)節(jié)腔及周圍滑膜囊內(nèi)不同量積液提供客觀依據(jù)和定量標(biāo)準(zhǔn)。 方法: (1)標(biāo)本鑄型成人新鮮尸體下肢標(biāo)本20側(cè),經(jīng)股動(dòng)脈注入紅色乳膠懸浮液;在關(guān)節(jié)腔和髕下深囊內(nèi)注入1:1牙托粉和牙托水混合液。填充劑凝固后,放入30%的鹽酸液中腐蝕,制作成下肢鑄型標(biāo)本。 (2)形態(tài)學(xué)觀察對(duì)30側(cè)膝關(guān)節(jié)標(biāo)本進(jìn)行解剖,肉眼觀察髕上囊、髕下深囊、髕軟骨、后內(nèi)側(cè)隱窩處滑膜的形態(tài)及髕下深囊與關(guān)節(jié)腔間組織結(jié)構(gòu);并于上述部位取材,行組織學(xué)觀察。 (3)標(biāo)本、活體測(cè)量測(cè)量20側(cè)膝關(guān)節(jié)標(biāo)本在屈、伸位時(shí),髕下深囊的形態(tài)變化;對(duì)20例自愿者髕骨下緣和脛骨粗隆體表定位,測(cè)量其膝關(guān)節(jié)在屈、伸運(yùn)動(dòng)時(shí),髕韌帶連于髕骨下緣和脛骨粗隆的長(zhǎng)度。 (4)積液的定量對(duì)10件無(wú)積液、積氣、結(jié)構(gòu)正常的成人尸體膝關(guān)節(jié)腔內(nèi)依次注入1、5、10、15、20、30、40ml對(duì)比劑,分別于每次注射后行冠狀面、矢狀面、橫斷面T2WI,厚度4 mm,間距1 mm,MRI掃描。 結(jié)果: 髕下深囊特點(diǎn):髕下深囊與關(guān)節(jié)腔有相同的滑膜組織,但彼此間并非延續(xù)而成,二者之間被髕下脂肪組織填充分隔;關(guān)節(jié)腔、髕下深囊及其之間區(qū)域主要通過(guò)膝降動(dòng)脈、膝下內(nèi)側(cè)動(dòng)脈和膝上、下外側(cè)動(dòng)脈及其分支連通。膝關(guān)節(jié)標(biāo)本伸位時(shí),髕下深囊長(zhǎng)0.9cm～1.1cm,最寬處0.5cm,高0.3cm～0.5cm,髕韌帶長(zhǎng)度4.5cm～4.8cm;膝關(guān)節(jié)標(biāo)本屈位(45°)時(shí),髕下深囊長(zhǎng)0.8～1.0cm,最寬處0.6cm,高0.4cm～0.6cm�；铙w測(cè)量髕骨下緣與脛骨粗隆的距離,伸位時(shí)4.5cm～4.8cm,屈位時(shí)(145°)9.0cm～9.5cm。 滑膜形態(tài)學(xué)特點(diǎn):髕軟骨上緣處滑膜質(zhì)地變硬發(fā)生率為87%(26/30)、髕上囊內(nèi)滑膜厚度大于5mm發(fā)生率為73%(22/30)、髕下深囊內(nèi)滑膜表面粗糙發(fā)生率為70%(21/30),與其他部位比較差異均有顯著性意義(p0.001)。髕軟骨上緣、后內(nèi)側(cè)隱窩處滑膜細(xì)胞及小血管增生發(fā)生率分別為80%(24/30)和57%(17/30)、間質(zhì)纖維化及玻璃樣變發(fā)生率分別為83%(25/30)和74%(22/30),與其他部位比較差異均有顯著性意義(P0.001)。 積液定量測(cè)定:①在膝關(guān)節(jié)冠狀面MRI掃描:注入10 ml對(duì)比劑時(shí),經(jīng)膝關(guān)節(jié)內(nèi)側(cè)中點(diǎn)處,關(guān)節(jié)腔內(nèi)均可見(jiàn)高信號(hào)。②在膝關(guān)節(jié)正中矢狀層面內(nèi)側(cè)1.5 cm處MRI掃描:5 ml對(duì)比劑時(shí),高信號(hào)區(qū)呈前粗后細(xì)達(dá)髁間隆起前緣,70%脛骨內(nèi)側(cè)髁后上方可見(jiàn)高信號(hào)區(qū)。③在膝關(guān)節(jié)橫斷面經(jīng)髕骨尖下緣處MRI掃描:對(duì)比劑5 ml時(shí),90%關(guān)節(jié)腔后1/3段可見(jiàn)高信號(hào);對(duì)比劑10 ml,70%股骨前緣平面出現(xiàn)高信號(hào)區(qū)。 結(jié)論:髕下深囊與關(guān)節(jié)腔滑膜不延續(xù),髕韌帶摩擦是其滑膜形成的原因之一。髕下深囊、髕上囊、髕軟骨上緣處滑膜易發(fā)生大體形態(tài)學(xué)改變,后內(nèi)側(cè)隱窩和髕軟骨上緣處滑膜是組織學(xué)改變最顯著的部位。通過(guò)對(duì)膝關(guān)節(jié)腔及周圍滑膜囊注入不同量對(duì)比劑,建立不同量積液的參照標(biāo)準(zhǔn),對(duì)MRI診斷膝關(guān)節(jié)腔及周圍滑膜囊積液具有重要價(jià)值。
[Abstract]:Objective: synovial abnormalities, joint effusion is a common lesion of the knee joint. However, due to the complexity of the knee joint structure, abnormal synovial membrane and joint effusion, it is difficult to diagnose and treat the clinical diagnosis and treatment. MRI observation was carried out on specimens of normal knee joint of fresh adult cadavers by injecting different contrast agents to provide objective and quantitative criteria for the clinical diagnosis of different amount of fluid in the knee joint cavity and the surrounding synovial capsule.
Method:
(1) 20 sides of the specimens of fresh cadaver specimens of adult cadavers were injected into the femoral artery and injected with red latex suspension; the 1:1 denture powder and denture water mixture were injected into the joint cavity and the deep patellar capsule. After the filling agent was solidified, 30% hydrochloric acid was put into the fluid and made into a lower limb cast specimen.
(2) morphological observation of the 30 sides of the knee joint specimens, the naked eye observed the upper patellar capsule, the deep capsule of the patellar, the patellar cartilage, the posterior medial recess, the morphology of the synovium in the posterior medial recess and the tissue structure between the deep capsule and the articular cavity.
(3) specimen, measuring and measuring the morphological changes of the deep Subpatellar bursa in the flexion and extension of the 20 sides of the knee joint, and the location of the lower patellar and tibial tuberosity in 20 volunteers, and measuring the length of the patellar ligament at the lower margin of the patella and the tibial tuberosity when the knee joint was flexed and extended.
(4) 1,5,10,15,20,30,40ml contrast agent was injected into the knee joint of 10 pieces of adult cadavers without fluid accumulation, gas accumulation and normal structure. After each injection, the coronal surface, sagittal plane, cross section T2WI, thickness 4 mm, distance 1 mm, MRI scan were performed after each injection.
Result:
The characteristics of the deep Subpatellar capsule: the Subpatellar deep capsule and the articular cavity have the same synovial tissue, but they are not continuous. The two are filled with the subpatellar fat tissue; the joint cavity, the Subpatellar deep sac and the area between the patellar and the joints are mainly through the knee descending artery, the medial inferior knee, the lower lateral artery and its branches. The deep capsule of the patella is 0.9CM to 1.1cm, the width of 0.5cm, the height 0.3cm to 0.5cm, the length of the patellar ligament 4.5cm to 4.8cm; when the knee joint specimen is flexion (45), the deep capsule of the patellar is long 0.8 to 1.0cm, the width is at the maximum, and the distance between the lower margin of the patella and the tibial tuberosity is measured by the high 0.4cm to 0.6cm..
The morphologic characteristics of synovial membrane: the incidence of the synovium hardening in the upper patellar cartilage was 87% (26/30), the incidence of the synovium thickness greater than 5mm in the superior patellar capsule was 73% (22/30). The incidence of the surface roughness of the synovium in the deep capsule of the patellar was 70% (21/30), and the difference was significant (p0.001). The upper margin of the patellar cartilage, the synoviocytes at the posterior medial recess and the synovial cells and the synovial cells in the posterior medial part of the patellar cartilage The incidence of small vascular hyperplasia were 80% (24/30) and 57% (17/30) respectively. The incidence of interstitial fibrosis and hyaline change were 83% (25/30) and 74% (22/30) respectively, and there were significant differences compared with other parts (P0.001).
Quantitative determination of effusion: (1) MRI scan on the coronal plane of the knee: high signal in the articular cavity is visible at the middle point of the knee joint when 10 ml contrast agent is injected. (2) MRI scan at the medial sagittal plane of the knee joint: when the 5 ml contrast agent is 5, the high signal area is before the anterior condylar eminence, and the high signal is visible above the posterior medial condyle of the tibia, and the high signal is visible in the upper part of the medial condyle of the 70% tibia. MRI scan in the transverse section of the knee through the inferior patellar edge of the knee joint: when the contrast agent was 5 ml, the high signal was seen in the 1/3 segment of the 90% articular cavity; the contrast agent was 10 ml, and the high signal area appeared in the plane of the anterior margin of the femur.
Conclusion: the deep capsule of the patellar and the synovial membrane of the articular cavity are not extended, and the friction of the patellar ligament is one of the reasons for the formation of the synovial membrane. The deep capsule of the patellar, the upper patellar capsule, and the synovium at the upper edge of the patellar cartilage are easily morphologically changed. The synovial membrane of the posterior medial recess and the upper patellar cartilage is the most significant part of the histological change. It is important to establish the reference standard for different volumes of fluid with different amounts of contrast agents, which is of great value in the diagnosis of synovial pouch effusion around the knee joint cavity by MRI.

【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：R322.72

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