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INTRODUCTION: This review article addresses the best evidence currently available for the effectiveness of injection therapy for musculoskeletal conditions involving the peripheral joints. The research is presented by anatomical region and areas of controversy and the need for additional research are identified. DISCUSSION: Randomized controlled trials, meta-analyses and systematic reviews are lacking that address the effectiveness of therapeutic injections to the sternoclavicular, acromioclavicular, ankle and foot joints. No research studies of any kind have been reported for therapeutic injections of the sternoclavicular joint. With the exception of the knee, possibly the hip and patients with inflammatory arthropathies, research does not unequivocally support the use of therapeutic joint injections for most of the peripheral joints, including the shoulder. Additionally, controversy exists in some areas as to whether or not corticosteroids provide better outcomes compared to local anesthetic injections alone. CONCLUSION: When viscosupplementation injections are compared to corticosteroids in patients with osteoarthritis of the knee, the evidence supports the use of viscosupplementation for more prolonged improvement in outcomes, with corticosteroids being good for short-term relief.

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简介：本评论文章讨论了目前最好的证据的注射疗法对涉及周围关节肌肉骨骼的有效性提供条件。这项研究提出的部位和争议地区和需要进一步研究确定。讨论：随机对照试验，荟萃分析和缺乏系统的评语是针对注射的治疗效果的胸锁，肩，踝关节和脚。没有任何形式的研究，已为治疗胸锁关节注射。随着膝关节异常，可能与髋关节发炎arthropathies患者，研究并没有明确支持对周边缝最注射治疗联合使用，包括肩膀。此外，存在争论是否不皮质类固醇提供更好的结果相比，注射局部麻醉独自在有些领域。结论：当黏注射相比，与膝关节骨性关节炎患者皮质类固醇，有证据支持黏的成果进行更长时间的改善使用，皮质类固醇被短期的救济良好。

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OBJECTIVE: The present study aimed to assess the reliability of intra and inter-examiner subacromial impingement index (SII) measures obtained from radiographs. MATERIALS AND METHODS: Thirty-six individuals were enrolled and divided into two groups: control group, composed of 18 volunteers in good general health without shoulder problems, and a group of 18 patients with subacromial impingement syndrome (SIS). Radiographic images were taken with the dominant upper limb in neutral rotation, while the volunteers held their arm at 90 degrees of abduction in the frontal plane. The beam of radiation at 30 degrees craniocaudal inclination was used to provide an antero-posterior image view. Three blinded examiners each performed three measurements from the subacromial space (SS) and the anatomical neck of the humerus (NH). The SII was calculated as the ratio of the SS and the NH measures. The mean values of SII were compared using t-tests. The intra-class correlation coefficient (ICC) was used to assess intra- and inter-examiner reliability of the measures. RESULTS: The mean values of SII were greater for the control group (0.12) than for the SIS group (0.08; p = 0.0071). SII measurements showed excellent intra (0.96-0.99) and inter-examiner reliability (0.94) for both the control and SIS group. CONCLUSION: The results of this study show the potential use of the SII; a greater mean value for the control group compared to the SIS group and excellent reliability for intra- and inter-examiner measurement. Validation studies of the index should be conducted to correlate the index with clinical findings from subacromial impingement syndrome.

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目的：本研究旨在评估内部和区域之间的可靠性检验肩峰下撞击指数（SII）时获得的X光片的措施。材料与方法：36人报读，并分成两组：无肩伤困扰对照组，18健康情况大致良好志愿者组成划分，以及18肩峰下撞击综合征（SIS）的病人。 X光图像采取中立的主流旋转上肢，而志愿者举行了90度的绑架在额面的手臂。在辐射的头尾倾角30度的光束被用于提供安特罗，后形象。每个演出三从肩峰下空间（SS）的3个测量和肱骨（信息NH）解剖颈蒙蔽考官。此外，SiI计算作为SS和比例的NH措施。对精工的平均值进行了比较采用t检验。该组内相关系数（ICC）是用于评估内部和跨审查员措施的可靠性。结果：SII的平均值分别是更大的对照组（0.12比申根信息系统组）（0.08，p = 0.0071）。精工仪器测量显示，在控制和SIS的优秀内部（0.96-0.99）和机构检验的可靠性（0.94）。结论：本研究结果表明了该精工仪器公司的潜在用途;为对照组更大的平均值相比，SIS的组和内部良好的可靠性和机构检验测量。该指数的验证研究应当进行关联与肩峰下撞击综合征临床表现指数。

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OBJECTIVE: To report on the biochemistry and clinical and genetic findings of two siblings, the younger sister presenting with recurrent bone pain of the radius and ulna, and medullary sclerosis, and the older brother with soft tissue calcific deposits (tumoral calcinosis) but who later developed bone pain. Both were found to be hyperphosphaturic. MATERIALS AND METHODS: The index family comprised four individuals (father, mother, brother, sister). The affected siblings were the offspring of a non-consanguineous Indian family of Tamil origin. Bidirectional sequencing was performed on the DNA from the index family and on 160 alleles from a population of 80 unrelated unaffected control individuals of Tamil extraction and 72 alleles from individuals of non-Tamil origin. RESULTS: Two symptomatic siblings were found to harbour previously unreported compound heterozygous missense UDP-N-acetyl-D-galactosamine: polypeptide N-acetylgalactosaminyltransferase 3 (GalNAc-transferase; GALNT3) mutations in exon 4 c.842A>G and exon 5 c.1097T>G. This sequence variation was not detected in the control DNA. This is the first report of siblings exhibiting stigmata of familial tumoral calcinosis and hyperostosis-hyperphosphataemia syndrome with documented evidence of autosomal recessive missense GALNT3 mutations. CONCLUSION: The findings from this family add further evidence to the literature that familial tumoral calcinosis and hyperostosis-hyperphosphataemia syndrome are manifestations of the same disease and highlight the importance of appropriate metabolic and genetic investigations.

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目的：报告和临床生化和两个兄弟，妹妹同尺桡骨性疼痛演示和骨髓硬化的基因发现，和哥哥与软组织（肿瘤沉着症），但后来谁钙化存款开发骨痛。两人都发现hyperphosphaturic。材料与方法：该指数系列包括四个人（父亲，母亲，兄弟，姐妹）。受影响的兄弟姐妹是一个非后代，近亲印度的泰米尔族家庭。双向测序的对象是从索引家庭的DNA和160等位基因从80无关的泰米尔提取和72等位基因未受控制的非个人，泰米尔族个人的人口。结果：两个症状的兄弟姐妹港发现以前未复合杂义的UDP - N -乙酰- D -氨基半：多肽N - acetylgalactosaminyltransferase 3（半乳糖转移酶; GALNT3）外显子4 c.842A“G和5角外显子突变1097T“湾这个序列变异，没有检出控制的DNA。这是展示痕家族肿瘤钙化和骨化，高磷血症与记载的常染色体隐性遗传错义突变的证据综合征GALNT3兄弟的第一次报告。结论：从这个家庭的调查结果进一步补充证据文学家族肿瘤钙化和骨化，高磷血症综合征是同一种疾病的表现，并强调适当的代谢和遗传调查的重要性。

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We report on a 19-year-old woman with a rapidly growing, solid variant of aneurysmal bone cyst (solid ABC) in the right part of the lateral mass of the sacrum. On admission, the magnetic resonance imaging (MRI) scan disclosed an inhomogeneous low intensity mass right of the centre of the os sacrum with a diameter of 38 x 64 mm and a height of 56 mm on T1 and T2 weighted images. The mass showed homogenous high signal intensity on Gd-enhanced images. Computed tomography demonstrated an expansile osteolytic lesion and (99m)Tc-methylene diphosphonate bone scintigraphy revealed uniform accumulation in the lesion. The histological evaluation showed a proliferation of fibroblasts, histiocytes, chronic inflammatory cells and numerous multinucleated giant cells. Nevertheless, the cells were devoid of nuclear atypia. A cystic component was not observed. In spite of thorough curettage, the patient suffered from recurrence and severe neurological deficits. A review of the literature revealed no previous cases of solid ABC in the sacrum.

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我们报告一个19岁女子与快速发展，固体变动脉瘤样骨囊肿（固体ABC ）的正确的部分侧块骶骨。入院，磁共振成像（ MRI ）扫描发现一不均匀低强度大规模权利中心的全部骶骨直径为38 × 64毫米，而高度的五十六毫米的T1和T2加权像。大众表明均匀高信号钆增强图像。计算机断层扫描显示出一个膨胀溶骨性病变（九十九米）锝-甲基diphosphonate骨显像显示统一积累的病变。组织学评价表明，成纤维细胞增殖，组织球，慢性炎性细胞和许多多核巨细胞。然而，细胞缺乏核异型性。囊状部分不遵守。尽管彻底刮除，病人因复发和严重的神经功能缺损。文献复习没有发现以前的案件坚实的美国广播公司在骶骨。

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OBJECTIVES: The objectives of this communication were to discuss radiographic and magnetic resonance (MR) imaging manifestations and clinical outcome after complete and incomplete resection of the mass of dysplasia epiphysealis hemimelica (DEH). MATERIALS AND METHODS: Clinical records, radiographs, and MR images of eight patients with DEH were retrospectively examined. Six patients were treated by complete excision of the lesional mass, and two patients were treated by incomplete resection at our University Hospitals during the period from 1980 to 2006. RESULTS: We found that, unlike in osteochondroma, DEH was radiographically not clearly separable from the underlying or host bone with preserved cortical bone and marrow continuity. The finding in the talus distinguished DEH from (osteochondroma-like) parosteal osteosarcoma, in which a radiolucent demarcation line clearly separated the tumor from the host bone. The DEH mass had a well-defined low to intermediate signal intensity on T1-weighted images and an intermediate to high signal intensity on T2-weighted images, with irregularity of the articular surface. Simple excision was performed in all patients. The excision was complete in six patients and incomplete in two patients whose lesions was juxta-articular in the ankle and articular in the knee, respectively. The residual mass slowly absorbed and vanished, resulting in mild flaring of the affected portion of the epiphysis. No local recurrence or complication was seen in any of the eight patients. CONCLUSIONS: Although the radiographic signs of DEH are characteristic, (osteochondroma-like) parosteal osteosarcoma should be differentiated from DEH when there is a radiolucent separation line between the mass and host bone in the talus. Simple excision was effective in the management of DEH if the deformity was not complicated. Incompletely excised masses resolved and vanished with time.

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目标：本沟通的目的是讨论后，完全和不完全的大规模切除射线和磁共振（MR）影像学表现及临床结果半肢骨骺发育不良（DEH系统）。材料与方法：临床记录，X线，和电液控制系统的8个患者进行回顾性磁共振成像检查。 6例的治疗质量完全切除病灶，2例经我们的大学医院治疗不完全切除，在1980年至2006年。结果：我们发现，不同于软骨，X线片DEH系统是没有明确分离从底层或主机与保存皮质骨骨和骨髓的连续性。从（骨软骨瘤样）骨旁骨肉瘤，其中一射线分界线明显脱离宿主骨肿瘤中发现距骨杰出代。大规模的电液控制系统进行了明确界定在T1低信号强度中间加权图像和在T2中间一个高信号强度加权图像，与关节面不规则。简单切除，所有患者。完整的切除6例和2例，其病变是关节旁的踝关节和膝关节，分别不完整的。大量的剩余慢慢吸收和消失，造成轻度的骨骺受影响的部分燃烧。无局部复发或并发症看到8个病人是没有。结论：虽然DEH系统的影像学特征迹象，（骨软骨瘤样）骨旁骨肉瘤，应区别时，从DEH系统之间存在的质量和宿主骨放射线分离的距骨线。简单切除是有效的DEH系统的管理，如果畸形并不复杂。不完全切除群众解决，随着时间的推移消失。

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