(Staphylococcus aureus) 80%-90% 臨床症狀 (flexion) 臨床評估 ( ) ( ) (exquisite tenderness) ( ) ( ) (gout) (rheumatoid arthritis) ( ) () ( ) ( ) (a ballotable

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1 家庭醫業前言病理生理學 (prepatellar bursitis) (housemaid's knee) (miner's knee) 0.6% [1] [2-3] 1. (chronic aseptic) 2. (acute aseptic) 3. (septic) 4. (crystal-induced) 圖一膝蓋骨前滑液囊解剖示意圖解剖學 (bursa) (synovial joint) () 1 高雄醫學大學醫學系學士後醫學系 2 彰化基督教醫院家庭醫學科 Prepatellar bursitis, housemaid's knee 244 家庭醫學與基層醫療第九期

2 (Staphylococcus aureus) 80%-90% 臨床症狀 (flexion) 臨床評估 ( ) ( ) (exquisite tenderness) ( ) ( ) (gout) (rheumatoid arthritis) ( ) () ( ) ( ) (a ballotable cyst) (cobblestone-like roughness) ( ) (range of motion) (extra-articular pain syndromes) 診斷家庭醫學與基層醫療第九期 245

3 (bursal fluctuance) (septic prepatellar bursitis) / 1. (bursal fluid aspiration) (pseudogout) 2. 3 (bursal fluid WBC count and differential) 3. (Gram stain and culture) (fungi) (mycobacterium) (Brucella) [4] 4. (crystal analysis of bursal fluid) [5] 5. X X (differential diagnosis) (calcium pyrophosphate dihydrate deposition disease pseudogout) 3. (infrapatellar bursitis) 4. (rheumatoid arthritis) 5. (tendinitis) 6. (peripheral type seronegative spondyloarthropathy) 治療表一各項膝蓋骨前滑液囊炎白血數的變化與白血球分類狀況滑液囊炎類別白血球數血球分類計數感染性滑液囊炎 (septic bursitis) 無菌性滑液囊炎 (aseptic bursitis) 結晶誘發滑液囊炎 (crystalinduced) 資料來源 : 參考資料 3 1, ,000/mcL 50-11,000/mcL 1,000-6,000/mcL 多形核白血球為主 (polymorph nuclear cells) 單核球為主 (mononuclear cell) 白血球分類不一定 (variable) 246 家庭醫學與基層醫療第九期

4 圖二左腳的膝蓋骨前滑液囊炎的外觀表現資料來源 : Charlie Goldberg, M.D. ( extremities_prepatellar_bursitis2.htm Copyright 2005, The Regents of the University of California. All rights reserved) (NSAID) (clindamycin 150mg to 450 mg/qid dicloxacillin 500 mg/qid) [6] [7] ( ) 50~60% 2 5~10% (drainage) (bursectomy) [7] [8,9] 結論家庭醫學與基層醫療第九期 247

5 圖三類固醇注射治療膝蓋骨前滑液囊炎參考資料治療方法為患者平躺伸直膝蓋後, 標定滑液囊的上下邊界, 將欲插針處局部麻醉後, 使用 18 號 1.5 吋針頭, 從髕骨底部平行髕骨入針, 將針頭一直深入到滑液囊中心處, 再開始進行滑液囊積液抽吸時, 一手回抽針筒, 另一手從滑液囊另一邊配合施予適當的壓力幫助抽吸抽吸完後, 針頭留原處, 將裝有液體的針筒替換另一支裝有類固醇 (triamcinolone acetonide (40 mg/ml) 1Ml) 的針筒, 再將其類固醇打入至滑液囊內, 最後移除針頭與針筒, 完成注射 30 [10] 1. Le Manac'h AP, Ha C, Descatha A, Imbernon E, Roquelaure Y: Prevalence of knee bursitis in the workforce. Occup Med 2012; 62: McAfee JH, Smith DL: Olecranon and prepatellar bursitis. Diagnosis and treatment. West J Med. 1988; 149: Gómez-Rodríguez N, Méndez-García MJ, Ferreiro-Seoane JL, Ibáñez-Ruán J, Penelas- Cortés Bellas Y: Infectious bursitis: study of 40 cases in the pre-patellar and olecranon regions. Enferm Infecc Microbiol Clin. 1997; 15: Cea-Pereiro JC, Garcia-Meijide J, Mera-Varela A, Gomez-Reino JJ: A comparison between septic bursitis caused by Staphylococcus aureus and those caused by other organisms. Clin Rheumatol 2001; 20: Dawn B, Williams JK, Walker SE: Prepatellar bursitis: a unique presentation of tophaceous gout in an normouricemic patient. J Rheumatol. 1997; 24: Zimmermann B 3rd, Mikolich DJ, Ho G Jr.Semin: Septic bursitis. Arthritis Rheum. 1995; 24: Stell IM: Management of acute bursitis: outcome study of a structured approach. J R Soc Med. 1999; 92: Ogilvie-Harris DJ, Gilbart M.: Endoscopic bursal resection: the olecranon bursa and prepatellar bursa. Arthroscopy 2000; 16: Huang YC, Yeh WL: Endoscopic treatment of prepatellar bursitis. Int Orthop. 2011; 35: 家庭醫學與基層醫療第九期

8% 13% 40% ( P a r k i n s o n s d i s e a s e - a s s o c i a t e d psychosis, PDAP) (NINDS-NIMH criteria ) UK Brain Bank ( ) () 病理生理 (PDAP) A. - (Il

8% 13% 40% ( P a r k i n s o n s d i s e a s e - a s s o c i a t e d psychosis, PDAP) (NINDS-NIMH criteria ) UK Brain Bank ( ) () 病理生理 (PDAP) A. - (Il 1 2 3 臨床案例 77 69 1 Madopar(250mg) 1 tab q4h Entacapone 1 tab tid 1 10 9 5 2 1 2 1 1 彰化基督教醫院家庭醫學科住院醫師 2 彰化基督教醫院家庭醫學科主任 3 彰化基督教醫院家庭醫學科主治醫師 Parkinson's disease, psychosis, hallucinations, delusions (CASI)