骨關節炎的介紹

骨關節炎是一種以關節軟骨退行性變和繼發性骨質增生爲特性的慢性關節疾病。接下來小編爲大家整理了骨關節炎的介紹，希望對你有幫助哦!

Walking，the world'smost natural exercise， is one of the best ways to keep healthy. It is less dangerous than running. Walking strengthens muscles without stretching them too much and it puts less pressure on bones and people are active in what is called fitness walking take short walks a few times each week to improve their health ess walking can be done almost anywhere and anytime No special equipment is needed.

Going down the pub could seriously affect men's health—but in a positive way， a study said. A Leeds University researcher said that the local watering hole's welcoming atmosphere helps men to get rid of the stresses of modern life and is vital for their psychological well-bein. .

步行，世界上最自然的活動，是保持健康的最好的方法之一。它比跑步危險小。步行加強肌肉而不致過度伸展，而且作用於骨胳和關節的壓力很小。許多人積極參加所謂健美步行，每週進行幾次，短途步行以增進健康。健美步行幾乎能在任何時候任何場合進行，不需要特殊器材。

Osteoarthritis has traditionally been described as “wear and tear” joint degeneration attributable to the aging process. Pain due to osteoarthritis constitutes the most common joint complanint for which patien is seek medical attention. Primary osteoarthritis affects the articular cartilage of otherwise normal joints. Secondary osteoarthritis occurs as a sequela of trauma， joint disease such as Legg-Perthes disease， or subtle anomalies such as mild acetabular dysplasia resulting in long-standing joint incongruity.

骨關節炎被傳統地描述爲由於老年化過程而出現的磨損性關節變性。由骨關節炎引起的關節能疼痛是病人就醫時最多的主訴。原發性骨關節炎犯其他正常侵犯其他正常的骨關節軟骨面。繼發性骨關節炎是作爲創傷、關節病(如Legg-Perthe病)或輕微畸形(如輕度髖臼發育不良導致長期關節不交合)的後遺症而發生的。

Osteoarthritis is the most common of all arthropathies， affecting roughly 30-50% of the entire population. Heritability has not been demonstrated. Women are more often affected than men， though virtually all persons overage 55 have some x-ray evidence of this disease. Fortunately， less than half of patients with x-ray changes will experience joint symptoms. Onset of symptomatic disease is usually in the sixth decade.

骨關節炎是所有骨關節病中最常見，整個人羣中約有30~50%受累。遺傳性未得到證實。女性較男性患者多。事實上超過55歲的人都有一點患此病的X線證據，幸而只有不到一半有X線證變化的病人感到有關節症狀，通常是在60歲開始出現。

Though the specific in citing agent remains unclear， the earliest histopathologic change in osteoarthritic joints is loss of mucopolysaccharide ground substance in the outermost layers of articular cartilage. As a result the mechanical properties of the cartilage are altered and resistance to deformation is lowered. The weakened superficial layers of cartilage develop fissures in response to increased deformation by normal loads. This results in uneven distribution of stress transmission to deeper layers of cartilage and to the underlying subchondral bone. This concentration of stress further accelerates cartilage wear with thinning of outer layers and propagation of cracks and fissures in the deeper layers. Cartilage debris within the joint results in low-grade chronic inflammatory synovitis and joint effusion.

雖然特異性刺激因素尚不清楚，但是在骨關節炎關節中最早的組織病理學變化是在關節軟骨的最外層中喪失粘液多糖基質。結果是軟骨的機械性能發生改變，對變形的耐受力下降。變弱的表層軟骨因對正常負荷增加變形而發生裂隙。這導致應力分佈不均勻地傳導至深層軟骨及其下面的軟骨下骨。集中的應有盡有力進一步加速外民支軟骨磨損及變薄，也加速深層碎裂和裂隙的擴布。在關節內軟骨碎片導致低度慢性囊炎和關節積液。

If weight bearing or stress loading of the affected joint continues， thinning of the cartilage may progress to eventual full-thickness cartilage loss. The subchondral bone bears progressively greater loads as cartilage destruction evolves. Increased loading of bone stimulates bone remodeling and new bone deposition， manifested by marginal osteophyte formation and sclerosis within the overloaded subchondral bone incite a chronic inflammatory response Replacement of nercrotic bone by fibrous tissue results in subchondral cyst formation.

如果受損的關節持續負重或承受應力，軟骨變薄可進行下去，直到最後全層軟骨消失。軟骨破壞過程中，軟骱下骨胳的負荷逐漸加重，骨負荷加重刺激骨胳重新塑和新骨沉積，表現爲邊緣的骨贅形成和軟骨下骨質硬化。過度負荷的軟骨下骨質中的細微骨折激起慢性炎症反應，壞死的骨骼被纖維組織替代導致軟骨下囊腫形成。

Clinical Findings

a. Sympoms and Signs： Osteoarthritis is a local condition without systemic manifestations. Asymptomatic degenerative joint changes in the hands and spine are common， but weight-bearing joints such as the knee and hip are often stiff and painful， particularly following the activities of the day. Symptoms may be episodic， with long periods of spontaneous remission， or slowly but steadily progressive， resulting in profound disability and intractable pain. Discomfort is characteristically more severe at night， and morning stiffness is minimal. Monarticular osteoarthritis is unusual. Both knees are typically involved， though one usually more extensively than the other. Osteoarthritis of the hip occurs slightly less frequently but is still quite common， Nodular swelling of the distal joints of the fingers (Heberden's nodes) is painful in over half of affected individuals. and painful degeneration of the carpometacarpal joint of the thumb and the metocar pophalangeal joint of the great toe is common， the ankle， shoulder， and elbow are rarely involved， and the wrist least frequently of all.

臨牀表現

a.症狀與體徵：骨關節炎是一局部病變無全身症狀。無症狀的退行性關節變化常見於手和脊柱，而在負重的膝及髖關節等常是僵凝和疼痛的。特別是在一在活動之後更是如此。症狀可以是發作性的。可長期自行緩解或緩慢地穩步發展，導至嚴重的殘廢和難治的疼痛，不適的特徵是夜間較重，而早上僵硬程度最輕。單關節骨關炎不多見。典型的爲侵犯雙側膝關節，不過一側較另一側嚴重。髖關節骨關節炎發生得輕些少些，但仍不少見。半數以上患者的手指遠端關節出現結節性腫脹(Heberden's 結節)，拇指腕骨關節及大 趾的，跖趾關節疼痛性變性最常見。踝，肩及肘關節很少受到侵犯，在所有關節中腕關節受累最少。

Examination of osteoarthritic joints is remarkable for the absence of inflammatory signs. Effusion， when present， is slight， and redness and warmth are usually absent. Pain with motion is the predominant finding， and crepitation may be palpated with passive motion. Rnage-of-motion testing reveals limitation of terminal flexion and extension in the involved knee joints and internal rotation in involved hips. More severe limitation is characteristic of more advanced disease. Varus or valgus deformity of the knee may be present， depending upon the predominance of involvement of the medial or lateral joint compartment. Heberden's nodes of the distal interphalangeal joints of the hand are classic findings. These dorsal bony prominences represent marginal osteophytes， Similar degenerative changes of the proximal interphalangeal joints may be present and are knoiwn as Bouchard's nodes.

引入注意的是檢查骨關節炎性關節時無炎症性體徵。如有滲出液，一般都很輕微。通常無發紅和發熱現象。最突出的表現是活動時疼痛，被動活動可觸到磨擦感。活動範圍試驗顯示受累膝關節不能完全屈曲和伸直，髖關節內旋受限。病情越發展，活動範圍更嚴重受限。隨着關節內側和外側明顯受累，可出現膝內翻或外翻畸形。手遠側指間關節的Heberden's結節是典型的表現。這些前側骨突起表明有邊緣性骨贅。近側指間關節可出現類似的退行性變。這種病變稱爲Bouchard氏結節。

b. Laboratory Findings： Laboratory studies are usually normal.

b.實驗室檢查：實驗室檢查通常正常。

c. X-Ray Findings： X-ray findings are consistent with the histopathologic stage of degeneration. Early changes consist of mild joint space narrowing and minimal osteophyte formation (“spurring”)。 of the periphery of involved joints. More advanced disease is manifested by severe joint space narrowing， marked osteophyte formation at the joint margins， dense sclerosis of subchondral bone， and subchondral cysts. Subluxation and joint space narrowing are often apparent only on weight-bearing films， which should be obtained for both knees and hips.]

c.X 線表現：X線所見與組織病理的變性期一致，早期變化有輕度關節間隙窄狹窄，受累關節周圍有很輕的骨贅形成(骨刺)。更嚴重的疾病，表現爲關節間隙更窄狹，在關節邊緣有明顯骨贅形成，軟骨下骨堅實硬化以及軟骨下囊腫。不完全脫位和關節間隙狹窄只是在關節承受重力時所拍的片中常是明顯的但兩側的膝及髖關節都應拍片。

Treatment

a. External Support Measures： Management of osteoarthritis depends upon the stage of disease. When degeneration in a weight-bearing joint is mild， symptoms are significantly relieved by use of external supports such as a cane， crutches， or a walker. Though actual healing of osteoarthritic cartilage is difficult to demonstrate， remission of joint pain is sometimes dramatic when stress is diminished by use of external aida.

治療

a.外支撐法：骨關節炎的處理方法取決於疾病處於何階段，當一負重的關節變性較輕時，使用外支撐物如手杖，柺杖或步行器可使症狀明顯緩解。雖然骨關節炎的軟骨實際癒合很難證實，但通過支架減輕壓力，關節疼痛的緩解有時是很明顯的。

b. Medication： Anti-inflammatory drugs are less effective in osteoarthritis than in rheumatoid arthritis or gout. A trial of nonsteroidal antiinflammatory drugs is warranted， however， as some patients report considerable relief with their use. Analgesics， hot packs， ultrasound， and massage may also provide symptomatic relief. Physical therapy for joint strengthening exercises may occasionally by warranted， and weight reduction is beneficial.

b.藥物治療：抗炎藥物對骨關節炎的作用比起類風溼性關節炎或痛風要小些。試用非類固醇類抗炎藥物是有根據的，正如某些病人所言，在使用後有一定緩解。止痛藥，熱敷法，超聲及按摩亦可使症狀緩解。增強關節的運動等物理療法，偶爾有用，減輕負重是有利的。

c. Surgical Treatment： Joint arthroplasty has revolutionized the management of severe and disabling osteoarthritis. Pain can be reliably eliminated in most patients with hip or knee joint disease， and improvement in joint motion is generally achieved. Because the cemented prosthetic components often loosen over decades of use， total joint arthroplasty has the longest-lasting results in older， less active individuals.

c.手術治療：關節成形術使嚴重和可致殘的骨關炎的處理明顯改善，多數髖或膝關節病的患者確實消除了疼痛，一般也改善了關節活動。膠合劑所作的假體部位，用十多年後會鬆動，而全關節成形術對老年和活動較少的人，卻有維持最長時間的效果。

Persons in the fifth and sixth decades may benefit from osteotomy， particularly when arthropathy is moderate. Following surgical realignment of a joint， the load upon the joint may be shifted toward less severely damaged cartilage. Several years of serviceable joint function may be achieved. Joint replacement may be performed later if required， and the likelihood of component failure will be proportionately diminished.

截骨術對40~60歲的人有益，特別對較輕的關節病。經手術重新調整關節位置，使關節的負重轉移至損傷較少的軟骨，可在術後數年內維持關節功能。如果需要，以後還可以作關節置換，而組成部件失敗的可能性將成比例地降低。