胫骨高位截骨术治疗膝关节骨关节炎的长期随访

目的 :为了观察胫骨高位截骨术治疗膝关节骨关节炎的远期治疗效果。方法 :作者随访了 1988～ 1997年10年间在新加坡中央医院行胫骨高位截骨术的 438名 (486膝 )膝关节骨关节炎的患者。结果 :手术后 5年内的优良率为 88.5 % ,手术后 5～ 10年的优良率为 6 1.9%。但在手术后仍有 18.9%的患者因治疗效果的下降须再次手术置换人工膝关节。结论 :我们认为胫骨高位截骨术虽然是治疗膝关节骨关节炎的一种有效手段 ,但远期仍有一部分患者因治疗效果下降须再次手术。     

The pathogenesis of osteoarthrosis.

Recent investigations on protease inhibitors in articular cartilage have provided new insights into the possible initial lesions of osteoarthrosis. A hypothesis has been formulated based upon an impaired ability of chondrocytes to synthesize protease inhibitors, which leads to loss of matrix integrity and vascular invasion from subchondral bone and the joint margins.     

Autosomal dominant spondylarthropathy due to a type II procollagen gene(COL2A1) point mutation

Osteoarthrosis represents a very common disease with heterogeneous etiology. In some pedigrees linkage of the condition with the type II collagen gene (COL2A1) has been established, but information on the underlying gene defect is still incomplete as only one mutation causing this phenotype has been identified. We analyzed the COL2A1 gene in a 27-year-old woman and her 47-year-old mother presenting with severe premature osteoarthrosis and X-ray signs compatible with mild spondyloepiphyseal dysplasia. Examination of the complete gene in both patients was done by amplification of all 54 exons, screening of the PCR products by SSCP-analysis, and subsequent sequencing. In mother and daughter a G to A transition at the 5′-end of exon 21 was detected, leading to a substitution of serine for glycine at position 274 of the triple helical domain. The mutation was not present in unaffected family members or in healthy control individuals. The autosomal dominant spondylarthropathies may represent the less severe entities of the clinical spectrum of type II collagenopathies. © 1994 Wiley-Liss, Inc.     

胫骨高位截骨治疗膝关节骨性关节炎的远期随访

本文报告了31例33膝骨性关节炎高位截骨术的远期疗效,31例随访1～8年9个月,平均5年10个月,优良率81.81％。作者认为能够取得良好疗效主要是术后恢复正常的关节负重力线,平衡膝内机械应力,为关节功能的恢复创造了必要的条件。同时可使滑膜刺激减少,肿胀消退,改善软骨营养状态。并强调疗效与功能锻炼,手术时机自动控制重要性。分析了个别病例疗效不佳的原因。     

Noninflammatory sclerosis of the sternal end of the clavicle: a follow-up study and review of the literature

The cases of 14 adult females with swelling, tenderness, and sclerosis of the inferomedial part of the clavicle are presented. They were seen during a 16-year period, suggesting that the condition is rare. In ten patients strain at the sternoclavicular joint seemed to be an etiological factor. Eleven patients were followed for periods of 1–13 years (mean 5 years). The clavicular sclerosis regressed and they all developed signs of osteoarthrosis. Based upon available biopsy results and review of reported cases, it is hypothesized that the radiographic changes are due to osteonecrosis of the medial end of the clavicle with subsequent development of osteoarthrosis.     

间接性颞颌关节损伤后的扫描电镜观察

目的：观察颞颌关节间接性损伤后，局部超微结构改变。方法：以１０ｍ／ｓ的撞击速度、撞击能量为１０Ｊ、方向平行于下颌角—颞下凹撞击５只山羊右侧下颌角部，伤后１月处死动物，扫描电镜观察关节盘及髁突形态的改变。左侧关节为对照。结果：损伤侧髁突和关节盘表面的凝胶样物质被破坏，暴露出下面疏松的、排列紊乱的胶原原纤维组织。结论：间接性ＴＭＪ损伤使具有抗原性的髁突表面纤维暴露，激发了抗原—抗体反应，引起关节自身破坏，导致颞下颌关节骨关节病的发生。     

颞下颔关节骨关节病临床病理研究

目的：研究颞下颌关节骨关节病的病理特点。方法：选取30例颞下颌关节骨关节病患者，均进行手术治疗。所有获取的新鲜标本用4％的福尔马林固定，然后用5％的甲酸脱钙，梯度酒精脱水，石蜡包埋，5μm厚连续切片，HE染色，光镜观察。结果：关节软骨表层纤维毛糙，排列紊乱，纤维水肿，互相分离，有的纤维断裂，出现水平裂隙及垂直裂隙；增殖带变薄甚至消失，有的软骨层明显增厚，增殖带内未分化间充质细胞较多；肥大带内可见到较多软骨细胞，细胞内有空泡形成；钙化层与非钙化层之间出现明显的潮标线；密质骨变薄，软骨直接与松质骨骨髓腔相通。结论：骨关节病的主要病理特征表现为关节软骨的破坏和增生，有时伴随软骨下骨质的破坏与改建。     

间接性TMJ损伤后髁突软骨增殖能力的改变

目的：探讨间接性颞下颌关节损伤在颞下颌关节骨关节病发生、发展过程中的作用。方法：用撞击装置撞击山羊右侧下颌角部，间接造成ＴＭＪ损伤，以对侧关节为对照，伤后２小时，１、３、６月处死动物，采用免疫组化方法观察髁突软骨细胞ＰＣＮＡ阳性细胞的分布及改变。结果：与对照侧相比，髁突软骨ＰＣＮＡ阳性细胞在伤后２小时无变化，伤后１月时增多而在伤后３月和６月时明显减少。结论：ＴＭＪ损伤导致ＴＭＪＯＡ的机理是由于损伤破坏了髁突面屏障，使胶原纤维裸露于关节腔内，引起关节局部内环境变化，使滑液中的异物在关节内压作用下进入软骨或骨髓，破坏和抑制了软骨的增殖能力，引起软骨组织进行性丧失，导致ＴＭＪＯＡ。     

In Vivo Kinematics of the Rabbit Knee in Unstable Models of Osteoarthrosis

The effects of osteoarthrosis inducing surgery on the kinematics of the rabbit knee were evaluated in vivo. A video motion analysis system was used to track reflective markers attached to two pins fixed in both femur and tibia, and from these data knee kinematics were computed. The control for all measurements was the gait after pins were implanted, but the knee was unaltered. Both a release of the anterior cruciate ligament and a partial medial meniscectomy were then performed, and the animals' gait was recorded at 4, 8 and 12 weeks after knee surgery. Knee kinematics were described by three translations and three rotations and were analyzed in terms of maximum and minimum values and range of motion. Statistical comparisons of these data between control and operated knees were made using Wilcoxon's signed rank test. Results showed an initial increase in maximum anterior displacement which returned to normal after 12 weeks. In addition there was a persistent increase in knee adduction and an increase in the minimum value of external rotation over the 12 week period. At 12 weeks after surgery there was no change in range of any measurable kinematic parameter. Overall, the changes in joint kinematics following partial medial meniscectomy and release of the anterior cruciate ligament were small, suggesting that altered joint kinematics might not be a critical factor in the development of osteoarthrosis in this animal model.