退变性膝骨关节病病因的实验观察和临床治疗的初步报告

A Preliminary Report on the Pathoenesis Study andClinical Treatment the Degenerative Osteoarthrosis(DOA) of Knee

膝退变性骨关节病（ＤＯＡ）病变早期表现在髌股关节，中期出现退变性膝内翻，晚期全关节间隙消失伴屈曲畸形。通过骨内静脉造影、骨内压测量、髌骨回流静脉解剖学研究井初步建立损害家兔髌骨回流静脉、结札股静脉术后保留膝关节活动而诱发髌股ＯＡ的动物模型。研究证实静脉郁滞、骨内高压并伴有骨内血气异常，在ＤＯＡ和引起关节疼痛机制中有重要作用。对本病早、中期患者作关节囊外髌骨钻孔术，其中部分病例加作胫骨内髁钻孔或改良Ｃｏｖｅｎｔｒｙ－Ｍａｑｕｅｔ手术矫正退变性膝内翻，７５例术后平均随诊２９个月：优８１％，良１３．７％，差和失败５．３％，对晚期病例视情况可作，髌骨切除。

AbstractEarly stage lesions of knee-DOA are pressented atpattelofemoral joint,the middle stage is developed as de-generative genu varum,and in the late stage,the articu-lar space of the whole knee disappears with flexional de-formity.The author used intraosseous venography and mea-surement of intraosseuca pressure to study the venousdrainage of the patella. The author also established a pre-liminary animal model of patellofemoral OA by blockingvenous drainage of the patella and lower extremity of therabbits,The studies proved that venous stasis and in-traosseuos hypertension are the eitiology and symptoms(pain) of knee-DOA.The author suggests the patella drilling out side theknee capsule may be applied for the early and middlestages of knee-DOA,Some cases require drilling ofcondylum medialis tibiae or a modification of Coventry-Maquet’s operation to correct genu varum. The averagepost-operative follow-up of this series of 75 patients is29 months,Results:excellent(81%),good(13.7%%)andpoor or failure(5.3%).For the latestage cases, oper-ation such as patelleotomy, arthrodesis of the knee or kneereplacement arthroplasty are indicated