髌股关节骨关节病关节软骨、软骨下骨及滑膜组织超微结构的研究

Ultramicrostructural Changes of Articular Cartilage,Subchondral Bone and Synovium in Human Osteoarthritis of Patellofemoral Joint

对１０例髌股关节骨关节病患者病变关节软骨、软骨下骨及滑膜组织的超微结构进行了研究。实验结果表明：（１）髌股关节骨关节病患者关节软骨、软骨下骨及滑膜组织均呈不同程度超微结构变化。（２）髌股关节内侧间隙呈Ⅰ～Ⅱ级退变，主要由于该部位关节软骨缺乏相应的载荷刺激所致废用性退变；外侧间隙呈Ⅲ～Ⅳ级退变，主要由于股四头肌内侧头萎缩，髌骨半脱位，导致局部应力集中，关节面不断撞击、磨损所致。（３）软骨下骨呈强烈硬化趋势，其改变可先于、晚于或平行于关节软骨改变，变化规律与载荷性质有关。（４）Ⅰ～Ⅱ级软骨退变的修复组织更接近于正常软骨组织，而Ⅲ～Ⅳ级退变的修复组织则更像纤维软骨组织，两者差异可能由于其修复组织的来源不同所致。（５）滑膜组织的改变则为继发于关节软骨退变的非特异性炎性反应，并可进一步加重前者退变。（６）临床对Ⅰ～Ⅱ级病变可行保守治疗，Ⅲ～Ⅳ级病变则需行髌股关节表面置换术。

Ten patients with patellofemoral joint osteoarthritis(OA)were studied by electron microscope(SEM&TEM)to identify ultramicrostructural changes in the destroyed articular cartilage,subchondral bone and synovium. According to the results obtained,the author suggested that(1) Articular cartilage,subchondral bone and synovium in patellofemoral jointOA were noted to be in various degree of ultramicrostructural changes;(2) The cartilage degeneration in lateral compartment of patellofemoral joint were much more severe than that inmedial compartment;(3) The subchondral bone had a strong tendency to undergo selerosisin the form of thicking and confluence of the trabeculae to form massive block of bone,whichwere not parallel to alteration of cartilage,and the rules of alteration were related to thecharacter of loading;(4) The repair tissues of Ⅰ-Ⅱ grade degenerative cartilage were similar to normal cartilage,but those of Ⅲ-Ⅳ grade degenerative cartilage were similar to fibrocartilage in many ways,because the source of repair tissues were different between them;(5) Alteration of synovium revealed only mild non-specific inflammatory changes followingthe changes of articular cartilage;(6) Ⅰ-Ⅱ grade patellofemoral joint OA was treated byconservative methods and Ⅲ-Ⅳ grade OA should be treated by patellofemoral joint resurfacing.