骨關(guān)節(jié)炎是一種以關(guān)節(jié)軟骨退行性變和繼發(fā)性骨質(zhì)增生為特性的慢性關(guān)節(jié)疾病。接下來小編為大家整理了骨關(guān)節(jié)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 joints.Many people are active in what is called fitness walking .They take short walks a few times each week to improve their health .Fitness 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(qiáng)肌肉而不致過度伸展，而且作用于骨胳和關(guān)節(jié)的壓力很小。許多人積極參加所謂健美步行，每周進(jìn)行幾次，短途步行以增進(jìn)健康。健美步行幾乎能在任何時候任何場合進(jìn)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(guān)節(jié)炎被傳統(tǒng)地描述為由于老年化過程而出現(xiàn)的磨損性關(guān)節(jié)變性。由骨關(guān)節(jié)炎引起的關(guān)節(jié)能疼痛是病人就醫(yī)時最多的主訴。原發(fā)性骨關(guān)節(jié)炎犯其他正常侵犯其他正常的骨關(guān)節(jié)軟骨面。繼發(fā)性骨關(guān)節(jié)炎是作為創(chuàng)傷、關(guān)節(jié)病(如Legg-Perthe病)或輕微畸形(如輕度髖臼發(fā)育不良導(dǎo)致長期關(guān)節(jié)不交合)的后遺癥而發(fā)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(guān)節(jié)炎是所有骨關(guān)節(jié)病中最常見，整個人群中約有30~50%受累。遺傳性未得到證實(shí)。女性較男性患者多。事實(shí)上超過55歲的人都有一點(diǎn)患此病的X線證據(jù)，幸而只有不到一半有X線證變化的病人感到有關(guān)節(jié)癥狀，通常是在60歲開始出現(xiàn)。

　　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(guān)節(jié)炎關(guān)節(jié)中最早的組織病理學(xué)變化是在關(guān)節(jié)軟骨的最外層中喪失粘液多糖基質(zhì)。結(jié)果是軟骨的機(jī)械性能發(fā)生改變，對變形的耐受力下降。變?nèi)醯谋韺榆浌且驅(qū)φＸ?fù)荷增加變形而發(fā)生裂隙。這導(dǎo)致應(yīng)力分布不均勻地傳導(dǎo)至深層軟骨及其下面的軟骨下骨。集中的應(yīng)有盡有力進(jìn)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(kuò)布。在關(guān)節(jié)內(nèi)軟骨碎片導(dǎo)致低度慢性囊炎和關(guān)節(jié)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(guān)節(jié)持續(xù)負(fù)重或承受應(yīng)力，軟骨變薄可進(jìn)行下去，直到最后全層軟骨消失。軟骨破壞過程中，軟骱下骨胳的負(fù)荷逐漸加重，骨負(fù)荷加重刺激骨胳重新塑和新骨沉積，表現(xiàn)為邊緣的骨贅形成和軟骨下骨質(zhì)硬化。過度負(fù)荷的軟骨下骨質(zhì)中的細(xì)微骨折激起慢性炎癥反應(yīng)，壞死的骨骼被纖維組織替代導(dǎo)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.

　　臨床表現(xiàn)

　　a.癥狀與體征：骨關(guān)節(jié)炎是一局部病變無全身癥狀。無癥狀的退行性關(guān)節(jié)變化常見于手和脊柱，而在負(fù)重的膝及髖關(guān)節(jié)等常是僵凝和疼痛的。特別是在一在活動之后更是如此。癥狀可以是發(fā)作性的?？砷L期自行緩解或緩慢地穩(wěn)步發(fā)展，導(dǎo)至嚴(yán)重的殘廢和難治的疼痛，不適的特征是夜間較重，而早上僵硬程度最輕。單關(guān)節(jié)骨關(guān)炎不多見。典型的為侵犯雙側(cè)膝關(guān)節(jié)，不過一側(cè)較另一側(cè)嚴(yán)重。髖關(guān)節(jié)骨關(guān)節(jié)炎發(fā)生得輕些少些，但仍不少見。半數(shù)以上患者的手指遠(yuǎn)端關(guān)節(jié)出現(xiàn)結(jié)節(jié)性腫脹(Heberden's 結(jié)節(jié))，拇指腕骨關(guān)節(jié)及大 趾的，跖趾關(guān)節(jié)疼痛性變性最常見。踝，肩及肘關(guān)節(jié)很少受到侵犯，在所有關(guān)節(jié)中腕關(guān)節(jié)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(guān)節(jié)炎性關(guān)節(jié)時無炎癥性體征。如有滲出液，一般都很輕微。通常無發(fā)紅和發(fā)熱現(xiàn)象。最突出的表現(xiàn)是活動時疼痛，被動活動可觸到磨擦感?；顒臃秶囼烇@示受累膝關(guān)節(jié)不能完全屈曲和伸直，髖關(guān)節(jié)內(nèi)旋受限。病情越發(fā)展，活動范圍更嚴(yán)重受限。隨著關(guān)節(jié)內(nèi)側(cè)和外側(cè)明顯受累，可出現(xiàn)膝內(nèi)翻或外翻畸形。手遠(yuǎn)側(cè)指間關(guān)節(jié)的Heberden's結(jié)節(jié)是典型的表現(xiàn)。這些前側(cè)骨突起表明有邊緣性骨贅。近側(cè)指間關(guān)節(jié)可出現(xiàn)類似的退行性變。這種病變稱為Bouchard氏結(jié)節(jié)。

　　b. Laboratory Findings： Laboratory studies are usually normal.

　　b.實(shí)驗室檢查：實(shí)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(xiàn)：X線所見與組織病理的變性期一致，早期變化有輕度關(guān)節(jié)間隙窄狹窄，受累關(guān)節(jié)周圍有很輕的骨贅形成(骨刺)。更嚴(yán)重的疾病，表現(xiàn)為關(guān)節(jié)間隙更窄狹，在關(guān)節(jié)邊緣有明顯骨贅形成，軟骨下骨堅實(shí)硬化以及軟骨下囊腫。不完全脫位和關(guān)節(jié)間隙狹窄只是在關(guān)節(jié)承受重力時所拍的片中常是明顯的但兩側(cè)的膝及髖關(guān)節(jié)都應(yīng)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(guān)節(jié)炎的處理方法取決于疾病處于何階段，當(dāng)一負(fù)重的關(guān)節(jié)變性較輕時，使用外支撐物如手杖，拐杖或步行器可使癥狀明顯緩解。雖然骨關(guān)節(jié)炎的軟骨實(shí)際愈合很難證實(shí)，但通過支架減輕壓力，關(guān)節(jié)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(guān)節(jié)炎的作用比起類風(fēng)濕性關(guān)節(jié)炎或痛風(fēng)要小些。試用非類固醇類抗炎藥物是有根據(jù)的，正如某些病人所言，在使用后有一定緩解。止痛藥，熱敷法，超聲及按摩亦可使癥狀緩解。增強(qiáng)關(guān)節(jié)的運(yùn)動等物理療法，偶爾有用，減輕負(fù)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(shù)治療：關(guān)節(jié)成形術(shù)使嚴(yán)重和可致殘的骨關(guān)炎的處理明顯改善，多數(shù)髖或膝關(guān)節(jié)病的患者確實(shí)消除了疼痛，一般也改善了關(guān)節(jié)活動。膠合劑所作的假體部位，用十多年后會松動，而全關(guān)節(jié)成形術(shù)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(shù)對40~60歲的人有益，特別對較輕的關(guān)節(jié)病。經(jīng)手術(shù)重新調(diào)整關(guān)節(jié)位置，使關(guān)節(jié)的負(fù)重轉(zhuǎn)移至損傷較少的軟骨，可在術(shù)后數(shù)年內(nèi)維持關(guān)節(jié)功能。如果需要，以后還可以作關(guān)節(jié)置換，而組成部件失敗的可能性將成比例地降低。