I. Definition.
It is a chronic arthritic disease characterized by degenerative degeneration and loss of articular cartilage and regeneration of joint edges and subchondral bone. Most commonly seen in middle-aged and elderly people, more women than men. It occurs in the knee, hip, spine and finger joints, which are heavily weight-bearing joints. The disease is also known as osteoarthrosis, degenerative arthritis, proliferative arthritis, age-related arthritis and hypertrophic arthritis.
Second, classification.
1, primary osteoarthritis: is the cause of the onset is unclear, the patient does not have a history of trauma, infection, congenital deformities, no genetic defects, no systemic metabolic and endocrine heterogeneity of osteoarthritis. Most commonly seen in obesity over 50 years of age.
2, secondary osteoarthritis: is due to congenital deformity, trauma, joint surface unevenness, joint instability, and long-term inappropriate application of corticosteroids and other factors caused by osteoarthritis.
3. Etiology: The specific cause is unknown and may be related to the following factors
1. Aging
2. Abnormal cartilage metabolism
3, biochemical and nutritional changes
4, injury one of the important conditions
5, other factors such as a combination of
Fourth, pathological changes
1. Articular cartilage: cartilage loses elasticity and collagen fiber degeneration. In the joint activities occurring wear, cartilage can be broken, exfoliation, subchondral bone exposed.
2, subchondral bone: at the edge of the cartilage or tendon attachment due to bone growth, the formation of bone superfluous, the so-called “bone spur”.
3. Synovial membrane: two types. 1) Proliferative synovitis 2) Fibrous synovitis.
4. Joint capsule and surrounding muscles: The joint capsule may become fibrous degeneration and thickening, and the surrounding muscles may become protective spasms due to pain, limiting joint movement, and deformity may occur.
V. Clinical symptoms
1, pain: is the early symptoms of osteoarthritis, initially not serious, occurring during activity and improving at rest. It can be aggravated by cold and moisture.
2, stiffness: patients often feel inflexible joint activities, stiffness, morning or after rest can not immediately move, need a certain amount of time after the activity to lift the stiffness, that is, “morning stiffness.
3. Dysfunction: When arthritis develops to a certain extent, joint swelling is obvious, especially when accompanied by synovitis, there may be fluid in the joint, and active or passive activities are restricted.
VI. Physical signs.
1. Swelling of the joint with moderate effusion, positive floating patella test of the knee joint.
2. The pain increases when the angle of internal rotation of the hip joint increases.
3. Atrophy of the muscles around the joint, and the joint is accompanied by a ringing sound when moving actively or passively.
4. In the advanced stage, there are often deformities of the hip and knee joints.
Seven, auxiliary examination
1.X-ray film: no obvious changes in the early stage. In the late stage, the joint space is narrowed, and there is bone superfluous formation at the edge of the joint. In the later stage, the bone ends are deformed, the joint surface is uneven, and there is obvious osteophytes at the edges. The subchondral bone has sclerosis and cyst formation, and the subpatellar fat pad is blurred or disappears when it is accompanied by synovitis.
2. Laboratory tests: generally within the normal range. The joint fluid examination shows an increase in white blood cells and occasionally red blood cells.
Diagnosis
According to symptoms, signs and auxiliary examinations
9. Treatment.
1.Conservative treatment
(1) General therapy: pay attention to the protection of joints, avoid excessive weight-bearing activities or injury, and appropriate rehabilitation therapy can be used. For obese people, weight loss also has certain effect. In severe cases, bed rest, brace fixation, to prevent deformation.
(2) Drug therapy: internal use of herbs to invigorate blood circulation and remove blood stasis, as well as external hot compresses, fumigation and soaking can relieve symptoms and slow down the course of the disease. Non-steroidal anti-inflammatory and analgesic drugs can relieve pain. For early stage patients, studies have shown that there are oral drug components involved in cartilage metabolism.
2.Surgical treatment
1) Arthroscopic debridement: For early stage patients, arthroscopic removal of inflammatory factors, free bodies and proliferated synovium in the joint is effective.
2）Surgical treatment: When deformity or persistent pain occurs in the late stage and life cannot be taken care of by oneself, surgical treatment is available.
(3) Artificial joint replacement: Artificial joint replacement can be used according to age, occupation and living habits.