中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (32): 5209-5215.doi: 10.3969/j.issn.2095-4344.1400

• 骨与关节综述 bone and joint review • 上一篇    下一篇

骨性关节炎中的软骨下骨囊肿:软骨下骨异常重建

陆锦炜1,陈  曦2,叶陈毅1,何荣新3,汤  澜1,余运贤2
  

  1. 浙江大学医学院,1临床医学二系,2公共卫生系流行病学与卫生统计学教研室,浙江省杭州市  310058;3浙江大学医学院附属第二医院骨科,浙江省杭州市  310009
  • 出版日期:2019-11-18 发布日期:2019-11-18
  • 通讯作者: 余运贤,博士,副教授,博士生导师,浙江大学医学院公共卫生系流行病学与卫生统计学教研室,浙江省杭州市 310058
  • 作者简介:陆锦炜,男,1995年生,浙江省慈溪市人,汉族,2018年温州医科大学毕业,主要从事骨外科方面的研究。 并列第一作者:陈曦,男,1991 年生,湖北省武汉市人,汉族,2016年浙江大学毕业,硕士,主要从事骨外科学临床研究及统计学研究。

Subchondral bone cysts in osteoarthritis: abnormal reconstruction of subchondral bone

Lu Jinwei1, Chen Xi2, Ye Chenyi1, He Rongxin3, Tang Lan1, Yu Yunxian2   


  • Online:2019-11-18 Published:2019-11-18
  • Contact: Yu Yunxian, MD, Associate professor, Doctoral supervisor, Teaching and Research Section of Epidemiology and Health Statistics, Department of Public Health, School of Medicine of Zhejiang University, Hangzhou 310058, Zhejiang Province, China
  • About author:Lu Jinwei, Second Department of Clinical Medicine, School of Medicine of Zhejiang University, Hangzhou 310058, Zhejiang Province, China Chen Xi, Master, Teaching and Research Section of Epidemiology and Health Statistics, Department of Public Health, School of Medicine of Zhejiang University, Hangzhou 310058, Zhejiang Province, China Lu Jinwei and Chen Xi contributed equally to this study.

摘要:

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文题释义:
软骨下骨囊肿:骨性关节炎的常见影像学改变之一,常为多发圆形或卵圆形腔隙病灶,术中所见为灰色凝胶状区域。其成因仍不十分明确,但现有研究表明其可能与炎症相关性骨吸收并继发成骨有关,该病理过程反映了骨性关节炎的软骨下骨异常重建。其临床意义包括被覆关节软骨丢失、关节疼痛、关节活动度下降、局部生物力学改变,亦增加关节置换的风险。当前基于研究的治疗方法包括非类固醇抗炎药、抗骨吸收药物、植骨、骨水泥填充等。
软骨下骨异常重建:骨性关节炎软骨下骨的特征性改变,现有研究表明其可能早于关节软骨退变,表现为立体结构改变、屈曲性能改变、软骨下骨小梁低矿化、软骨下骨板硬化、钙化软骨层增厚并有新生血管神经长入、骨赘形成,以及软骨下骨髓病变、软骨下骨囊肿等。基于软骨下骨异常重建为靶点的治疗联合基于软骨的治疗可能为骨性关节炎带来更多获益。
 
摘要
背景:骨性关节炎是骨科最常见的慢性疾病之一。近期研究表明软骨下骨的病变在骨性关节炎的发生发展中具有重要地位,并可能先于并加剧软骨的病变。软骨下骨的病变以异常重建为主要特征,表现为软骨下骨髓病变和软骨下骨囊肿等。当前针对软骨下骨囊肿的研究还不充分,探究软骨下骨囊肿的成因及临床意义有助于从软骨下骨的角度为骨性关节炎的诊治提供新的思路。
目的:综述近年骨性关节炎软骨下骨囊肿的成因假说、病理学特征、临床意义、临床诊断及治疗的研究进展。
方法:2位共同第一作者应用计算机检索2019年1月及以前PubMed、Embase数据库,英文检索式:(osteoarthritis OR osteoarthrosis OR osteoarthropathy) AND (subchondral cyst OR pseudocyst OR intraosseous cyst OR bone cyst),语言设定为“英语”,共检索到1 224篇文献,58篇符合纳入标准,另手工检索11篇文献,最终纳入69篇文献。
结果与结论:①软骨下骨髓病变可能是软骨下骨囊肿的“前置病变”,二者属同一病理变化的不同阶段;②软骨下骨囊肿的形成可能与炎性骨吸收后继发反应性成骨有关;③软骨下骨囊肿与关节软骨的退变、关节疼痛显著相关;④非类固醇抗炎药、抗骨吸收药、软骨下骨成形术、关节置换术中植骨等可能对软骨下骨髓病变/软骨下骨囊肿有治疗作用,但仍需大样本临床试验证明。

ORCID: 0000-0002-1982-2376(陆锦炜)

关键词: 骨性关节炎, 软骨下骨, 骨囊肿, 骨髓病变, 病理, 成因假说, 关节置换

Abstract:

BACKGROUND: Osteoarthritis is one of the most common chronic diseases in orthopedics. Pathological changes in subchondral bone, characterized mainly as abnormal remodeling, manifested as subchondral bone marrow lesions and subchondral bone cysts, have been revealed their significance in the pathogenesis and progression of osteoarthritis by recent studies. Pathological changes in subchondral bone may precede which in cartilage and even aggravate it. Given the paucity of studies on subchondral bone cyst, an insight into subchondral bone cyst’s pathogenesis and clinical significance may contribute to novel diagnosis and therapy of osteoarthritis in terms of subchondral bone.
OBJECTIVE: To summarize the advances in researches on the etio-pathogenic hypothesis, pathological traits, clinical significance, clinical diagnosis and therapy of subchondral bone cysts in osteoarthritis.
METHODS: Computer-based searches of PubMed and Embase databases before January 2019 with the mesh terms of “(osteoarthritis OR osteoarthrosis OR osteoarthropathy) AND (subchondral cyst OR pseudocyst OR intraosseous cyst OR bone cyst)” were conducted by two co-first authors. Articles’ language was set as “English”. A total of 1 224 articles were retrieved after excluding the duplicate ones. 58 articles were eligible for the inclusion criteria to which 11 articles were retrieved manually in addition, thus 69 articles were included eventually.
RESULTS AND CONCLUSION: (1) Subchondral bone marrow lesions may be the “predisposed change” of subchondral bone cyst, two of which belong to the respective stage of one pathological process. (2) Subchondral bone cyst may result from the inflammatory bone absorption and subsequent reactive bone formation. (3) Subchondral bone cyst is evidently correlated with cartilage degeneration and joint pain. (4) Non-steroidal anti-inflammatory drugs, anti-absorptive drugs, subchondroplasty, and bone grafting during arthroplasty may ameliorate subchondral bone marrow lesions or subchondral bone cyst. Further large sample clinical trials are warranted.

Key words: osteoarthritis, subchondral bone, bone cyst, bone marrow lesions, pathology, genesis hypothesis, joint replacement

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