Evidence for a distinctive pattern of bone formation in enthesophytes
Evidence for a distinctive pattern of bone formation in enthesophytes
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DOI：
10.1136/ard.2008.091074
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发表时间：
2009-06-01
影响因子：
27.4
通讯作者：
McGonagle, D.
中科院分区：
文献类型：
--
作者：
Benjamin, M.;Toumi, H.;McGonagle, D.
目的：脊柱关节炎（SpA）附着点新骨形成的机制知之甚少，但它是导致疾病残疾的关键因素。骨刺的发展也是一个与年龄有关的现象，骨刺在老年人解剖室尸体进行了研究，以建立有关其development.Methods的一般原则：不同大小的马刺进行了研究，通过常规组织学在26个不同的附着点（共76个标本）从上肢，下肢和脊柱。骨的百分比：骨髓进行了比较，在后方部分的跟骨在尸体与和没有阿基里斯spurs，以确定之间的关系spurs和直接相邻的松质bone.Results：骨刺形成是一种常见的年龄相关的现象，通常发生在最纤维的一个附着点的一部分。奇怪的是，它往往预示着一个厚厚的钙化纤维软骨区，随后在其中发展成骨结节。未钙化的纤维软骨在大马刺周围更为突出。endochondrium，膜内和软骨样骨化都有助于骨刺的形成和生长，但细胞肥大和华丽的血管入侵的细胞钙化软骨，典型的endochondrium骨化，是不显着的features.Conclusion：Entheseal新骨形成的三种方法的组合骨化发生。然而，软骨内骨化是不典型的，不同于软骨骨的正常发育或骨折愈合过程中所见。炎症过程如何调节这些过程可能会导致更好地了解附着点新骨形成的SpA。
Objectives: The mechanism of new bone formation at entheses in spondyloarthritis (SpA) is poorly understood, but it is a key factor contributing to disability in disease. As bony spur development is also an age-related phenomenon, spurs in elderly dissecting room cadavers were studied in order to establish general principles relating to their development.Methods: Spurs of different sizes were studied by routine histology at 26 different entheses (a total of 76 specimens) from the upper limb, lower limb and spine. The percentage of bone: marrow was compared in the posterior part of the calcaneus in cadavers with and without Achilles spurs to ascertain the relationship between spurs and immediately adjacent trabecular bone.Results: Bony spur formation was a common age related phenomena and typically occurred in the most fibrous part of an enthesis. Paradoxically, it was often heralded by the initial appearance of a thick zone of calcified fibrocartilage that subsequently developed bony nodules within it. Uncalcified fibrocartilage was more prominent around large spurs. Endochondral, intramembranous and chondroidal ossification all contributed to spur formation and growth, but cell hypertrophy and florid vascular invasion of a cellular calcified cartilage, typical of endochondral ossification, were not conspicuous features.Conclusion: Entheseal new bone formation occurs by a combination of three methods of ossification. However, endochondral ossification was atypical and differed from that seen in the normal development of cartilage bones or during fracture healing. How the inflammatory process modulates these processes could lead to a better understanding of entheseal new bone formation in SpA.