Synovial membrane involvement in osteoarthritic temporomandibular joints - A light microscopic study
Synovial membrane involvement in osteoarthritic temporomandibular joints - A light microscopic study
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DOI：
10.1016/s1079-2104(97)90246-8
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发表时间：
1997-03-01
影响因子：
--
通讯作者：
deBont, LGM
中科院分区：
文献类型：
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作者：
Dijkgraaf, LC;Liem, RSB;deBont, LGM
目标。研究骨关节炎颞下颌关节滑膜的光镜特征，评价滑膜在骨关节炎过程中的受累情况。研究设计。40例患者在单侧关节镜下行滑膜活检。31个颞下颌关节被诊断为骨关节炎。骨关节炎亚组是根据与椎间盘移位和穿孔相关的症状来定义的。对照组包括9个未患骨关节炎的颞下颌关节。在光镜下检查滑膜时，记录了几个光镜变量。组间和亚组间的差异采用chi(2)或Fisher精确检验，采用Mann-Whitney U检验和Student t检验。骨关节炎组滑膜内膜细胞层数明显高于对照组，纤维性内膜基质和纤维性内膜下的出现频率明显高于对照组。此外，在骨关节炎组中，在出现临床症状和体征的第一年，内膜细胞肥大合并紧密的细胞组成更为常见，而在出现临床症状和体征的前两年，内膜增生、纤维性内膜基质、致密的表面物质和内膜下弹性纤维更为常见。本研究结果提示，颞下颌关节骨关节炎最初可能导致滑膜内膜增生和细胞肥大，随后在内膜基质中沉积纤维物质。最终，内膜下组织的纤维化可能与滑膜内膜细胞层的变性和随后的正常化同时发生。总的来说，纤维化是骨性关节炎颞下颌关节滑膜最典型的特征。总之，颞下颌关节骨性关节炎的滑膜受累表现为早期增生期和晚期纤维期。看来，强烈和延长的纤维期可能不是对最初侮辱的正常适当反应，而是一种异常的适得其反的反应。
Objective. To study the light microscopic characteristics of the synovial membrane of osteoarthritic temporomandibular joints to evaluate synovial membrane involvement in the osteoarthritic process.Study design. Synovial membrane biopsies were obtained during unilateral arthroscopy in 40 patients. Thirty-one temporomandibular joints were diagnosed with osteoarthritis. Osteoarthritis subgroups were defined on the basis of the presence of symptoms related to disk displacement and perforation. The control group consisted of nine temporomandibular joints that were not involved by osteoarthritis. During light microscopic examination of the synovial membranes, several light microscopic variables were recorded. Differences between groups and between subgroups were tested with chi(2) Or Fisher's exact tests with Mann-Whitney U tests and with Student's t tests.Results. In the osteoarthritis group, the number of synovial intima cell layers was significantly higher, and fibrous intima matrix and fibrous subintima were found significantly more frequently than in the control group. Moreover, in the osteoarthritis group, intima cell hypertrophy in combination with a closely packed cell composition was found significantly more often in the first year of clinical signs and symptoms, whereas intima hyperplasia, fibrous intima matrix, dense surface material, and subintima elastic fibers were found significantly more frequently in the first 2 years of clinical signs and symptoms.Conclusions. The findings in this study suggest that osteoarthritis of the temporomandibular joint may initially result in synovial intima hyperplasia and cell hypertrophy, and subsequently in deposition of fibrous material in the intima matrix. Eventually, fibrosis of the subintimal tissue may occur in combination with degeneration and subsequent normalization of the synovial intima cell layer. Overall, fibrosis was the most characteristic feature of synovial membranes of osteoarthritic temporomandibular joints. In conclusion, the involvement of the synovial membrane in osteoarthritis of the temporomandibular joint is characterized by an early proliferative phase and a late fibrous phase. It appears that the intense and prolonged fibrous phase may not be a normal appropriate response to an initial insult but rather an aberrant counterproductive response.