PATHOGENETIC TYPES OF COXARTHROSIS AND IMPLICATIONS FOR TREATMENT
PATHOGENETIC TYPES OF COXARTHROSIS AND IMPLICATIONS FOR TREATMENT
复制标题
DOI：
10.1007/bf00379940
复制
发表时间：
1983-01-01
影响因子：
2.3
通讯作者：
SCHNITZLER, CM
中科院分区：
文献类型：
--
作者：
SOLOMON, L;SCHNITZLER, CM
据推测，关节关节病多变的临床和影像学表现与其发病机制有关，是决定治疗选择的重要因素。在一项对150名患者的研究中，根据是否存在一些可能导致机械负荷的局部解剖缺陷，以及是否存在一些可能导致软骨退变的原发性疾病，对髋关节疾病进行了分类。新骨形成和重塑也进行了评估。这种修复反应在解剖异常（肥厚性OA[骨关节炎]）的关节中最为明显，而在先前有炎症性疾病（萎缩性OA）的关节中最不明显。显然，关节融合的行为是由三个相互作用的因素决定的：软骨退变、过大的机械应力和修复性骨反应。讨论了各种类型的预后和治疗的意义。在解剖异常和力学特征占主导地位的情况下，软骨损失最初是局部的，重塑通常良好，髋关节可以稳定；在这些病例中，截骨术通常是成功的，假体固定可能保持安全。当炎症和退行性特征占主导地位时，修复性新骨形成很少，进展更迅速；在这种情况下，截骨术的效果要小得多。
It is postulated that the variable clinical and radiological appearances of coxarthrosis are related to its pathogenesis and are important in deciding the choice of treatment. In a study of 150 patients the hip disorder was classified according to the presence or absence of some local anatomical defect which could predispose to mechanical overload, and also according to the presence or absence of some primary disorder which could cause cartilage degeneration. New bone formation and remodeling were also assessed. This reparative response was most marked in joints with anatomical abnormalities (hypertrophic OA [osteoarthritis]) and least evident in those with previous inflammatory disease (atrophic OA). Apparently, the behavior of coxarthrosis is determined by 3 interacting factors: cartilage degeneration, excessive mechanical stress and the reparative bone response. Prognosis of the various types and the implications for treatment are discussed. Where anatomical abnormalities and mechanical features are dominant, cartilage loss is at first localized, remodeling is usually good and the hip can stabilize; in these cases osteotomy is often successful and prosthetic fixation is likely to remain secure. Where inflammatory and degenerative features predominate, reparative new bone formation is minimal and progression is more rapid; osteotomy is much less likely to be effective in these cases.