traumatic arthritis
Introduction
Introduction to traumatic arthritis Traumatic arthritis, also known as traumatic arthritis, is caused by trauma, which is caused by degenerative degeneration of articular cartilage and secondary cartilage hyperplasia and ossification as main pathological changes, joint pain, and activity dysfunction. A disease that is primarily a clinical manifestation. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific population Mode of infection: non-infectious Complications: Osteosclerosis Osteoporosis Fracture
Cause
Causes of traumatic arthritis
(1) Causes of the disease
The main causes of this disease are:
1. Violent trauma such as falling pressure, impact, etc. cause fractures of the bones and joints, cartilage damage, foreign bodies in the joints, etc., so that the joint surface is not flat, so that it suffers from abnormal wear and damage.
2. Bearing weight imbalance such as joint congenital, acquired deformity (such as knee, valgus, ankle tilt, tumor, etc.) and bone fracture horn deformity healing, the joint negative gravity line is not correct, the joint surface of the long-term pressure is subject to excessive wear And destruction.
3. Activity, excessive weight, such as certain occupations require certain joint activities of the body frequently or often take a certain posture, or severe obesity, or unilateral limb weight bearing after amputation, etc., can cause cumulative damage, resulting in the corresponding joint Excessive wear and tear of the articular surface.
(two) pathogenesis
1. Western medicine pathogenesis The disease is intra-articular fracture, cartilage damage, foreign body retention in the joint, weight bearing imbalance, activity, excessive weight, etc., so that the joint surface is not flat, so that it suffers from abnormal wear and damage.
The disease is a bone and joint disease, which can occur in multiple joints, showing a chronic pathological process. The pathology is mainly the degeneration of articular cartilage, and its secondary cartilage hyperplasia and ossification, causing progressive narrowing of joint space, joints There are bone spurs on the edges and cystic changes in the subchondral bone.
2. Chinese medicine etiology and pathogenesis Chinese medicine believes that this disease is mostly caused by insufficient kidney gas, wind, cold and dampness invade the bones, or fall into the servant, and damage the bones, resulting in stagnant blood stasis, running unsettled, and forming osteophytes for a long time.
(1) Blood stasis of the broken bone: the bone and bone damage caused by trauma or strain, the joint of the joint is the joint, the joint of the big tendon is connected, and the small tendon is attached to the outside of the bone, so the bruise is damaged, the light is hurt, the heavy is the damage. Bone, blood stasis, suffocation, so pain and disease.
(2) liver and kidney deficiency: liver main rib, kidney main bone, liver and kidney filling, then strong bones and muscles, joint smooth, flexible movement, liver and kidney homologous, liver yin and kidney yin mutually use, therefore, tendon and The same, the bone marrow is strong, the bone is soft and soft, if the liver and blood kidney essence is losing, the blood is not enough or the patient is hurting the liver and kidney, causing the bones to be dystrophic and the disease.
(3) Exogenous sinners: Inadvertently living, taking the wind and cold, sitting in the cold and wet places, or rushing into the rain, or sweating out, clothes and wet, etc. can cause cold and wet passengers, wind and cold wet passengers Invading the meridians, the meridians, the qi and blood, the dysfunction of the bones and the dysfunction, as the "Jishengfang" cloud: "All due to physical weakness, ignorance of empty space, by the wind and cold moisture, it is also,"
Prevention
Traumatic arthritis prevention
prevention:
1. Early diagnosis of traumatic osteoarthritis is generally not difficult, but should also be differentiated from secondary osteoarthritis.
2. Early treatment
(1) Adjustment and lifestyle change: This is the most important measure for secondary prevention of osteoarthritis. Its purpose is to reduce the load on the affected joint and reduce or avoid further strain on the affected joint. This is the knee and hip joint. Inflammatory patients are particularly important. When asymptomatic osteoarthritis (only changes in joint structure seen by radiology) or mild symptomatic osteoarthritis is found, patients should be instructed and asked to change their original condition. Inappropriate lifestyle, taking knee osteoarthritis as an example, requires patients to:
Reduce the total amount of exercise per day: refers to walking, lower extremity exercise, running, etc., so that the knee and hip joints have a full rest, while avoiding fatigue in the joints and the whole body.
Avoid or reduce knee flexion: As above stairs, especially knee flexion will increase the pressure in the knee joint and increase the burden on the knee joint, stimulate the diseased tissue to cause severe pain, and should be avoided.
If necessary, adjust the type of work: If occupational labor is related to the above two items (the total amount of exercise is large, often knee-squatting, squatting, up and down stairs), the type of work should be adjusted to work on the above two requirements.
Reasonable diet: The goal is to lose weight and lose weight (for obese patients).
(2) Medical gymnastics: The purpose is to maintain or improve the range of joint movement, increase muscle strength, thereby indirectly reducing joint load and improving the patient's exercise capacity. Recent studies have proved that patients with knee osteoarthritis can improve knees by appropriate medical gymnastics. Joint function, and help to relieve pain, the effect is better than single electrotherapy, medical gymnastics includes:
Joint gymnastics: maintain or increase joint mobility and prevent joint contracture. This kind of gymnastics should be fully active according to the movement axis of the joint itself (without causing pain), for example, the knee joint should be actively and fully flexed and stretched.
Isometric exercises: make the muscles of the same length contraction (static tension, no joint movement), which is an effective way to strengthen muscle strength and prevent disuse muscle atrophy, such as quadriceps muscle in knee osteoarthritis The isometric contraction exercise to strengthen the quadriceps, the isometric contraction lasts 5s each time, and then relaxes and can be repeated 30 to 40 times.
Stretching: Stretching muscles and tendons around the joints, preventing contractures, and improving muscle coordination, improving gait in patients with lower extremity osteoarthritis.
Endurance exercise: Generally, the bicycle is fixed on the fixed knee, and the appropriate endurance exercise is carried out under the weight of the knee joint. The time is usually no more than 8 to 10 minutes. It can also be used for swimming, walking on the ground, etc., but it is not suitable for uneven roads or slopes. Walk on.
Note: When there is an acute exacerbation or severe pain in osteoarthritis, stop the medical gymnastics, or just make a small amount of muscle training with equal length contraction.
(3) Joint protection: A series of simplified and effortless actions to reduce the load on the joints to complete daily activities, so that the affected joints are not strained.
(4) Nutrient intake of antioxidants: It has been observed that chondrocytes may react with reactive oxygen species (ROS), and ROS promote degenerative damage, using micronutrient antioxidants. To protect against this damage process, in Framingham's Knee Osteoarthritis Study (1996), vitamin C, E, and beta carotene were found to help reduce the risk of developing the disease (as seen in radiology), vitamin C. E also helps to prevent pain. In addition, vitamin C is also observed to play a role in the antioxidants, but also contribute to the biosynthesis of prostaglandin in cartilage, thereby inhibiting the biological process of cartilage destruction; vitamin E It also has the effect of alleviating synovial inflammation, which is beneficial to change the process of osteoarthritis. Therefore, vitamin C and E can be used as secondary prevention of osteoarthritis.
(5) Smoking cessation: clinical observations of obesity, high blood pressure, smoking, poor mental state (depression, boredom, etc.), will promote the symptoms of osteoarthritis, should be dealt with these risk factors for the symptoms, including smoking cessation .
(6) Drug treatment: Is it possible for osteoarthritis to use drugs that treat both the symptoms and the symptoms, on the one hand, alleviate the symptoms, and at the same time limit the development of the pathological process of the disease itself, and play a secondary prevention role? There are different opinions. Many people tend to use not only the anti-inflammatory analgesics that have been used for many years, but also the drugs that change the process of osteoarthritis.
Anti-inflammatory and analgesic drugs: This is a palliative drug to relieve pain symptoms. There are many drugs to choose from, but for patients with high risk factors (such as heart, kidney, liver dysfunction, stomach, duodenal ulcer) ), it is not advisable to use anti-inflammatory painkillers with high-risk side effects.
(7) physical factor treatment: mainly used for anti-inflammatory and pain relief, relieve muscle spasm.
(8) Psychotherapy: psychological counseling for the existence of depression and anxiety, health education, psychological state improvement helps prevent and control pain.
Complication
Traumatic arthritis complications Complications Osteoporosis Osteoporotic fractures
Can be complicated by bone collapse, subchondral bone sclerosis, late knee joint space gap disappeared, osteosclerosis knee joint subluxation, lower limb deformity.
Symptom
Traumatic arthritis symptoms Common symptoms Joint pain, wind, cold, dampness, spur formation, joint effusion, joint pain, over-the-line, bone sclerosis, compensatory lumbar lordosis
1. Traumatic history of intra-articular fractures, which are intra-articular fractures. The most common joints are the elbow joints, including the internal or external humerus fractures, followed by the ankle joints, including the ankle and talus fractures, and the knee joint again. Including femoral condyles, humeral condyles and tibia fractures, causing damage to articular cartilage, is one of the most common causes of traumatic arthritis.
2. Excessive weight-bearing due to obesity or fracture deformity healing, intra-knee and valgus deformity, the weight-bearing line moves or moves outward, and the effective weight-bearing area of the articular surface decreases, and the trabecular bone pressure increases in the joint unit area. A small fracture of the trabecular bone occurs, and bone collapse occurs. At the same time, subchondral bone sclerosis occurs. In the advanced stage, the medial joint space of the knee disappears, the osteosclerosis area expands, the lateral joint space widens, and the medial plateau bone mass absorbs, leading to the lateral side. Ligament relaxation and knee subluxation.
3. Congenital malformation is secondary osteoarthritis, which refers to the presence of certain lesions, such as congenital dislocation of the hip joint, acetabular congenital dysplasia, flat hip and other reasons.
4. Symptoms The disease can occur in any age group, but it is more common in young and middle-aged adults. It is often caused by joints with unbalanced weight and active weight bearing after trauma.
(1) Early clinical manifestations: pain and stiffness of the affected joints are more obvious at the beginning of the activity, less after the activity, and the activities are aggravated for a long time. The symptoms are relieved after the rest, and the pain is obviously related to the activity.
(2) Late clinical manifestations: joints are repeatedly swollen, pain persists and gradually worsens, and there may be limited mobility, joint effusion, deformity and intra-articular free body, and rough friction sounds when joints move.
5. Signs
(1) Gait: Different conditions may have special pathological gait, and traumatic arthritis is an anti-pain gait, that is, when walking, when the affected side is on the ground, the foot is quickly replaced due to weight-bearing pain. In order to reduce the weight, the affected limbs are small and the limbs are big.
(2) Malformation: lower limb deformity may occur due to negative gravity changes, such as knee joint, valgus, normal knee joint has a certain range of varus and valgus, physiological valgus angle, normal male about 10 °, female 10 ° ~15 ° standard standing position with two knees, the distance between the two knees is not more than 5cm, if the knee valgus angle is greater than 15 °, the inversion of the knees is greater than 5cm, called the knee, valgus deformity, the disease is clinically varus deformed more see.
Examine
Examination of traumatic arthritis
There is no specific laboratory test for traumatic arthritis. White blood cell count, hematocrit, and serum protein electrophoresis are normal. Except for systemic primary osteoarthritis and traumatic synovitis, erythrocyte sedimentation rate is normal in most cases.
1. X-ray examination This disease is formed after a long period of fracture or joint acute injury. When the injured joint forms a degenerative change, it will show that the joint space is narrowed, the bone end is hardened, and the osteophyte is formed at the edge of the joint. There may be free bodies in the joints, or due to bone growth and development disorders, or bone and joint damage, leaving limb deformities, sometimes combined with calcification or ossification in the soft tissue around the joints. This method is simple and easy.
2. CT can easily obtain cross-sectional scan images, and can reconstruct sagittal or coronal images, so three-dimensional information can be obtained. The density resolution of CT is obviously better than that of X-ray plain films, which is more conducive to the size, extent and extent of joint and soft tissue lesions. Changes in density, as well as the invasion of bone disease to adjacent tissues, certain types of fractures and cartilage-damaged lesions are indications for CT examination.
3. MRI can be used for imaging at any level, with high density resolution, which can accurately distinguish various tissues of the same anatomical region, the contours of organs and the boundaries between them, and the unique airflow effects of MRI. It is beneficial to observe the extent and internal structure of soft tissue and cartilage lesions. MRI has better resolution of soft tissue level than CT, but it does not recognize edema and calcification as CT.
4. ECT can obtain the scintillation map of the whole body bone in one scan. It is suitable for systemic screening examination. The sensitivity of ECT is high, so it can be found early, which is conducive to localization and quantitative examination.
Diagnosis
Diagnosis and diagnosis of traumatic arthritis
Diagnostic criteria
The diagnostic points have the following four points:
1. There is a history of chronic cumulative joint damage or a history of obvious trauma, and the pathogenesis is slow.
2. Early joint joint pain, exercise stiffness, improved after the activity, but the symptoms worsened after overwork.
3. Later joint pain is related to activity. Rough friction may occur during activity, and joint interlocking or intra-articular free body and joint deformation may occur.
4. X-ray examination shows that the joint space is narrowed, the subchondral articular surface is hardened, the edge of the joint is different in degree, and the joint surface is not complete, the bone end is deformed, and there is a loose body in the joint.
Differential diagnosis
1. Osteoarthritis, also known as proliferative arthritis, degenerative arthritis, senile arthritis, this disease is caused by degenerative changes of articular cartilage, joint lesions mainly based on bone hyperplasia, also daily joints The accumulation of activity on articular cartilage damage, the accumulation damage of articular cartilage in older people is more, and the content of mucopolysaccharide in the cartilage matrix is reduced, the fiber component is increased, the elasticity of cartilage is reduced, and it is easy to suffer from mechanical damage. Degenerative changes, the clinical features of the disease: the average age of proliferative arthritis is about 50 years old, and traumatic arthritis can occur in any age group, with obvious history of trauma and accumulation of injuries, the pathogenesis is fundamentally different, Early complaints of bone and joint are joint pain, which is persistent dull pain, or sudden pain during activity, weakness (sliding sensation). Joint pain usually has aggravation after exercise, and it is relieved at rest. The affected joints often have a glue phenomenon. The joint stays in a certain position for a long time, it is difficult to start the activity, the pain is heavier, and it is relieved after a short period of activity. Therefore, the patient does not Resting in a position for too long, it is necessary to change the position frequently. Another characteristic is that the lesion is mostly the degenerative change of the weight-bearing joint of the lower limb. When the affected joint is active or passive, it often hears or touches the hair-like or rupture-like friction sound. X-ray examination: the edge of the joint becomes sharp and gradually develops into cumbersome, while the symptoms of traumatic arthritis are similar to the above, but the biggest difference is caused by intra-articular fracture or fracture deformity.
2. Rheumatoid arthritis This disease is connective tissue disease, joint swelling and pain deformity, activity disorder, rheumatoid arthritis often invade multiple proximal interphalangeal joints, single incidence in negative major joints is rare, the disease begins slowly There are often systemic symptoms and anemia and nodules, etc., laboratory tests: increased erythrocyte sedimentation rate, rheumatoid factor positive, and traumatic arthritis tests are in the normal range.
3. Kaschin-Beck disease Kaschin-Beck disease is a localized bone disease in which children with articular cartilage, tendon cartilage and epiphyseal cartilage degeneration and necrosis are the main lesions. The occurrence of Kashin-Beck disease pain varies with the condition. The condition is heavy and the pain is correspondingly increased. Most of the pain symptoms are accompanied by bending of the distal end of the finger, the fingers are skewed, the pain is often multi-joint, symmetry, especially the knee and ankle joints. The clinical manifestations of early patients are not obvious, affecting the activities of the children. X-ray findings have been very serious, all parts of the body have varying degrees of joint degeneration and secondary hyperplasia changes, this change is multiple, symmetrical and unbalanced, especially the shortening of the calcaneus, is Kaschin-Beck disease Differentiating the important identification basis of other joint degeneration, the patient occurs in the epidemic area and is a strong basis for X-ray diagnosis of Kashin-Beck disease.
