Degenerative disease of the knee
Introduction
Introduction to knee degenerative diseases Knee degenerative diseases, also known as osteoarthritis, osteoarthrosis, degenerative joint disease, proliferative arthritis, hypertrophic arthritis, senile arthritis, etc., are the most common chronic and progressive joint diseases. . Its pathological features are articular cartilage degeneration, destruction, subchondral bone sclerosis, reactive hyperplasia of the joint edge and subchondral bone, and osteophyte formation. basic knowledge The proportion of illness: 0.078% Susceptible people: good for middle-aged and older people over 40 years old and engaged in weight-bearing, long-standing, sedentary staff Mode of infection: non-infectious Complications: swelling
Cause
Causes of knee degenerative disease
Pathogenesis
The normal knee-off surface has a thin, but very friction-resistant hyaline cartilage that is light blue, translucent, smooth and shiny. This layer of friction-resistant hyaline cartilage is very important in the motor function of the knee joint. The knee joint is the most weight-bearing joint in the human body, and it is also the earliest and most damaged joint in the human body. Middle-aged and elderly people over the age of 45, especially women, may cause degeneration and shrinkage of the hyaline cartilage of the knee joint due to the decrease in hormone levels in the body. Coupled with some minor damage, the smooth, mirror-like hyaline cartilage will appear spotted. The "rust spots", that is, local necrosis. At this point, the body will mobilize a variety of internal forces to repair "rust spots," including more and more joint fluid and bone repair. However, the exudate joint fluid is an acidic liquid, which is not only unfavorable for the repair of "rust spots", but instead forms a variety of chemical inflammatory mediators, causing a series of symptoms such as swelling, pain, and difficulty walking around the joints.
Prevention
Knee degenerative disease prevention
1. Avoid long-term strenuous exercise
Long-term, excessive, intense exercise or activity is one of the basic causes of this disease. Especially for heavy joints (such as knee joints and hip joints), excessive movement increases the joint surface and increases wear. Long-term intense exercise can also cause excessive stress and traction on the bones and surrounding soft tissues, resulting in local soft tissue damage and uneven force on the bones, so long-term strenuous exercise should be avoided.
2, appropriate physical exercise
Avoiding long-term intense exercise is not inactive. On the contrary, proper physical exercise can effectively prevent this disease. Because the nutrition of articular cartilage comes from joint fluid, and the joint fluid can only enter the cartilage by "squeezing", promoting the metabolism of cartilage. Proper exercise, especially the movement of the joints, can increase the pressure in the joint cavity, facilitate the penetration of the joint fluid into the cartilage, reduce the degenerative changes of the articular cartilage, thereby reducing or preventing the hyperplasia and degenerative changes of the articular cartilage.
3, timely treatment of joint damage
Joint damage includes soft tissue damage and bone damage. Degenerative lesions of the joint are often directly related to intra-articular fractures. Due to incomplete fracture reduction, the articular cartilage surface is not flat, resulting in traumatic arthritis. For patients with intra-articular fractures, if they can be treated in time, anatomic reduction can completely avoid the occurrence of traumatic arthritis and joint degenerative diseases.
4, reduce weight
Overweight is one of the important reasons for the degeneration of the spine and joints. Excessive weight will accelerate the wear of the articular cartilage and make the pressure on the articular cartilage surface uneven. Therefore, for people who are overweight, proper weight loss can prevent degenerative diseases of the spine and joints.
Complication
Complications of knee degenerative disease Complications swelling
Can cause joint swelling and muscle atrophy.
Symptom
Knee degenerative symptoms common symptoms limb pain joint migration pain, swollen joint swelling joint stiffness
pain
It is characterized by increased pain during activities, reduced rest, and pain or even heavier activity. It is especially difficult to go up and down the stairs. You can only use one leg with a good leg or a light symptom to climb up and down the stairs. Instead of going up and down the stairs like a normal person, it is often more difficult to go down the stairs than to go up the stairs. Joint sprains, cold, and overwork can often induce or aggravate joint pain. In severe cases, the legs cannot move and affect sleep.
Joint swelling
Joint swelling is caused by synovial hyperplasia and intra-articular effusion. It is often caused by a sprain in the initial stage, and it will become a persistent swelling. There is a sense of friction when the joints move or listen to the sound.
Knee soft
Also called soft legs. The phenomenon that the knee joint suddenly becomes soft and the person wants to trip or fall is accompanied by severe pain. "Glue" phenomenon: after the joint is stationary for a long time at a certain position, it is very painful when it is active. The flexion and extension cannot be performed. After a certain period of time, it must be gradually moved for a while, the "glue" phenomenon will disappear, and the knee joint can flex and stretch. . If you take a bus, you often need to stand one stop in advance, and the patient has to stand up to the active joints in order to get the car.
Twist lock
It means that during walking and other exercises, the knee joint is suddenly locked in a certain position and cannot move. If something is stuck in the joint, it is often necessary to test the joint to bend and stretch, often after feeling "cracking". The joints resume their original activities. Free bodies formed by exfoliation of articular cartilage and ruptured meniscus are common causes of joint locks.
Joint dysfunction
Due to cartilage destruction, osteophyte formation, synovial hyperplasia, the knee joint can not be fully extended, the flexion is not complete, can not squat and hold weight, and even difficult to sit. Joint deformity: As the disease progresses, the knee joint becomes coarse and deformed, such as the "O" leg.
Examine
Examination of knee degenerative disease
If patients do blood tests, erythrocyte sedimentation rate, C-reactive protein, anti-chain "O", rheumatoid factor and other tests, generally in the normal range, a small number of severe inflammation, ESR and C-reactive protein may be slightly elevated.
1, synovial fluid examination
Involved joints such as associated with synovitis can increase the amount of synovial fluid. Typical is clear, sticky, and the number of cells is not high (<20 × 10 / liter), mostly mononuclear cells. Cartilage or cartilage debris can be seen, and chondrocytes can be seen in cartilage fragments.
2, arthroscopy
Can directly observe the internal conditions of the joint, can clearly observe the articular cartilage and its surrounding tissue, but because this examination is a traumatic examination, may be associated with adverse reactions such as infection or bleeding, and the cost is high, it is impossible to be a routine examination.
3, X-ray film
Track changes in the condition. When taking a knee joint piece, the patient should take the front and back position and the lateral position piece of the standing position, and the hip joint and the hand joint can only take the front and rear position piece. In the early stage, most of the X-ray films are normal. In the middle and late stages, the asymmetry of the joint space is narrow, the articular surface is hardened and deformed, the joints of the joints are formed, the cystic changes of the articular surface and the free body of the joint cavity. The x-ray features of osteoarthritis are: 1 joint gap stenosis, such as in the knee joint, can be less than 3 mm. 2 joint surface hardening deformation. 3 joint edge osteophytes. 4 joint mice. 5 subchondral cystic changes, the edge boundary is clear. 6 bone deformation or joint subluxation.
X-ray films can be divided into five levels. Level 0: No change. Level 1: Slightly osteophytes. Grade 2: obvious osteophytes, normal joint space. Grade 3: moderate stenosis of the joint space outside the epiphysis. Grade 4: The joint space of the epiphysis is severely narrowed with subchondral bone sclerosis.
4, other
With imaging new technologies such as micro-focus photography. The application of CT, magnetic resonance and three-dimensional reconstruction, in addition to the diagnosis of osteoarthritis, has a reference value for detailed understanding of the pathological progress of osteoarthritis and drug efficacy.
Diagnosis
Diagnosis and differentiation of knee degenerative diseases
Corresponding diagnosis can be made based on clinical manifestations and related examinations.
