创伤性关节炎研究现状与展望(2)-找论文网

2.2.3 手术治疗当症状严重且药物治疗效果不佳时才考虑手术治疗，关节镜检术能够对退变的关节软骨进行清创和冲洗，从而缓解症状，最近Morrey通过研究表明，关节镜镜检术能够较好的改善创伤后肘关节僵硬［34］。但关节镜检术却不能阻止创伤性关节炎的发展。从病变关节的软骨板边缘取正常的软骨，在体外培养再植入关节软骨的缺损处，这种自体软骨移植是一种有效的技术，但是由于这种技术比较昂贵，所以目前并不推荐作为治疗创伤性关节炎软骨缺损的首选治疗方法［35］。通过截骨来改变创伤性关节炎的负重面，对于早期的创伤性关节炎能够缓解症状并减慢病程的发展，但其作用也较为有限。关节融合术对于缓解症状效果很好，可以用于腕关节、脊柱、踝关节等处，但术后关节将失去功能。对于许多患者来说，关节置换能够既缓解症状又保留关节功能，是一种较好的治疗方法；但是关节置换有一定的使用寿命，而且对国内患者来说其费用也是一个问题。

3 展望

回顾近10年来创伤性关节炎在实验和临床研究，应该看到，在研究取得巨大进展的同时仍有很多问题值得进一步深入研究：创伤引发关节炎发生的机制，各种炎症因子和炎症细胞在促进创伤性关节炎发展中的具体作用及相互作用，如何早期诊断创伤性关节炎，能否逆转创伤性关节炎的病变及如何更为有效的治疗创伤性关节炎都是值得进一步探讨的课题，相信今后在创伤性关节炎的研究上定会取得更大的进展。

【参考文献】
［1］ Martin JA，Brown T，Heiner A，et al．Posttraumatic osteoarthritis:the role of accelerated chondrocyte senescence［J］．Biorheology,2004,41(3-4)：479-91．

［2］ Kopec JA，Sayre EC．Traumatic experiences in childhood and the risk of arthritis：a prospective cohort study［J］．Can J Public Health,2004,95(5)：361-65．

［3］ Haq I，Murphy E，Dacre　ＪOsteoarthritis［J］．Postgrad　Med J,2003,79(933)：377-83．

［4］ Conrozier T，ChappuisCellier C，Richard M，et al．Increased serum Creactive protein levels by immunonephelonletry in patients with rapidly destructive hip osteoarthritis［J］. Rev Rhunl Engl Ed，1998，65(12):759-65.

［5］ Wolfe Ｆ. The Creactive protein but not erythrocyte sedimentation rate is associated with clinical severity in patients with osteoarthritis of the knee or hip［J］. J Rheumatol， 1997，24:1486-1488.

［6］ Haywood L, McWilliams DF, Pearson CＩ， et al. Inflammation and angiogenesis in osteoarthritis［J］. Arthritis Rheum, 2003,48(8):2173-2177.

［7］ Gabay C, Kushner I. Acutephase proteins and other systemic responses to inflammation［J］. N Engl J Med, 1999,340(6):448-454.

［8］ Liu R, O'Connell M, Johnson K, et al. Extracellular signalregulated kinase I/extracellular signalregulated kinase 2 milogenactivated protein kinase signaling and activation of activator protein 1 and. nuclear factor kappaB transcription factors play central roles in interleukin8 expression stimulated by monosodium urate monohydrate and calcium pyrophosphate crystals in monocytic cells［J］. Arthritis Rheum,2000,43(5):1145-1155.

［9］ Niissalo S, Hukkanen M, lmai S, et al. Neuropeptides in experimental and degenerative arthritis［J］. Ann N Y Acad Sci, 2002,966:384-399.

［10］Walsh DA. Angiogenesis and arthritis［J］. Rheumatology, 1999,38(2):103-112.

［11］Mayer DJ, Mao J, Holt J, et al. Cellular rnechanisms of neuropathic pain, morphine tolerance, and their interactions［J］. Proc Natl Acad Sci USA，1999，96(14):7731-7736.

［12］Kidd BL, Urban LA. Mechanisms of inflammatory pain［J］. Br J Anaesth， 2001，87(1):3-11.

［13］Sandy JD. Proteolytic degradation of normal and osteoarthritic Cartilage rnatrix. In: Brandt KD, Doherty M, Lohmander LS, eds. Osteoarthritis［M］. New York: Oxford University Press, 2003，82-91.

［14］Pule T, Petersen W, Tilhnann B, et al. The splice variants VEGF121 and VEGF189 of the angiogenic peptide vascular endothelial growth factor are expressed in osteoarthritic cartilage［J］. Arthritis Rheum, 2001,44(5):1082-1088.

［15］Deckers MM, van Bezooijen RL, van der Horst G, et al. Bone morphogenetic proteins stimulate angiogenesis through osteoblastderived vascular endothelial growth factor A［J］. Endocrinology， 2002, 143(4):1545-1553.

［16］Lingen MW. Role of leukocytes and endothelial cells in the development of angiogenesis in inflammation and wound healing［J］. Arch Pathol Lab Med， 2001， 125(1 ):67-71.

［17］Jackson JR, Minton JA, Ho ML, et al. Expression of vascular endothelial growth factor in synovial fibroblasts is induced by hypoxia and interleukin I beta［J］. J Rheumatol，1997，24(7):1253-1259.

［18］Giatromanolaki A, Sivridis E, Maltezos E, et al. Upregulated hypoxia inducible factorlalpha and 2alpha pathway in rheumatoid arthritis and osteoarthritis［J］. Arthritis Res Ther， 2003，5(4):193-201.

［19］BucklandWright CJ. Quantitative radiography in osteoarthritis: microfocal radiography［J］. Baillems Clin Rheumatol, 1996,10:415-420.

［20］Bruyere O, Honore A, Giacovelli G, et al. Radiologic features poorly predict clinical outcomes in knee osteoarthritis［J］. Scand J Rheumatol， 2002，31(1):13-16.

［21］DeGroot J, Bank, RA, Tchetverikov I, et al. Molecular markers for osteoarthritis: the road ahead［J］. Curr Opin Rheumatol, 2002,14:585-589.

［22］Vignon E, Garnero P, Delmas P, et al. Recommendations for the registration of drugs used in the treatment of osteoarthritis: an update on biochemical markers［J］. Osteoarthritis Cartilage， 2001，9(4):289-293.

［23］Otterness IG, Swindell AC, Zimrnerer RO, et al. An anlaysis of 14 molecular markers for monitoring osteoarthritis: segregation of tile markers into clusters and distinguishing osteoarthritis at baseline［J］.Osteoartllritis Cartilage, 2000,8:180-185.

［24］WalkerBone K, Javaid K, Arden N, et al. Medical management of osteoarthritis［J］. BMJ， 2000，321(7266):936-940.

［25］Thomas KS, Muir KR, Doherty M, et al. Home based exercise programme for knee pain and knee osteoarthritis: randomised controlled trial［J］. BMJ， 2002，325(7367):752-756.

［26］Messier SP， Loeser RF， Mitchell MN, et al. Exercise and weight loss in obese older adults with knee osteoarthritis: a preliminary study［J］. J Am Geriatric Soc， 2000，48(9):1062-1072.

［27］Altman RD, Hochberg MC, Moskowitz RW, et al. Recommendations for the medical management of osteoarthritis of the hip and knee［J］. Arthritis Rheum, 2000,43:1905-1915.

［28］Courtney P, Doherty M. Key questions concerning paracetamol and NSAIDs for osteoarthritis［J］. Ann Rheum Dis, 2002,61(9):767-773.

［29］Brandt KD, Bradley JD. Should the initial drug used to treat osteoarthritis pain be a nonsteroidal antiinflammatory drug［J］. J Rheumatol, 2001,28:467-473.

［30］Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis［J］. N Engl J Med，2000，343(21):1520-1528.

［31］Reginster JY, Deroisy R, Rovati LC, et al. Long term effects of glucosamine sulphate on osteoarthritis progression. A randomised, placebo controlled trial［J］. Lancet， 2001，357(9252):251-256.

［32］McAlindon TE, LaValley MP, Gulin JP, et al. Glucosamine and chondroitin for treatment of osteoarthritis: a systematic quality assessment and metaanalysis［J］. JAMA, 2000,283(11):1469-1475.

［33］Hughes R, Carr A. A randomised, doubleblind, placebocontrolled trial of glucosamine sulphate as an analgesic in osteoarthritis of the knee［J］. Rheumatology， 2002，41:279-284.

［34］Morrey BF. The posttraumatic stiff elbow［J］. Clin Orthop Relat Res,2005,(431):26-35.

［35］National Institute for Clinical Excellence. Technology appraisal guidance No 16. Guidance on the use of autologous cartilage transplantation for full thickness cartilage defects in knee joints［S］. London: NICE,December, 2000.

共2页: 上一页 [1] 2

非退变型腰椎间盘突出症的界定及其治疗

人工关节置换术后感染诊断及治疗