膝关节骨关节炎.ppt

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1、OSTEOARTHRITISOFTHEKNEEBACKGROUNDOsteoarthritis:MostcommoncausesoffunctionaldisabilityandseverepainTheprevalenceofarthriticsymptomsamongadultsismorethan50%BACKGROUNDOsteoarthritis:BeginingwithdamageandprogressivedegradationofarticularhyalinecartilagestructureandfunctionCartilagethick

2、nesslossRemodelingandattritionofsubarticularboneGrowthofosteophytesSynovitis,ligamentouslaxity,andperiarticularmuscleweaknessJointtiltingandmalalignmentNormalandarthritickneeEPIDEMIOLOGY–riskfactorsAgeObesityWork-relatedbendingandheavyphysicalworkloadRecreationalandphysicalsportingac

3、tivitiesHyaluronicacidserumlevelsKneeinjuryCongenitalconditionsSystemicmetabolicdiseasesEndocrinediseasesBonedysplasiasCalciumcrystaldepositiondiseasesCLASSIFICATIONPrimary(idiopathic)articulardegenerationoccursintheabsenceofanobviousunderlyingabnormalitySecondaryresultfromsomeriskfa

4、ctors(injury,repetitivemotionsuchasfoundincertainoccupations,congenitalconditions,systemicmetabolicdiseases,etc.)DIAGNOSISDiagnosticcriteriaforosteoarthritisoftheknee(proposedbytheAmericanCollegeofRheumatology,ACR)First:presentingwithpainSecond:meetingatleastfiveofthefollowingcriteri

5、a:Patientolderthan50yearsofageLessthan30minutesofmorningstiffnessCrepitus(noisy,gratingsound)onactivemotionBonytendernessBonyenlargementNopalpablewarmthofsynoviumErythrocytesedimentationrate(ESR)<40mm/hrRheumatoidfactor<1:40NoninflammatorysynovialfluidDIAGNOSISX-rayMRIDIAGNOSISMolecu

6、larbiomarkerssC2C(serumcartilagetypeIIcollagencleavagebycollagenase)sCPII(serumcartilagetypeIIprocollagencarboxypropeptide)sHA(serumhyaluronicacid)uNTX(urineN-terminalcrosslinkingtelopeptideoftypeIcollagen)uCTX-II(urinecartilagetypeIIcollagenC-telopeptide)uCTX-II(urinecartilagetypeII

7、collagenC-telopeptideRelationshipsbetweenbiomarkersofjointmetabolismandcartilage,bone,synovialmetabolismmayreflectearlychangesincartilagestructurew/okneepainEVALUATIONSYSTEMKneeinjuryandOsteoarthritisOutcomeScore(KOOS)LikertscaleSF-36WesternOntarioandMcMasterosteoarthritis(WOMAC)scal

8、eVASscoringE