Obayashi O
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo.
Ryumachi. 1996 Aug;36(4):627-36.
In order to investigate the status of osteoporosis associated with rheumatoid arthritis, a histomorphometric study was performed on the specimens taken from the iliac bone of the patients who underwent total knee arthroplasty. All of them had received double tetracycline labeling preoperatively. Twenty consecutive patients admitted to Nakaizu Spa Hospital for the surgery from February to July, 1989 were subjected for the study. All the patients were women with the age ranging from 38 to 68 years (aver. 56.8 years). Seventeen out of the 20 patients were of class 3 or more according to Steinbrocker's staging. There were MUD (multilating disease), 14 MES (more erosive subset) and no LES (least erosive subset) patients according to Ochi's classification. Basically the Frost's method was used for the morphometric examination, and Parfitt's histomorphometric parameters were used for the results evaluation. The results demonstrated that bone volume and trabecular thickness were decreased whereas bone absorption and bone formation rate were increased. Histological findings showed resemblance with that of hyperparathyroidism in view of thin trabecular pattern. The osteoporosis in the present rheumatoid patients were considered to be due to abnormal bone remodeling, secondary to high turn-over of the bone. The bone in the more advanced type (MUD) patients showed much increased bone turn-over and osteoporosis than that of less advanced ones (MES). Hence force, the degree of osteoporosis was in positive relationship with the severity of rheumatoid arthritis. The postoperative clinical results were assessed by the Japanese Orthopaedic Association (JOA) Rheumatoid Knee Scoring System. Sixteen out of the 20 patients survived at the time of the follow-up (follow-up period: 4 years and 4 months to 6 years and 8 months). Among them, 11 patients were directly examined and the remaining five patients answered a questionnaire. The JOA score showed no correlation with bone volume or bone formation rate, but significant negative correlation with bone eroded surface and osteoclast surface in the morphometric examination.
为了研究类风湿性关节炎相关的骨质疏松症状况，对接受全膝关节置换术患者的髂骨标本进行了组织形态计量学研究。所有患者术前均接受了双四环素标记。选取了1989年2月至7月间连续入住中津温泉医院接受手术的20例患者进行该研究。所有患者均为女性，年龄在38至68岁之间（平均56.8岁）。20例患者中，根据斯坦布鲁克分期，有17例为3级或更高。根据奥奇分类，有14例多关节破坏型（MUD）、无最少侵蚀型（LES）患者，有14例侵蚀性更强亚型（MES）患者。形态计量学检查基本采用弗罗斯特方法，结果评估采用帕菲特组织形态计量学参数。结果表明，骨体积和骨小梁厚度降低，而骨吸收和骨形成率增加。组织学结果显示，鉴于骨小梁模式较细，与甲状旁腺功能亢进相似。目前类风湿患者的骨质疏松症被认为是由于骨高转换继发的骨重塑异常所致。病情较重类型（MUD）患者的骨转换和骨质疏松症比病情较轻者（MES）明显增加。因此，骨质疏松症的程度与类风湿性关节炎的严重程度呈正相关。术后临床结果采用日本矫形外科学会（JOA）类风湿性膝关节评分系统进行评估。20例患者中有16例在随访时存活（随访期：4年4个月至6年8个月）。其中，11例患者接受了直接检查，其余5例患者回答了问卷。JOA评分与骨体积或骨形成率无相关性，但与形态计量学检查中的骨侵蚀表面和破骨细胞表面呈显著负相关。
