McIlwraith C W, Vachon A
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins 80523, USA.
Equine Vet J Suppl. 1988 Sep(6):3-11. doi: 10.1111/j.2042-3306.1988.tb04641.x.
Treatment of degenerative joint disease (osteoarthritis) is discussed in relationship to pathogenesis of five clinical entities, defined to facilitate discussion:-1) occurring in high motion joints and associated with synovitis; 2) associated with low motion joints; 3) "non-progressive" articular cartilage erosion; 4) secondary to other identified problems (intra-articular fractures, ligamentous damage, wounds, septic arthritis, osteochondrosis); and 5) chondromalacia of the patella. In addition to direct damage to articular cartilage, synovitis and capsulitis and depletion of matrical glycosaminoglycans and proteoglycans play important roles. The natural healing response in damaged articular cartilage is inadequate. The principles of treatment are divided into: 1) prevention or treatment of primary causes. These include the effects of track surface, shoeing, and the appropriate resolution of intra-articular fractures, septic arthritis and osteochondritis dissecans. 2) treatment of active soft tissue disease contributing to articular cartilage degeneration, including rest, physical therapy, synovectomy and administration of anti-inflammatory drugs, sodium hyaluronate and polysulfated glycosaminoglycans. 3) attempts at treatment of articular cartilage loss or degeneration, including articular cartilage curettage, subchondral bone drilling, osteophyte removal, articular cartilage grafting and arthrodesis.
退行性关节病（骨关节炎）的治疗将结合五种临床病症的发病机制进行讨论，这五种病症的定义有助于讨论：-1）发生在活动频繁的关节并伴有滑膜炎；2）与活动较少的关节相关；3）“非进行性”关节软骨侵蚀；4）继发于其他已确定的问题（关节内骨折、韧带损伤、伤口、化脓性关节炎、骨软骨病）；5）髌骨软骨软化症。除了对关节软骨的直接损伤外，滑膜炎、关节囊炎以及基质糖胺聚糖和蛋白聚糖的消耗也起重要作用。受损关节软骨的自然愈合反应不足。治疗原则分为：1）预防或治疗原发性病因。这些包括跑道表面、蹄铁的影响，以及关节内骨折、化脓性关节炎和剥脱性骨软骨炎的适当处理。2）治疗导致关节软骨退变的活动性软组织疾病，包括休息、物理治疗、滑膜切除术以及使用抗炎药物、透明质酸钠和多硫酸化糖胺聚糖。3）尝试治疗关节软骨缺失或退变，包括关节软骨刮除术、软骨下骨钻孔术、骨赘切除术、关节软骨移植术和关节融合术。
