Imhof H, Breitenseher M, Kainberger F, Trattnig S
Universitãtsklinik für Radiodiagnostik, Vienna, Austria.
Skeletal Radiol. 1997 Jul;26(7):398-403. doi: 10.1007/s002560050254.
The aetiology of degenerative joint disease is multifactorial, but one main cause is overloading (mechanical stress). While until recently it was well accepted that this represented primarily a disorder of cartilage with reactive subchondral changes, there is now some evidence that it might be primarily a subchondral problem with secondary changes in the articular cartilage. Early subchondral changes include redistribution of blood supply with marrow hypertension, oedema and probably micro-necrosis. These findings are very similar to those in avascular necrosis of bone and raise the question of a vascular aetiology. While these first reports need further proof, it seems clear that the articular cartilage and subchondral regions are one functional unit, in which the subchondral region is more stress sensitive. Recently described channels connecting these two regions strengthen this opinion. These new concepts are exciting and may make a major impact in the near future on the management of and research into degenerative joint disease.
退行性关节病的病因是多因素的，但一个主要原因是负荷过重（机械应力）。直到最近，人们普遍认为这主要是一种软骨疾病，并伴有反应性软骨下改变。然而，现在有一些证据表明，这可能主要是一个软骨下问题，伴有关节软骨的继发性改变。早期软骨下改变包括血液供应重新分布，伴有骨髓高压、水肿，可能还有微坏死。这些发现与骨缺血性坏死的发现非常相似，引发了血管病因的问题。虽然这些初步报告需要进一步证实，但很明显关节软骨和软骨下区域是一个功能单位，其中软骨下区域对压力更敏感。最近描述的连接这两个区域的通道强化了这一观点。这些新概念令人兴奋，可能在不久的将来对退行性关节病的管理和研究产生重大影响。
