摘要
背景:疾病和创伤等常伴有关节滑膜的改变,由于膝关节滑膜的分布范围较大,各部病变形态不一,为临床诊治带来困难。目的:观察膝关节滑膜在髌上囊、髌下深囊、髌软骨上缘和后内侧隐窝处的大体形态学和组织学改变,寻找患者膝关节病变的滑膜变化特征。设计、时间及地点:单一样本观察,于2008-10/12在成都医学院解剖学实验室完成。材料:经MRI检查具有膝关节滑膜增厚或关节腔积液的新鲜尸体标本15具(30侧膝关节),其中风湿性关节炎6例、结核性滑膜炎4例、银屑病关节炎3例和肠病性关节炎2例。方法:对30侧膝关节标本进行解剖,充分暴露髌上囊、髌下深囊、髌软骨上缘、后内侧隐窝处滑膜,进行大体形态学观察;并于上述部位取材,经苏木精-伊红染色行组织学观察。主要观察指标:膝关节滑膜大体形态学观察及组织学观察结果。结果:大体观察显示:髌软骨上缘处滑膜质地变硬发生率为87%(26/30)、髌上囊内滑膜厚度大于5mm发生率为73%(22/30)、髌下深囊内滑膜表面粗糙发生率为70%(21/30),与其他部位比较差异均有显著性意义(P<0.001)。组织学观察显示:髌软骨上缘、后内侧隐窝处滑膜细胞及小血管增生发生率分别为80%(24/30)和57%(17/30)、间质纤维化及玻璃样变发生率分别为83%(25/30)和74%(22/30),与其他部位比较差异均有显著性意义(P<0.001)。结论:髌下深囊、髌上囊、髌软骨上缘处滑膜易发生大体形态学改变,后内侧隐窝和髌软骨上缘处滑膜是组织学改变最显著的部位。
BACKGROUND： The majority of joint diseases and injuries are often accompanied with synovial changes. As the synovial membrane is distributed widely within the knee joint, pathological changes at different sites are different, leading to the difficulty in clinical diagnosis and treatment. OBJECTIVE： To observe the general morphologic and histological changes of the synovial membrane of the knee joint at the suprapatellar bursa, deep infrapatellar bursa, superior border of patella-cartilage and post-wall crypt, and to explore the synovial changing characteristics following patients’ knee joint lesions. DESIGN, TIME AND SETTING： The observation of a single sample was performed in Department of Anatomy, Chengdu Medical College from October to December 2008. MATERIALS： Fifteen fresh cadaver specimens with the knee joint synovial thickening or joint effusion confirmed by MRI were selected, of which 6 cases were rheumatoid arthritis, 4 cases were tuberculous synovitis, 3 cases were psoriatic arthritis and 2 cases were enteropathy arthritis. METHODS： Bilateral knee joints （30 sides） of 15 cadaver specimens were anatomized to expose the suprapatellar bursa, deep infrapatellar bursa, superior border of patella-cartilage and post-wall crypt for general morphologic observation, and then the above specimens were observed histologically after hematoxylin-eosin staining. MAIN OUTCOME MEASURES： The results of general morphology and histology observation. RESULTS： The general observation revealed that 26 of the 30 sides were present with synovial hardening at the superior border of patella-cartilage, accounting for 86.67%, 22 of the 30 sides （73.33%） present with synovial thickness 〉 5 mm at the suprapatellar bursal, and 21 of the 30 sides （70 %） present with synovial roughness at the deep infrapatellar bursal. Every index of the rest parts had a significant deviation （P 〈 0.001）. Histology observation showed that, at the superior border of patella-cartilage and post-wall crypt, hyperplasia incidences of synovial cells and small vessels were 80 %（24/30）and 56.67%（17/30）, respectively, and interstitial fibrosis and hyalinization was 83.33% （25/30） and 73.53%（22/30）, respectively, which significantly differed from other parts（P 〈 0.001）. CONCLUSION： Synovial membrane at the deep infrapatellar bursa, suprapatellar bursa, and superior border of patella-cartilage was easily changed in morphology, and the histological variation was often found in the superior border of patella-cartilage and post-wall crypt.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第33期6461-6464,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
四川省教育厅资助项目(08zc040)~~
