【作者】 秦霞南；

【导师】 李金荣；

【作者基本信息】 武汉大学 ， 口腔临床医学， 2004， 博士

【摘要】 颞下颌关节骨关节病(osteoarthrosis,OA)是以关节软骨的破坏与耗损为主要特征，伴发软骨下骨组织改建和滑膜相应病变的一种退行性疾病。它是由于软骨细胞控制的合成代谢与分解代谢不平衡所导致的，临床上常表现为关节疼痛、弹响、杂音及功能障碍。迄今为止，对OA的病因及病理机制还不甚清楚，临床上对其治疗与否主要是根据物理检查及影像学检查进行评价。虽然关节的影像学检查可能揭示一些与这一疾病相关的结构上的变化，但其检查结果与其临床症状并不总是相符的，而且对于OA的治疗至今没有找到一种理想的方法。因此，对骨关节病的病因、病理特征、临床诊断以及治疗方法进行研究是很有必要的。本课题由三部分组成，集中研究了骨关节病组织病理特点、临床诊断以及治疗。 第一部分 颞下颌关节骨关节病的组织病理学研究 目的：研究颞下颌关节骨关节病的病理特点及其临床意义。 材料和方法：选取30例经临床检查、X线检查所确诊的OA患者，其中男性6例，女性24例，年龄范围16～69岁，平均年龄35岁；另外选取8例非颞下颌关节疾病而进行髁突切除的正常关节软骨做正常对照。所有获取的新鲜标本都用4％的福尔马林固定，然后用5％的甲酸脱钙，梯度酒精脱水，石蜡包埋，5um厚连续切片，HE染色，光镜观察。 结果：正常髁突软骨表面光滑，有光泽。在镜下，可观察到软骨从表及里可分为四层：纤维层，增殖层，肥大层，钙化软骨层。骨关节病关节软骨软化，表面干枯粗糙，无光泽，弹性丧失；有的软骨表面出现磨损及破裂，可见明显的粗糙面及溃疡，有的部分或者完全剥脱。镜下见：表面层胶原纤维毛糙，排列紊乱，纤维水肿，互相分离，有的纤维断裂，出现水平裂隙及垂直裂隙；增殖带变薄甚至消失，但是有的表现为软骨层明显增厚，增殖带内未分化间充质细胞较多；肥大带内可见到较多软骨细胞，有的细胞内有空泡形成；钙化软骨带内有较多软骨细胞，有的软骨细胞向下方骨质内生长，致使武汉大学口腔医学院博士学位论文2004.4软骨带与软骨下骨质界限不清，有的在钙化层与非钙化层之间出现明显的潮标线;密质骨变薄，软骨直接与松质骨骨髓腔相通，软骨剥脱者，骨质暴露，有肉芽组织长入骨髓腔中。 结论:骨关节病的主要病理特征表现为关节软骨的破坏和增生，有时伴随软骨下骨质的破坏与改建。更多还原

【Abstract】 Osteoarthrosis(OA) is a degenerative joint disease that is characterized by articular cartilage degradation and concomitant reparative osteogenesis.OA results from an imbalance between predominantly chondrocyte controlled anabolic and catabolic processes. Its clinical symptoms and signs include joint pain, click, crepirus and dysfunction. Hitherto, its etiology and pathology is not clear and its implication of treatment is majorly based on clinical symptoms ,signs and radiographic findings. Though radiographic examination can exhibit structural change, it is not always correspond with symptoms and signs of OA. Furthermore, treatment of OA is not ideal .It is necessary to study its etiology, pathology, clinical diagnosis and treatment. The present study consists of three parts.Part 1: Clinical pathology study of temporomandibular osteoarthrosis.Objective: To study pathology of temporomandibular osteoarthrosis and its clinical features.Methods: The study consisted of 30 patients (6 males and 24 females); the ages ranged from 16 to 69 years, with an average age of 35 years. All specimens were gained by surgery .The gross specimens were fixed in a solution of 4% neural formaldehede, decalcified by 5% formic acid and dehydrated in a graded series of alcohol;Results: Under micrograph,pathological changes varying extent were found in all OA specimens. In some cases,focal swelling,irregularities of the cartilage surface were found; thinning of the cartilage with loss of the hypertrophic cell zone and even vertical and horitical splitting in the cartilage were observed ;The collagen network showed signs of disorganization addition,proliferation and cluster formation of chondrocytes were found. However, chondrocyte degeneration and necrosis can also be found.Sometimes the cartilage2004.4were completely destroyed and replaced by fibrous tissue,extending through subchondral bone into marrow spaces ;remnants of cartilage and remodelling of adjacent bone were also seen.Conclusion:OA is characterized histologically by degeneration and proliferation of articular cartilage .associated with destroying and remodelling of the underlying bone.更多还原