骨性关节炎中的软骨下骨囊肿:软骨下骨异常重建
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摘要
背景:骨性关节炎是骨科最常见的慢性疾病之一。近期研究表明软骨下骨的病变在骨性关节炎的发生发展中具有重要地位,并可能先于并加剧软骨的病变。软骨下骨的病变以异常重建为主要特征,表现为软骨下骨髓病变和软骨下骨囊肿等。当前针对软骨下骨囊肿的研究还不充分,探究软骨下骨囊肿的成因及临床意义有助于从软骨下骨的角度为骨性关节炎的诊治提供新的思路。目的:综述近年骨性关节炎软骨下骨囊肿的成因假说、病理学特征、临床意义、临床诊断及治疗的研究进展。方法:2位共同第一作者应用计算机检索2019年1月及以前PubMed、Embase数据库,英文检索式:(osteoarthritis OR osteoarthrosis OR osteoarthropathy)AND(subchondralcyst OR pseudocyst OR intraosseous cyst OR bone cyst),语言设定为"英语",共检索到1 224篇文献,58篇符合纳入标准,另手工检索11篇文献,最终纳入69篇文献。结果与结论:(1)软骨下骨髓病变可能是软骨下骨囊肿的"前置病变",二者属同一病理变化的不同阶段;(2)软骨下骨囊肿的形成可能与炎性骨吸收后继发反应性成骨有关;(3)软骨下骨囊肿与关节软骨的退变、关节疼痛显著相关;(4)非类固醇抗炎药、抗骨吸收药、软骨下骨成形术、关节置换术中植骨等可能对软骨下骨髓病变/软骨下骨囊肿有治疗作用,但仍需大样本临床试验证明。
BACKGROUND: Osteoarthritis is one of the most common chronic diseases in orthopedics. Pathological changes in subchondral bone, characterized mainly as abnormal remodeling, manifested as subchondral bone marrow lesions and subchondral bone cysts, have been revealed their significance in the pathogenesis and progression of osteoarthritis by recent studies. Pathological changes in subchondral bone may precede which in cartilage and even aggravate it. Given the paucity of studies on subchondral bone cyst, an insight into subchondral bone cyst's pathogenesis and clinical significance may contribute to novel diagnosis and therapy of osteoarthritis in terms of subchondral bone. OBJECTIVE: To summarize the advances in researches on the etio-pathogenic hypothesis, pathological traits, clinical significance, clinical diagnosis and therapy of subchondral bone cysts in osteoarthritis. METHODS: Computer-based searches of PubMed and Embase databases before January 2019 with the mesh terms of "(osteoarthritis OR osteoarthrosis OR osteoarthropathy) AND(subchondral cyst OR pseudocyst OR intraosseous cyst OR bone cyst)" were conducted by two co-first authors. Articles' language was set as "English". A total of 1 224 articles were retrieved after excluding the duplicate ones. 58 articles were eligible for the inclusion criteria to which 11 articles were retrieved manually in addition, thus 69 articles were included eventually. RESULTS AND CONCLUSION:(1) Subchondral bone marrow lesions may be the "predisposed change" of subchondral bone cyst, two of which belong to the respective stage of one pathological process.(2) Subchondral bone cyst may result from the inflammatory bone absorption and subsequent reactive bone formation.(3) Subchondral bone cyst is evidently correlated with cartilage degeneration and joint pain.(4) Non-steroidal anti-inflammatory drugs, anti-absorptive drugs, subchondroplasty, and bone grafting during arthroplasty may ameliorate subchondral bone marrow lesions or subchondral bone cyst. Further large sample clinical trials are warranted.
BACKGROUND: Osteoarthritis is one of the most common chronic diseases in orthopedics. Pathological changes in subchondral bone, characterized mainly as abnormal remodeling, manifested as subchondral bone marrow lesions and subchondral bone cysts, have been revealed their significance in the pathogenesis and progression of osteoarthritis by recent studies. Pathological changes in subchondral bone may precede which in cartilage and even aggravate it. Given the paucity of studies on subchondral bone cyst, an insight into subchondral bone cyst's pathogenesis and clinical significance may contribute to novel diagnosis and therapy of osteoarthritis in terms of subchondral bone. OBJECTIVE: To summarize the advances in researches on the etio-pathogenic hypothesis, pathological traits, clinical significance, clinical diagnosis and therapy of subchondral bone cysts in osteoarthritis. METHODS: Computer-based searches of PubMed and Embase databases before January 2019 with the mesh terms of "(osteoarthritis OR osteoarthrosis OR osteoarthropathy) AND(subchondral cyst OR pseudocyst OR intraosseous cyst OR bone cyst)" were conducted by two co-first authors. Articles' language was set as "English". A total of 1 224 articles were retrieved after excluding the duplicate ones. 58 articles were eligible for the inclusion criteria to which 11 articles were retrieved manually in addition, thus 69 articles were included eventually. RESULTS AND CONCLUSION:(1) Subchondral bone marrow lesions may be the "predisposed change" of subchondral bone cyst, two of which belong to the respective stage of one pathological process.(2) Subchondral bone cyst may result from the inflammatory bone absorption and subsequent reactive bone formation.(3) Subchondral bone cyst is evidently correlated with cartilage degeneration and joint pain.(4) Non-steroidal anti-inflammatory drugs, anti-absorptive drugs, subchondroplasty, and bone grafting during arthroplasty may ameliorate subchondral bone marrow lesions or subchondral bone cyst. Further large sample clinical trials are warranted.
引文
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[38]Rechenberg B,Guenther H,McIlwraith CW,et al.Fibrous tissue of subchondral cystic lesions in horses produce local mediators and neutral metalloproteinases and cause bone resorption in vitro.Vet Surg.2000;29(5):420-429.
[39]Pelletier JP,Lajeunesse D,Reboul P,et al.Diacerein reduces the excess synthesis of bone remodeling factors by human osteoblast cells from osteoarthritic subchondral bone.J Rheumatol.2001;28(4):814-824.
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[41]Li G,Ma Y,Cheng TS,et al.Identical subchondral bone microarchitecture pattern with increased bone resorption in rheumatoid arthritis as compared to osteoarthritis.Osteoarthritis Cartilage.2014;22(12):2083-2092.
[42]Audrey HX,Abd Razak HR,Andrew TH.The truth behind subchondral cysts in osteoarthritis of the knee.Open Orthop J.2014;8:7-10.
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[2]Palazzo C,Nguyen C,Lefevre-Colau MM,et al.Risk factors and burden of osteoarthritis.Ann Phys Rehabil Med.2016;59(3):134-138.
[3]Glyn-Jones S,Palmer AJR,Agricola R,et al.Osteoarthritis.Lancet.2015;386(9991):376-387.
[4]Langdahl B,Ferrari S,Dempster DW.Bone modeling and remodeling:potential as therapeutic targets for the treatment of osteoporosis.Ther Adv Musculoskelet Dis.2016;8(6):225-235.
[5]Everhart JS,Abouljoud MM,Kirven JC,et al.Full-thickness cartilage defects are important independent predictive factors for progression to total knee arthroplasty in older adults with minimal to moderate osteoarthritis:data from the osteoarthritis initiative.J Bone Joint Surg Am.2019;101(1):56-63.
[6]Chen Y,Hu Y,Yu YE,et al.Subchondral Trabecular Rod Loss and Plate Thickening in the Development of Osteoarthritis.J Bone Miner Res.2018;33(2):316-327.
[7]Okada K,Yamaguchi S,Sato Y,et al.Comparison of meniscal extrusion and osteophyte formation at the intercondylar notch as a predictive biomarker for incidence of knee osteoarthritis-Data from the Osteoarthritis Initiative.J Orthop Sci.2019;24(1):121-127.
[8]Xu ZW,Chen TM,Luo J,et al.Cartilaginous Metabolomic Study Reveals Potential Mechanisms of Osteophyte Formation in Osteoarthritis.J Proteome Res.2017;16(4):1425-1435.
[9]Zhu QC,Xu JH,Wang K,et al.Associations between systemic bone mineral density,knee cartilage defects and bone marrow lesions in patients with knee osteoarthritis.International J Rheum Dis.2018;21(6):1202-1210.
[10]Alliston T,Hernandez CJ,Findlay DM,et al.Bone marrow lesions in osteoarthritis:What lies beneath.J Orthop Res.2018;36(7):1818-1825.
[11]Tanamas SK,Wluka A,Pelletier JP,et al.The association between subchondral bone cysts and tibial cartilage volume and risk of joint replacement in people with knee osteoarthritis:a longitudinal study.Arthritis Res Ther.2010;12(2):R58.
[12]Chen Y,Wang T,Guan M,et al.Bone turnover and articular cartilage differences localized to subchondral cysts in knees with advanced osteoarthritis.Osteoarthr Cartilage.2015;23(12):2174-2183.
[13]Ostrowska M,Maslinski W,Prochorec-Sobieszek M,et al.Cartilage and bone damage in rheumatoid arthritis.Reumatologia.2018;56(2):111-120.
[14]Wick MC,Weiss RJ,Jaschke W,et al.Erosions are the most relevant magnetic resonance imaging features in quantification of sacroiliac joints in ankylosing spondylitis.J Rheumatol.2010;37(3):622-627.
[15]Lakhotia D,Swaminathan S,Shon WY,et al.Healing process of osteonecrotic lesions of the femoral head following transtrochanteric rotational osteotomy:a computed tomography-based study.Clin Orthop Surg.2017;9(1):29-36.
[16]Takegami Y,Seki T,Higuchi Y,et al.Independent association of joint space narrowing,cyst formation and health-related quality of life of patients with hip osteoarthritis in Japan.J Orthop Sci.2017;22(6):1096-1101.
[17]Burnett WD,Kontulainen SA,McLennan CE,et al.Knee osteoarthritis patients with severe nocturnal pain have altered proximal tibial subchondral bone mineral density.Osteoarthr Cartilage.2015;23(9):1483-1490.
[18]Raynauld JP,Martel-Pelletier J,Berthiaume MJ,et al.Correlation between bone lesion changes and cartilage volume loss in patients with osteoarthritis of the knee as assessed by quantitative magnetic resonance imaging over a 24-month period.Ann Rheum Dis.2008;67(5):683-688.
[19]McErlain DD,Milner JS,Ivanov TG,et al.Subchondral cysts create increased intra-osseous stress in early knee OA:A finite element analysis using simulated lesions.Bone.2011;48(3):639-646.
[20]Kastelein M,Luijsterburg PA,Koster IM,et al.Knee osteoarthritis in traumatic knee symptoms in general practice:6-year cohort study.BMJ Open Sport Exerc Med.2016;2(1):e000153.
[21]Tanner G,Simon P,Sellers T,et al.Total shoulder arthroplasty with minimum 5-year follow-up:does the presence of subchondral cysts in the glenoid increase risk of failure?J Shoulder Elbow Surg.2018;27(5):794-800.
[22]Casey G.Arthritis:joints inflamed.Nurs N Z.2015;21(5):20-24.
[23]Maruotti N,Corrado A,Cantatore FP.Osteoblast role in osteoarthritis pathogenesis.J Cell Physiol.2017;232(11):2957-2963.
[24]Jones G.What's new in osteoarthritis pathogenesis?Intern Med J.2016;46(2):229-236.
[25]Landells JW.The bone cysts of osteoarthritis.J Bone Joint Surg Br.1953;35-B(4):643-649.
[26]Rhaney K,Lamb DW.The cysts of osteoarthritis of the hip-a radiological and pathological study.J Bone Joint Surg.1955;37(4):663-675.
[27]Carrino JA,Blum J,Parellada JA,et al.MRI of bone marrow edemalike signal in the pathogenesis of subchondral cysts.Osteoarthr Cartilage.2006;14(10):1081-1085.
[28]Crema MD,Roemer FW,Zhu YY,et al.Subchondral cystlike lesions develop longitudinally in areas of bone marrow edema-like lesions in patients with or at risk for knee osteoarthritis:detection with mr imaging-the most study.Radiology.2010;256(3):855-862.
[29]Weber A,Chan PMB,Wen C.Do immune cells lead the way in subchondral bone disturbance in osteoarthritis?Prog Biophys Mol Biol.2017.pii:S0079-6107(17)30181-5.
[30]Bonadio MB,Ormond AG,Helito CP,et al.Bone Marrow Lesion:Image,Clinical Presentation,and Treatment.Magnetic Resonance Insights.2017;10:1-6.
[31]Chan PMB,Wen CY,Yang WC,et al.Is subchondral bone cyst formation in non-load-bearing region of osteoarthritic knee a vascular problem?Med Hypotheses.2017;109:80-83.
[32]Stark DD,Genant HK,Spring DB.Primary cystic arthrosis of the hip.Skeletal Radiol.1984;11(2):124-127.
[33]Chiba K,Nango N,Kubota S,et al.Relationship between microstructure and degree of mineralization in subchondral bone of osteoarthritis:a synchrotron radiation microCT study.J Bone Miner Res.2012;27(7):1511-1517.
[34]Li B,Marshall D,Roe M,et al.The electron microscope appearance of the subchondral bone plate in the human femoral head in osteoarthritis and osteoporosis.J Anat.1999;195(Pt 1):101-110.
[35]Botter SM,van Osch GJ,Waarsing JH,et al.Cartilage damage pattern in relation to subchondral plate thickness in a collagenase-induced model of osteoarthritis.Osteoarthritis Cartilage.2008;16(4):506-514.
[36]McErlain DD,Ulici V,Darling M,et al.An in vivo investigation of the initiation and progression of subchondral cysts in a rodent model of secondary osteoarthritis.Arthritis Res Ther.2012;14(1):R26.
[37]Sabokbar A,Crawford R,Murray DW,et al.Macrophage-osteoclast differentiation and bone resorption in osteoarthrotic subchondral acetabular cysts.Acta Orthop Scand.2000;71(3):255-261.
[38]Rechenberg B,Guenther H,McIlwraith CW,et al.Fibrous tissue of subchondral cystic lesions in horses produce local mediators and neutral metalloproteinases and cause bone resorption in vitro.Vet Surg.2000;29(5):420-429.
[39]Pelletier JP,Lajeunesse D,Reboul P,et al.Diacerein reduces the excess synthesis of bone remodeling factors by human osteoblast cells from osteoarthritic subchondral bone.J Rheumatol.2001;28(4):814-824.
[40]Chiba K,Burghardt AJ,Osaki M,et al.Three-dimensional analysis of subchondral cysts in hip osteoarthritis:an ex vivo HR-pQCT study.Bone.2014;(66):140-145.
[41]Li G,Ma Y,Cheng TS,et al.Identical subchondral bone microarchitecture pattern with increased bone resorption in rheumatoid arthritis as compared to osteoarthritis.Osteoarthritis Cartilage.2014;22(12):2083-2092.
[42]Audrey HX,Abd Razak HR,Andrew TH.The truth behind subchondral cysts in osteoarthritis of the knee.Open Orthop J.2014;8:7-10.
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