Вплив ступеня артрозу колінного суглобу на вираженість синовіїту. Результати УЗД

Abstract

За допомогою ультразвукового методу виявлені 4 стадії вираженості синовіїту та 4 стадії артрозу колінного суглобу. Проаналізовано залежність вираженості синовіїту колінного суглобу від ступеня артрозу. Доведено, що пацієнти з більшим ступенем артрозу колінного суглобу мають більш виражений синовіїт колінних суглобів. Визначено схему розвитку неспецифічного синовіїту колінних суглобів. Досліджено, яким чином розвивається хронічний синовіїт. Він не буває вираженим та напруженим, так як є похідним комбінованої взаємодії зростаючого навантаження на м’язи та виражених ступенів артрозу; С помощью ультразвукового метода определены 4 стадии выраженности синовиита и 4 стадии артроза коленного сустава. Проанализирована зависимость выраженности синовиита коленного сустава от степени артроза. Доказано, что пациенты с большей степенью артроза коленного сустава имеют более выраженный синовиит коленных суставов. Определена схема развития неспецифического синовиита коленных суставов. Доказано, каким образом развивается хронический синовиит. Он не бывает выраженным и напряженным, так как является производным комбинированного взаимодействия возрастающей нагрузки на мышцы и степени выраженности артроза; Four stages of synovitis severity and four stages of gonarthrosis have been identified using ultrasound method. 461 patients have been examined during the period 08-09.2016, namely, 153 (33.2%) men and 308 (66.8%) women aged from 13 to 80 years, 218 (47.3%) – city-dwellers and 243 (52,7%) − rural residents. All the patients have been exposed to US examination of their both knee joints by the standard method for device company «BK Medical» with linear transducer with a frequency of 12.0 MHz. The front, side area and popliteal space in longitudinal and transverse projections have been scanned. Complaints about pain in the front thigh and shin have been considered. The dependence of the severity of knee synovitis from gonarthrosis degree has been analysed. It was determined that patients with higher stage of gonarthrosis have more marked knee joint synovitis. The scheme of development of nonspecific synovitis of the knee joint has been defined. With the absence of arthrosis and with its initial signs the protective properties of cartilage are not violated because synovitis develops when the load increases on account of increase in muscle spasm. Growth and expansion of the spasm up to 1/3 corresponds to most marked, intense synovitis. Further development of synovitis stops. The patient gets the treatment. With further overloading (physical and overweight) the patients have progress in osteoarthritis development within 3-5 year period. With marked stages of osteoarthritis (II-III radiographic stages by DOA) full absolution of fluid is not received on account of a permanent static power. Thus, chronic synovitis develops. It is never marked and intense as it is a derivative from combined interaction of the growing stress to muscles and severe stages of arthrosis. The study gives a new insight for understanding of the synovitis development. Synovitis of the knee joint develops in case when the load on the lower extremity exceeds the protective properties of the cartilage. The development process of synovitis has 4 stages that represent links of the same process: the first stage is muscular-tonic syndrome of semimembranous and medial gastrocnemius muscles, or nonexudative stage; the second stage – silent synovitis; the third stage – marked knee joint synovitis; the fourth stage – chronic synovitis. Thus, in addition to loads and excess weight, another cause of nonspecific knee joint synovitis development has been determined – the decrease of the cartilage protective forces (cartilage wear), that is, arthrosis development. The study has identified ultrasound stages of the knee joint synovitis that were divided into 4 groups depending on the degree of arthrosis development. Analysis of the correlation of the presence of ultrasonic synovitis signs and symptoms of gonarthrosis has determined that the highest number (33.3%) of patients without synovitis accounts for 1 group of patients without ultrasound signs of arthrosis. The greatest number of patients with the 2nd synovitis stage (silent synovitis) are represented in 4 group (72.7%) and 2 group (62.4%) – patients with dysplastic and initial signs of arthrosis, correspondingly. The third and fourth synovitis stages are the most common among 3 group patients with severe signs of arthrosis and amount to 30.5% and 24.4% in this group, correspondingly. These results demonstrate the correlation of the presence of synovitis ultrasound signs and gonarthrosis. It can be considered, that there is dependence between arthrosis stages and synovitis severity degree, namely, patients with more severe gonarthrosis degree present more pronounced knee joint synovitis.