Bone wear with osteophyte hyperplasia

Introduction Bone hyperplasia (bone spur) is also called proliferative osteoarthritis, osteoarthritis (OA), degenerative joint disease, etc. The main principle is that the cartilage that constitutes the joint is degenerated, and the hard bone part of the joint edge is thickened to form bone hyperplasia. In the early stage of patients with hyperosteogeny, the articular cartilage was severely worn, and it was shown by X-ray film as: articular cartilage wear (slit narrowing), accompanied by osteophyte formation at the edge. In the later stage, the bone ends are deformed, and the joint surface is uneven, which eventually leads to bone hyperplasia. Severe hyperosteogeny can cause joint deformation, causing joint pain when subjected to abnormal weight. Bone hyperplasia occurs mostly in middle-aged or older people over the age of 45. Men are more likely than women. Heavy physical workers and athletes are susceptible to this disease, most commonly in the knee, hip, lumbar, cervical, elbow and other joints.

Cause

Osteoporosis is a category of "sputum syndrome" of traditional Chinese medicine, also known as "bone sputum". Chinese medicine believes that this disease is related to trauma, strain, blood stasis, feeling cold and dampness, phlegm and dampness, liver and kidney deficiency.

1. Pathology: Irregular cartilage damage, subchondral bone sclerosis, cysts, marginal epiphyseal hyperplasia, increased blood flow to the metaphysis, and varying degrees of synovitis in the weight-bearing area.

2. Histology: early cartilage surface fragmentation, chondrocyte proliferation, cartilage surface longitudinal splitting, crystal deposition, cartilage repair, osteophyte hyperplasia; late cartilage destruction, manifested as cartilage sclerosis, cartilage disappearance and cartilage Lower focal osteonecrosis.

3. Biomechanics: The extensibility, anti-stress, shear resistance and cartilage permeability of articular cartilage are reduced. The cartilage has increased moisture, excessive swelling, and hardening of the subchondral bone.

4. Biochemical changes: The content (concentration) of proteoglycans decreased, the molecular size and aggregation degree changed, and the size and arrangement of collagen fibers and the synthesis and degradation of matrix macromolecules all changed abnormally.

Osteoporosis is a category of "sputum syndrome" of traditional Chinese medicine, also known as "bone sputum". Chinese medicine believes that this disease is related to trauma, strain, blood stasis, feeling cold and dampness, phlegm and dampness, liver and kidney deficiency.

5. Nutrition: The root cause of bone hyperplasia is calcium deficiency. It is the result of a stress response.

an examination

Related inspection

General radiography examination of serum osteocalcin (BGP) bones and joints of the extremities, flat bones, joints and soft tissue CT examination of bone and joint MRI

First, cervical vertebra hyperplasia:

Etiology: age factors, chronic strain, trauma, throat inflammation, developmental spinal stenosis, congenital malformations of the cervical spine, metabolic factors, mental factors, etc. can cause cervical hyperplasia.

Clinical manifestations: the neck has a strong feeling, limited activity, and the neck activity has a sound of sound. The pain is often radiated to the shoulders and upper limbs. The hands and fingers have numbness and electric shock, which can be aggravated by the neck activity. Different lesions involve different parts, and different symptoms appear, which can lead to paralysis in the late stage. Patients with severe cervical hyperplasia can also cause cervical spondylosis, cardiovascular and cerebrovascular diseases, gastritis, angina pectoris, and difficulty swallowing.

Second, lumbar vertebrae hyperplasia:

clinical manifestations:

Good hair parts, the waist three, waist four are the most common. Clinically, lumbar and lumbar soft tissue pain, pain, stiffness and fatigue often occur, and even bending is limited. If the adjacent nerve root is compressed, it can cause the corresponding symptoms, local pain, stiffness, post-root neuralgia, numbness and so on. Such as compression of the sciatic nerve can cause sciatica, severe limb pain, burning, pain, string pain, radiation to the entire lower extremity.

lesion development and classification:

(1) From time to time, lumbar hyperosteogeny can be divided into three stages.

The first stage is the concealed stage, and the hyperplasia has actually appeared. The thickness or length of the hyperplasia is only about 1 to 2 mm. At this time, it does not affect people's activities, and there is no self-feeling, or a slight feeling is not reflected as obvious symptoms. Therefore, in the hidden period generally can not attract people's attention. This phase lasts approximately one to two years.

The second stage is an obvious stage. The length of bone hyperplasia exceeds 5 mm, which has a significant effect on human activities. When the left intervertebral disc proliferates, the human body tilts and bends to the left, and the left limb causes acid, pain, and numbness. The opposite is also true. Some people also have some symptoms when they are in normal position, which means that somewhere nerves have been oppressed for a long time. If you don't get radical treatment at this stage, you may suffer from long-term pain and even affect normal life activities. This phase can last for many years and continues to enter the third phase.

The third stage is the stage of paralysis or dyskinesia. Generally, there are many sites of hyperosteogeny, and the length of hyperplasia exceeds 10 mm. It has not been well treated for many years, leading to difficulty in walking or walking. This situation is relatively rare in the clinic.

(B) from the morphological points, lumbar vertebrae hyperplasia can be divided into four.

1. Bubbling: It is the most common in clinical practice, that is, the outer layer of bone is thickened to make the surface layer bulge. It is called disc bulging, also called protrusion or hypertrophy.

2, horny hyperplasia: at the upper corner of the disc shaped like a horn plate protruding, and pick up, the edge has a pointed protrusion, the most likely to produce serious symptoms. It usually occurs on the cervical and lumbar discs.

3, columnar hyperplasia: occurs in the small joint parts with large movement angle, such as the knuckles, knee joints and so on. Local symptoms are more obvious but have little effect and less pain. However, some people also grow a column of up to 20 mm in the lumbar vertebrae, the impact is very serious.

4, granular sputum: occurs in the active joints of the thumb and palm joints, a spherical spheroid is produced outside the joint joint, the particle size can reach 4 ~ 6 mm. Affects the normal operation of his fingers, even powerless. This can also occur at the knee joint.

Third, knee joint bone hyperplasia:

Causes:

3.1 Trauma factors The changes of the negative gravity line of the knee joint due to injury, knee deformity or inflammation, so that the effective weight-bearing area of the knee joint surface is reduced, the joint surface is unevenly stressed, and the impact-concentrated part is prone to damage of the articular cartilage, and Caused a small fracture of the trabecular bone (sub-fracture), bone collapse, followed by subchondral bone sclerosis. At the same time, due to changes in the articular cartilage matrix and synovial fluid components of patients with knee joint hyperplasia, the cartilage elasticity and the lubrication of the surrounding synovial fluid are lost, so that the cartilage is susceptible to wear. The epiphyseal hyperplasia around the knee joint is a kind of repairing phenomenon of joint damage. The body is to increase the joint weight area and reduce the pressure to produce the modern compensatory epiphyseal hyperplasia.

3.2 Autoimmune response After the knee joint cartilage is damaged by mechanical factors and other factors, the "concealed antigen" of articular chondrocytes, mucopolysaccharide and collagen is exposed, causing autoimmune reaction and causing secondary damage of cartilage. Knee joint hyperplasia patients often have joint swelling, repeated joint synovitis, increased monocytes, immunoglobulins and complements in synovial fluid, hyperemia in the synovium and mononuclear cell infiltration, which suggest knee bone Hyperplasia may be related to autoimmune responses.

pathological changes:

Knee hyperosteogeny includes cartilage degeneration, cartilage softening, erosion, bone end exposure, synovial membrane, joint capsule and muscle changes.

1. Articular cartilage: normal knee cartilage is smooth blue-white, with regular and neat edges. In the early stage of knee joint hyperplasia, articular cartilage softens, loses elasticity and luster, and the color is light yellow. It wears off during activity. The cartilage is broken and exfoliated, causing the subchondral bone to be exposed. The peripheral cartilage surface with little wear appears proliferation and hypertrophy. Internalized bone to form osteophytes.

2. Subchondral bone: The central part of the cartilage has a large dentin, and the dentinal bone changes, the bone density increases and hardens, the peripheral stress is small, the subchondral bone atrophy, and cystic lesions appear.

3. Synovial membrane: The synovial membrane is characterized by proliferation and edema, which makes the effusion in the knee joint contain more mucin and is more viscous.

4. Joint capsule and muscle: The joint capsule is fibrotic and thickened, and the muscles around the joint produce protective tendons, which restrict the knee joint activity.

clinical manifestations:

In the early stage, the knee pain is not serious, the pain is persistent, the pain is aggravated when the temperature is lowered, it is related to climate change, the activity starts in the morning, the long-term walking, the strenuous exercise or the sedentary movement starts to walk and the knee pain Stiff, good after a little activity, difficult to go up and down, knee joints when the downstairs is soft, easy to fall. Pain, stiffness, severe, joint pain and pain, sputum walking, joint swelling and rheumatism, deformity, limited function, flexion and flexion of extension and flexion, some patients can see joint effusion, local swelling, Compression phenomenon.

4. Fingertip degeneration:

Most occur in the interphalangeal joints, nodules appear on the dorsal side of the joints, local joints have mild flexion deformity, joint soreness and pain, limited mobility, frictional sounds and joint swelling, often misdiagnosed as rheumatoid arthritis.

5. Heel bone spurs:

More common in the elderly, walking pain at the soles of the feet, heavy in the morning, light in the afternoon, the first step of getting out of bed is unbearable, when it is light and heavy.

1. Neck type:

The main complaint is head, neck and shoulder pain and other abnormal feelings, accompanied by corresponding tender points. It is characterized by stiff neck, discomfort, pain, and inflexible activity, which is also the most common type.

2. Nerve root type:

The patient's palm or arm is numb, painful, weak in grip, and sometimes feels incompetent even when holding the cup. When the condition is serious, it is difficult to fall asleep all night.

3. Vertebral artery type:

The patient's symptoms are migraine, dizziness, or chest tightness and chest pain. Each vertigo episode is related to the rotation of the neck.

4. Sympathetic type:

The clinical manifestations include dizziness, vertigo, tinnitus, hand numbness, tachycardia, and pain in the precordial area.

Cervical vertebrae hyperplasia symptoms:

Cervical vertebrae hyperplasia, light neck discomfort, soreness and pain; can be combined with spinal cord, vertebral artery, nerve root and other factors to become various types of cervical spondylosis, the corresponding clinical manifestations appear:

(1) Symptoms of nerve root type: pain in the back of the neck and shoulders and back, numbness of acupuncture or electric shock; limited neck activity, weak grip, finger movement, and difficulty in fine movement. I can't hold things.

(2) spinal cord symptoms; this type is most likely to cause paralysis, mostly manifested as gait instability, walking heavy, feeling that the soles of the feet seem to step on the cotton, one or both sides of the upper limbs numb, hands weak, or easy to lose.

(3) Sympathetic symptoms: blurred vision, eyelid weakness, eye socket swelling and pain, tearing; tachycardia or slowness, high pain in the precordial area and high blood pressure, limbs are cold, body temperature drops. In case of cold limbs, there is a sense of acupuncture, and then redness or pain is aggravated; head, face and neck may also cause numbness or pain, tinnitus, deafness, numbness of the tongue and the like.

(4) vertebral artery type symptoms: headache, dizziness, cerebral ischemia; when the head turns to a certain orientation, it is dizziness, nausea, vomiting, tinnitus, deafness, unclear vision, etc.; sudden limb numbness, abnormal feeling, weakness Or suddenly fell and so on.

For patients with cervical spondylosis caused by bone hyperplasia, due to the narrowing of the spinal canal, the spinal nerves and cerebral arteries in the tube are compressed for a long time, causing nerve conduction and blood flow to be blocked, causing long-term blood supply to the brain, malnutrition, and gradual Atrophy, necrosis, senile dementia, and eventually become "vegetarians."

Differential diagnosis

Bone wear has a differential diagnosis of epiphyseal hyperplasia:

(1) The patients with this disease are mostly middle-aged and elderly people over 40 years old, accompanied by lumbar stiffness pain or numbness of lower extremities. Some patients may have abnormal lumbar vertebral curvature; some muscles on both sides of the lumbar spine have tenderness.

(2) changes in lumbar X-ray films (positive position, lateral position, left and right oblique position), such as patients with lumbar curvature abnormalities, lumbar scoliosis, lumbar vertebral body space narrowing, lumbar vertebral body and facet joint hyperplasia, Lumbar spondylolisthesis, intervertebral foramen stenosis and other changes.

(3) The various symptoms of lumbar vertebra hyperplasia should be differentiated from a variety of lumbar diseases, such as lumbar disc herniation, vertebral body malformation, vertebral body tumor, lumbar tuberculosis and other diseases.

First, cervical vertebra hyperplasia:

Etiology: age factors, chronic strain, trauma, throat inflammation, developmental spinal stenosis, congenital malformations of the cervical spine, metabolic factors, mental factors, etc. can cause cervical hyperplasia.

Clinical manifestations: the neck has a strong feeling, limited activity, and the neck activity has a sound of sound. The pain is often radiated to the shoulders and upper limbs. The hands and fingers have numbness and electric shock, which can be aggravated by the neck activity. Different lesions involve different parts, and different symptoms appear, which can lead to paralysis in the late stage. Patients with severe cervical hyperplasia can also cause cervical spondylosis, cardiovascular and cerebrovascular diseases, gastritis, angina pectoris, and difficulty swallowing.

Second, lumbar vertebrae hyperplasia:

clinical manifestations:

Good hair parts, the waist three, waist four are the most common. Clinically, lumbar and lumbar soft tissue pain, pain, stiffness and fatigue often occur, and even bending is limited. If the adjacent nerve root is compressed, it can cause the corresponding symptoms, local pain, stiffness, post-root neuralgia, numbness and so on. Such as compression of the sciatic nerve can cause sciatica, severe limb pain, burning, pain, string pain, radiation to the entire lower extremity.

lesion development and classification:

(1) From time to time, lumbar hyperosteogeny can be divided into three stages.

The first stage is the concealed stage, and the hyperplasia has actually appeared. The thickness or length of the hyperplasia is only about 1 to 2 mm. At this time, it does not affect people's activities, and there is no self-feeling, or a slight feeling is not reflected as obvious symptoms. Therefore, in the hidden period generally can not attract people's attention. This phase lasts approximately one to two years.

The second stage is an obvious stage. The length of bone hyperplasia exceeds 5 mm, which has a significant effect on human activities. When the left intervertebral disc proliferates, the human body tilts and bends to the left, and the left limb causes acid, pain, and numbness. The opposite is also true. Some people also have some symptoms when they are in normal position, which means that somewhere nerves have been oppressed for a long time. If you don't get radical treatment at this stage, you may suffer from long-term pain and even affect normal life activities. This phase can last for many years and continues to enter the third phase.

The third stage is the stage of paralysis or dyskinesia. Generally, there are many sites of hyperosteogeny, and the length of hyperplasia exceeds 10 mm. It has not been well treated for many years, leading to difficulty in walking or walking. This situation is relatively rare in the clinic.

(B) from the morphological points, lumbar vertebrae hyperplasia can be divided into four.

1. Bubbling: It is the most common in clinical practice, that is, the outer layer of bone is thickened to make the surface layer bulge. It is called disc bulging, also called protrusion or hypertrophy.

2, horny hyperplasia: at the upper corner of the disc shaped like a horn plate protruding, and pick up, the edge has a pointed protrusion, the most likely to produce serious symptoms. It usually occurs on the cervical and lumbar discs.

3, columnar hyperplasia: occurs in the small joint parts with large movement angle, such as the knuckles, knee joints and so on. Local symptoms are more obvious but have little effect and less pain. However, some people also grow a column of up to 20 mm in the lumbar vertebrae, the impact is very serious.

4, granular sputum: occurs in the active joints of the thumb and palm joints, a spherical spheroid is produced outside the joint joint, the particle size can reach 4 ~ 6 mm. Affects the normal operation of his fingers, even powerless. This can also occur at the knee joint.

Third, knee joint bone hyperplasia:

Causes:

3.1 Trauma factors The changes of the negative gravity line of the knee joint due to injury, knee deformity or inflammation, so that the effective weight-bearing area of the knee joint surface is reduced, the joint surface is unevenly stressed, and the impact-concentrated part is prone to damage of the articular cartilage, and Caused a small fracture of the trabecular bone (sub-fracture), bone collapse, followed by subchondral bone sclerosis. At the same time, due to changes in the articular cartilage matrix and synovial fluid components of patients with knee joint hyperplasia, the cartilage elasticity and the lubrication of the surrounding synovial fluid are lost, so that the cartilage is susceptible to wear. The epiphyseal hyperplasia around the knee joint is a kind of repairing phenomenon of joint damage. The body is to increase the joint weight area and reduce the pressure to produce the modern compensatory epiphyseal hyperplasia.

3.2 Autoimmune response After the knee joint cartilage is damaged by mechanical factors and other factors, the "concealed antigen" of articular chondrocytes, mucopolysaccharide and collagen is exposed, causing autoimmune reaction and causing secondary damage of cartilage. Knee joint hyperplasia patients often have joint swelling, repeated joint synovitis, increased monocytes, immunoglobulins and complements in synovial fluid, hyperemia in the synovium and mononuclear cell infiltration, which suggest knee bone Hyperplasia may be related to autoimmune responses.

pathological changes:

Knee hyperosteogeny includes cartilage degeneration, cartilage softening, erosion, bone end exposure, synovial membrane, joint capsule and muscle changes.

1. Articular cartilage: normal knee cartilage is smooth blue-white, with regular and neat edges. In the early stage of knee joint hyperplasia, articular cartilage softens, loses elasticity and luster, and the color is light yellow. It wears off during activity. The cartilage is broken and exfoliated, causing the subchondral bone to be exposed. The peripheral cartilage surface with little wear appears proliferation and hypertrophy. Internalized bone to form osteophytes.

2. Subchondral bone: The central part of the cartilage has a large dentin, and the dentinal bone changes, the bone density increases and hardens, the peripheral stress is small, the subchondral bone atrophy, and cystic lesions appear.

3. Synovial membrane: The synovial membrane is characterized by proliferation and edema, which makes the effusion in the knee joint contain more mucin and is more viscous.

4. Joint capsule and muscle: The joint capsule is fibrotic and thickened, and the muscles around the joint produce protective tendons, which restrict the knee joint activity.

clinical manifestations:

In the early stage, the knee pain is not serious, the pain is persistent, the pain is aggravated when the temperature is lowered, it is related to climate change, the activity starts in the morning, the long-term walking, the strenuous exercise or the sedentary movement starts to walk and the knee pain Stiff, good after a little activity, difficult to go up and down, knee joints when the downstairs is soft, easy to fall. Pain, stiffness, severe, joint pain and pain, sputum walking, joint swelling and rheumatism, deformity, limited function, flexion and flexion of extension and flexion, some patients can see joint effusion, local swelling, Compression phenomenon.

4. Fingertip degeneration:

Most occur in the interphalangeal joints, nodules appear on the dorsal side of the joints, local joints have mild flexion deformity, joint soreness and pain, limited mobility, frictional sounds and joint swelling, often misdiagnosed as rheumatoid arthritis.

5. Heel bone spurs:

More common in the elderly, walking pain at the soles of the feet, heavy in the morning, light in the afternoon, the first step of getting out of bed is unbearable, when it is light and heavy.

1. Neck type:

The main complaint is head, neck and shoulder pain and other abnormal feelings, accompanied by corresponding tender points. It is characterized by stiff neck, discomfort, pain, and inflexible activity, which is also the most common type.

2. Nerve root type:

The patient's palm or arm is numb, painful, weak in grip, and sometimes feels incompetent even when holding the cup. When the condition is serious, it is difficult to fall asleep all night.

3. Vertebral artery type:

The patient's symptoms are migraine, dizziness, or chest tightness and chest pain. Each vertigo episode is related to the rotation of the neck.

4. Sympathetic type:

The clinical manifestations include dizziness, vertigo, tinnitus, hand numbness, tachycardia, and pain in the precordial area.

Cervical vertebrae hyperplasia symptoms:

Cervical vertebrae hyperplasia, light neck discomfort, soreness and pain; can be combined with spinal cord, vertebral artery, nerve root and other factors to become various types of cervical spondylosis, the corresponding clinical manifestations appear:

(1) Symptoms of nerve root type: pain in the back of the neck and shoulders and back, numbness of acupuncture or electric shock; limited neck activity, weak grip, finger movement, and difficulty in fine movement. I can't hold things.

(2) spinal cord symptoms; this type is most likely to cause paralysis, mostly manifested as gait instability, walking heavy, feeling that the soles of the feet seem to step on the cotton, one or both sides of the upper limbs numb, hands weak, or easy to lose.

(3) Sympathetic symptoms: blurred vision, eyelid weakness, eye socket swelling and pain, tearing; tachycardia or slowness, high pain in the precordial area and high blood pressure, limbs are cold, body temperature drops. In case of cold limbs, there is a sense of acupuncture, and then redness or pain is aggravated; head, face and neck may also cause numbness or pain, tinnitus, deafness, numbness of the tongue and the like.

(4) vertebral artery type symptoms: headache, dizziness, cerebral ischemia; when the head turns to a certain orientation, it is dizziness, nausea, vomiting, tinnitus, deafness, unclear vision, etc.; sudden limb numbness, abnormal feeling, weakness Or suddenly fell and so on.

For patients with cervical spondylosis caused by bone hyperplasia, due to the narrowing of the spinal canal, the spinal nerves and cerebral arteries in the tube are compressed for a long time, causing nerve conduction and blood flow to be blocked, causing long-term blood supply to the brain, malnutrition, and gradual Atrophy, necrosis, senile dementia, and eventually become "vegetarians."

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