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Arthrosis

Arthrosis (arthrosis; Greek arthron — a joint +-osis; synonyms: the osteoarthroses deforming the arthroses deforming osteoarthroses) — degenerative diseases of joints. They are the most widespread. The considerable part them proceeds asymptomatically. Depending on absence or existence of the previous pathology of joints arthroses divide on primary and secondary. Carry the forms beginning without the noticeable reason (40 years are aged more senior) in the joint cartilage which is not changed till this time to primary. They usually affect many joints at the same time, that is are polyarticulary. Secondary arthroses develop at any age owing to an injury, vascular disorders, anomaly of a statics, arthritis, an aseptic necrosis of a bone, an inborn dysplasia and affect or one, or several joints.
Pathogeny of primary arthroses are completely not found out. First place in an etiology is won the static load exceeding functionality of a joint, mechanical microtraumatization. With age there come changes of vessels of a synovial membrane. The important part is also assigned to some endocrine frustration. Value of infectious, allergic and toxic factors is not excluded. Some authors point to a heredity role in an etiology of arthroses. In an etiology and a pathogeny of secondary arthroses the injuries breaking an integrity or congruence (compliance) of joint surfaces have a principal value. Them inborn dysplasias and the acquired disturbances of a statics, the postponed arthritises, diseases of an epiphysis of bones, metabolism diseases (gout, an ochronosis, Kashin's illness — Beck), endocrine diseases (a hypothyroidism, a diabetes mellitus) are other Reasons.
Any arthrosis develops and proceeds very slowly and never leads to heavy dysfunctions of joints and especially to a false and bone ankylosis. Any its form proceeds without usual signs of an inflammation (increase in SOE, a disproteinemia, the increased temperature, emaciation, etc.). Primary arthrosis often is followed by disturbance of a lipometabolism, arterial hypertension, atherosclerosis and other diseases. At it discrepancy between the morphological changes in joints observed on roentgenograms and clinical displays of an illness is found. Sometimes at minor radiological changes severe pains and restriction of mobility are noted.
Joint symptoms of arthrosis consist of pains, feeling of constraint, fast exhaustion, rigidity, deformation, a crunch, etc. Pains are usually stupid. They are changeable, amplify during cold and wet weather, after an exercise stress, especially by the evening, and at intention movements after a condition of rest — "starting pains". In a hip joint of pain irradiate to the inguinal or sciatic area. Often, especially at senile arthroses, instead of pains only the ache and feeling of weight in bones and joints are noted. True restriction of mobility at arthrosis is observed seldom, rigidity and fast fatigue of joints are more often characteristic. All these symptoms are caused by disturbance of congruence of joint surfaces, changes (a thickening, calcification, a sclerosis) in a joint capsule, sinews and other soft tissues and a spasm of muscles.
Deformations of joints are best of all noticeable in distal interphalangeal joints of hands (geberdenovsky small knots), in coxofemoral (a condition of an inflection, adduction and external rotation of a hip), in knee joints (a thickening of a bone tissue at the expense of regional osteophytes) and are caused by bone growths (fig. 1). Roughnesses of joint surfaces, limy adjournment and a sclerosis of soft tissues are the reason of a crunch of joints (is more often than knee). The rough crunch unlike small, crepitant is characteristic of arthrosis at synovites. At X-ray inspection narrowing of a joint crack, especially in places of the greatest functional load, deformation of surfaces, bone growths, etc. are found. So, the diagnosis of arthrosis is made on the basis of clinical, radiological and datas of laboratory.

развитие деформирующего артроза
Fig. 1. The scheme of development of the deforming arthrosis.
And — a normal joint. B, In — the deforming arthrosis of I, II, III degrees.
Treatment depending on a form and localization of arthrosis, the general condition of the patient happens etiotropic, pathogenetic and symptomatic. Etiotropic it is possible only at secondary arthroses which etiology is known. It is generally reduced to orthopedic correction of a statics of joints, reduction of load of the joints which were injured in the past, sanatorium treatment. It is necessary to refer use of stimulators of formation of chondroid fabric for substitution of defects of a joint cartilage (Rumalonum and other biogenic stimulators) to actions of pathogenetic treatment of arthrosis, the muscle relaxants eliminating reflex spasms of muscles (Mydocalmum, Seduxenum, scutamil, etc.); the vasodilators improving food of a cartilage (niacin, thermal procedures, massage, etc.); sex and anabolic hormones (hexestrol, Nerobolum).
Conservative therapy is directed to elimination of pains. For this purpose use salicylates, drugs of a pyrazolon row (Butadionum, Rheopyrinum, pyramidon, analginum). Important to provide to periodically affected joint rest. It is rational to apply heat on area of the affected joint and surrounding soft tissues (the paraffin, a diathermy warming compresses, hot bathtubs, etc.), an infiltration of periartikulyarny fabrics novocaine solution, Bernard's currents, ultrasound, a roentgenotherapy. Sanatorium treatment (mud applications, hydrosulphuric and radonic bathtubs, massage and remedial gymnastics are effective).
Surgical treatment is applied at the heavy course of arthrosis, especially knee and coxofemoral joints. In the second stage palliative operations, for example Foss's operation (department of the muscles which are attached to proximal department of a hip) at arthrosis of a hip joint, in certain cases — an osteotomy are shown (valgiruyushchy, variziruyushchy or cross). The similar osteotomies made at arthrosis call osteotomia medicata as after them inflow of blood to a joint increases, its food improves. For movement of load of other site of a cartilage at arthrosis of a hip joint carry out an osteotomy with shift according to Mac-Marri. At the expressed forms of arthrosis more radical operative measures are shown: if there are no multiple cysts — an arthroplasty (see); in the presence of cysts and mobile other pair joint — an artificial ankylosis (see) ; at bilateral deforming — an arthroplasty on the "best" joint and an artificial ankylosis on other party in an advantageous position for a support. In certain cases apply endoprosthesis replacement of a hip joint across Sivash (see the Arthroplasty).

 
"Arthrogryposis   Hips paralytic dislocation"