糖尿病神经性关节病并发慢性骨髓炎时踝关节滑膜的组织形态特征

T. A. Stupina, I. N. Mezentsev
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引用次数: 0

摘要

目前尚未对滑膜在夏科氏足发病机制中的作用进行适当研究,也没有关于滑膜组织形态特征的资料。本研究旨在探讨糖尿病神经性关节病并发慢性骨髓炎患者滑膜的组织形态学特征。材料与方法研究人员对 35 名患者的踝关节骨软骨碎片和关节囊碎片进行了检查。第一组包括急性期伴有慢性骨髓炎的糖尿病神经性关节病患者(26 人)。第二组包括糖尿病神经性关节病伴慢性骨髓炎缓解期患者(9 人)。对照组包括未患糖尿病和肌肉骨骼系统疾病的患者(人数=7);他们尸检时获得的滑膜用于对比。使用AxioScope.A1显微镜和Zenblue软件(德国卡尔蔡司显微成像有限公司)对石蜡和半薄切片进行苏木精和伊红染色以及Masson三色染色,并进行组织形态测量。结果在第一组患者中,发现了高级别的滑膜炎和皮肤表层增生。在第 2 组患者中,发现了轻度滑膜炎和结缔组织层纤维化。两组患者都有微循环障碍的组织学表现。与对照组相比,第 1 组患者的覆盖层厚度增加了 1.5 倍;与对照组相比,第 2 组患者的这一参数值降低了 1.7 倍。两组患者的微血管数量密度都有所增加,其中以第一组患者最为明显。 结论。通过对糖尿病神经性关节病患者踝关节滑膜的组织形态计量学研究,可以发现在慢性骨髓炎的不同炎症阶段,滑膜以反应性和退行性炎症变化的形式进行重组的一些特征。
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Histomorphometrical features of the ankle synovium in diabetic neuroosteoarthropathy complicated by chronic osteomyelitis
The role of the synovium in the pathogenesis of the Charcot foot is not properly studied; there is no information on its histomorphometric features. The aim of the study was to investigate the histomorphometric features of the synovial membrane in patients with diabetic neuroosteoarthropathy complicated by chronic osteomyelitis. Material and methods. Osteochondral fragments and fragments of the articular capsule of the ankle joint obtained from 35 patients were examined. Group 1 included patients with diabetic neuroosteoarthropathy accompanied by chronic osteomyelitis in the acute stage (n=26). Group 2 included patients suffering from diabetic neuroosteoarthropathy with chronic osteomyelitis in remission (n=9). The control group included individuals who did not suffer from diabetes mellitus and diseases of the musculoskeletal system (n = 7); the synovial membrane obtained during their autopsy was used for comparison. Histomorphometry was performed on paraffin and semi-thin sections stained with hematoxylin and eosin, as well as Masson trichrome stain, using an AxioScope.A1 microscope and Zenblue software (Carl Zeiss MicroImaging GmbH, Germany). Results. In patients of group 1, high-grade synovitis and hyperplasia of the integumentary layer were registered. In patients of group 2, mild synovitis and fibrosis of the integumentary layer were noted. In both groups, histological signs of microcirculation disorders were revealed. In the 1st group, there was an increase in the thickness of the covering layer by 1.5 times compared to the control; in the 2nd group, the values of this parameter were 1.7 times lower compared to the control parameters. In both groups, an increase in the numerical density of microvasculature vessels was recorded, being the most pronounced in patients of Group 1. Conclusion. A histomorphometric study of the synovial membrane of the ankle joints in patients with diabetic neuroosteoarthropathy allowed identifying a number of features of its restructuring in the form of reactive and degenerative-inflammatory changes at different inflammatory stages of chronic osteomyelitis.
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