CHONDROMATOSIS of JOINTS (chondromatosis articularis; Greek chondros a cartilage + - oma, omatos + - osis) — the disease which is characterized by education intra joint cartilaginous is more rare — bone little bodies.
X. the page meets rather seldom. Among patients of X. pages prevail men a little. Most often knee and elbow joints are surprised, is more rare — humeral, talocrural, radiocarpal, distal radioulnar and other joints.
The etiology and a pathogeny of this disease are unknown. Apparently, X. the page arises owing to the reactive process causing a cartilaginous metaplasia (see) separate cells of a synovial membrane (see). The cartilaginous islands which are formed at the same time are connected with a synovial membrane in the beginning, and then otshnurovyvatsya and become free intra joint bodies.
Macroscopically at X. pages limited or extensive sites of a synovial membrane are covered with small knots and diffusion eminences of a dense consistence. Separate small knots act over a surface of a synovial membrane in the form of pediculated polypes. From them otshnurovyvatsya and located with Nek-rye in a cavity of a joint in the form of free intra joint little bodies from several millimeters to 1 — 2 cm in the diameter. Intra joint little bodies have the rounded and oval shape, a smooth surface of white or yellowish color. The quantity of such little bodies in a joint can reach tens and hundreds. At a tumorous form X. pages intra joint bodies have an appearance large (to 3 — 5 cm in the diameter) the hilly educations consisting of the merging nodes and segments of cartilaginous tissue. Microscopically synovial membrane is thickened, with giperplazirovanny fibers. In it infiltration lymphoid and plasmocytes, caused by a reactive synovitis (see) is noted. Separate fibers or all thickness of a synovial membrane contain the centers of cartilaginous tissue (see) in the form of small small knots and islands (fig. 1). Hond-romatoznye the centers consist of interstitial substance with the cartilaginous cells which are randomly located in it. Sometimes the very tectonics of the hondromatozny centers bears a faint resemblance to a joint cartilage, is more rare — a chondroma (see). In the large centers: often find zones of calcification (see Calcification) and osteogeneses (see Ossificates). The centers consisting only of the bone tissue presented by separate bone crossbeams or network of crossbeams of a lamellar structure with yellow can meet is more rare red, marrow in interframe spaces. Free intra joint little bodies consist of a hyaline cartilage, is more rare — from hyaline and fibrous cartilaginous tissue. The surface of intra joint little bodies is covered with a layer of the fibrous connecting fabric forming the capsule. Sometimes this fabric reminds perikhondr and, probably, is a source of formation of cartilaginous substance. Calcification is observed in the form of the centers or strips that indicates frequency of adjournment of salts of calcium.
Clinically X. the page is shown by pain in time and after an exercise stress, at the movements in the affected joint, restriction of movements in a joint, lameness, periodic «blockade» of a joint, accumulation of synovial fluid, increase in a joint in volume, crepitation at the movements, an atrophy of muscles of an extremity. At X. the page is, as a rule, observed the deforming arthrosis.
Important a beater *> in diagnosis of X. the page plays rentgenol. research. On the roentgenogram of the affected joint find a set of dense shadows of a spherical or oval shape with accurate contours (fig. 2). At careful studying, especially on roentgenograms with direct blowup and at a tomography (see), in intra joint little bodies it is possible to reveal more transparent central part, edges corresponds to their cartilaginous basis. The arrangement of cartilaginous little bodies is defined by anatomic features of the joint capsule and a structure of its torsions. In cases of considerable stretching of the joint capsule intra joint little bodies can be located on considerable [
with Fig. 1. Microdrug of a synovial membrane at a chondromatosis of a joint: shooters specified islands of cartilaginous tissue; coloring hematoxylin-eosine; x 100 *
Fig. 2. The roentgenogram of an elbow joint at a chondromatosis (a direct projection):
shooters designated multiple partially calciphied intra joint little bodies.
Fig. 3. Artropnevmogramma of a knee joint at a chondromatosis (a side projection): in upper torsion of the joint bag filled with gas the conglomerate of calciphied intra joint little bodies is defined (it is designated by an arrow).
removal from usual anatomic borders of a joint (fig. 3).
On survey roentgenograms only those intra joint little bodies can be revealed, to-rye contain salts of calcium. Indirect signs of existence of the cartilaginous little bodies which are not seen on the survey roentgenogram are regional uzura in the jointed bones. Authentic diagnosis of X. the page in such cases can be established only at an artro-grafiya and an artroyekopiya (see Joints).
Treatment is operational, consists in an arthrotomy (see) with removal of free intra joint little bodies and excision of meta silt of zirovanny sites of a sinovrtlny cover or total synovectomy (see) at a tumorous joint chondromatosis. Quick access shall provide broad approach to all departments of a joint. In the presence of the accompanying expressed deforming arthrosis (see) carry out are tro to plastic (see), at sharply expressed deforming arthrosis — endoprosthesis replacement of a joint or an artificial ankylosis (see).
The forecast for life favorable. Recovery of function of an extremity depends on prevalence of process and radicalism of an operative measure.
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