老人面對關(guān)節(jié)退行性變引起的疼痛很普遍，輕則行動不便,，重者撐拐杖坐輪椅,，生活素質(zhì)大受影響；近年來,，隨著手機的刷屏習慣,，大量的年輕男女都成了低頭族，頸椎退行性變問題（包括富貴包）越來越普及,，甚至手指的關(guān)節(jié)也出現(xiàn)不同程度的勞損退行性變,。
關(guān)節(jié)退行性變導致
一、關(guān)節(jié)軟骨進行性勞損和破壞；二,、軟骨下骨增厚,；三、骨刺形成滑膜炎,；四,、膝關(guān)節(jié)韌帶和半月板變性；五,、關(guān)節(jié)囊肥大(7,8,9,10,11,12)
主要臨床癥狀
一,、慢性疼痛；二,、關(guān)節(jié)不穩(wěn),；三、關(guān)節(jié)僵硬,；四,、關(guān)節(jié)間隙狹窄(18,19)
成因：
炎癥：炎癥介質(zhì)通過MMPs和ADAMTS活性的增加導致軟骨ECM降解(13,14,15,16,17)
老化：老化細胞表現(xiàn)出氧化應激增加，從而促進細胞衰老并改變線粒體功能(20,21,22,23)
肥胖：除了增加膝關(guān)節(jié)的生物力學負荷外,，肥胖還被認為通過分泌脂肪組織來源的細胞因子(稱為脂肪因子)而導致低級別的全身炎癥,。(24,25,26)
運動勞動損傷,、機械性磨損：
創(chuàng)傷相關(guān)的運動損傷可引起骨,、軟骨、韌帶和半月板損傷,，所有這些都會對關(guān)穩(wěn)定產(chǎn)生負面影響(26,27,28),；軟骨組織撕裂、關(guān)節(jié)脫位,、韌帶拉傷和撕裂是臨床上最常見的可能導致關(guān)節(jié)炎的損傷(29,30),。
遺傳傾向性：
主要通過誘導軟骨細胞分解反應來促進關(guān)節(jié)炎的發(fā)展和進展(６)；成纖維細胞生長因子(FGF)通路的改變主要通過誘導軟骨細胞分解反應來促進關(guān)節(jié)炎的發(fā)展和進展(31,32,33,34,35,36)
當我們面對關(guān)節(jié)退行性變導致的疼痛,，目前在藥物上面的治療,，廣泛使用的是氨基葡萄糖，但治療效果差強人意,。關(guān)于氨基葡萄糖的問題,，國際上也有了更新的研究，這個研究成果我們以后再專門介紹,。我們現(xiàn)在有更安全更理想的修補方案可選擇,。
今天就跟大家探討一下德國最新的一些與關(guān)節(jié)退行性變有關(guān)的新臨床研究。先探討關(guān)節(jié)退行性變導致的疼痛或者行動不便,，甚至坐輪椅撐拐杖,；以后還會與大家探討別的關(guān)節(jié)問題，包括痛的要命的痛風、還有類風濕性關(guān)節(jié)炎,、強直性脊椎炎等等,。希望大家多加留意或者關(guān)注我們。
早于2000年時,克利夫蘭大學醫(yī)院的Moskowitz RW博士等人已進行了膠原水解物在骨關(guān)節(jié)疾病中的作用(2,37),；2016和2017 M Schunck 及S Oesser兩位學者在德國的研究發(fā)現(xiàn),，用新鮮牛皮提煉的＜水解骨膠原蛋白＞可以修復關(guān)節(jié)軟組織，促進軟骨的再生,。水解骨膠原蛋白是膠原蛋白的水解產(chǎn)物,，與關(guān)節(jié)軟骨中主要成分2型的膠原蛋白相似(3)。與大分子的膠原相比,，水解產(chǎn)物更容易被人體吸收,，用來修補因關(guān)節(jié)退行性變而導致的關(guān)節(jié)軟骨的流失，同時減少關(guān)節(jié)的疼痛(1,5),。
此外,，德國弗賴堡大學施瓦茲沃德斯特爾分校的Daniel KönigSteffen Oesser, Stephan Scharla, Denise Zdzieblik及 Albert Gollhofer 等學者在2018年的另一項研究，發(fā)現(xiàn)每天口服5克的水解骨膠原蛋白,，可以增加停經(jīng)后婦女腰椎和股骨頸的密度,，大大緩解因礦物元素流失而引起的骨質(zhì)疏松癥的風險(4)。
水解骨膠原蛋白也可以刺激韌帶細胞外基質(zhì)的生物合成,，在2013年的研究發(fā)現(xiàn),，水解骨膠原蛋白可以增加50%彈性蛋白生物的合成，同時增加了2.4倍的膠原蛋白的合成,，在預防韌帶和肌腱病理性的病變起到了積極的作用(3),。
除了針對軟組織的修補外，醫(yī)學界同時還要面對其它關(guān)節(jié)退行性變的挑戰(zhàn),；怎樣解決關(guān)節(jié)內(nèi)粘連(Intraarticular adhesion)(38),、纖維化(fibrosis)(39)、軟骨鈣化(cartilage calcification) (40)（骨刺－骨質(zhì)增生）問題,。因要解決骨關(guān)節(jié)整體退行性變問題,，修補軟組織只完成小部份任務;發(fā)炎、粘連,、纖維化,、軟骨鈣化也需要別的研究突破來處理的，所以我們必須從生物醫(yī)學,、營養(yǎng)醫(yī)學等各方面,，全面去研究。 希望國內(nèi)相關(guān)大學,、醫(yī)學院,、科研機構(gòu)也能投入更多資源、精力在相關(guān)領(lǐng)域的臨床研究，能夠超越歐美成就,，帶領(lǐng)醫(yī)學進入新階段,！ 下次再跟大家分享更多國際上的新研究；如痛風,、強直性脊椎炎,、類風濕性關(guān)節(jié)炎等等。有興趣了解更多關(guān)節(jié)研究話題的,，歡迎關(guān)注我們,。
身邊如果有任何人正在面對關(guān)節(jié)疼痛的問題，歡迎大家把這一篇內(nèi)容轉(zhuǎn)發(fā)給他們,。希望這些學術(shù)研究成果能為他們帶來新的希望,，為他們帶來更理想的治療方案。
本文章屬於拜塞復康中心團隊原創(chuàng),，如要轉(zhuǎn)載請聯(lián)同作者機構(gòu)一并轉(zhuǎn)發(fā),，否則需取得作者書面同意方能節(jié)錄引用。
醫(yī)學文章需要專業(yè),、認真,、嚴謹?shù)膽B(tài)度，您的轉(zhuǎn)發(fā)和點贊會成為我們的重大動力,，謝謝,。
原創(chuàng)：拜塞復康中心
張陽生(顧問醫(yī)生)、高建偉(顧問醫(yī)生)
歐陽宏基(香港脊骨神經(jīng)科醫(yī)生),、
馬圓(英國注冊營養(yǎng)師),、施丹虹(香港營養(yǎng)學家)
鄭志雄(加拿大放射影像物理學家)
了解更多
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37.From the Case Western Reserve University; Division of Rheumatic Diseases, University Hospitals of Cleveland, OH. Roland W. Moskowitz, MD: Professor of Medicine, Case Western Reserve University; Director, Division of Rheumatic Diseases, University Hospitals of Cleveland Dr. Moskowitz was the Principal Investigator and Con-sultant for a study on pharmaceutical collagen hydrolysate for DGF Stoess. doi:10.1053/sarh.2000.9622
38.Osteoarthritic cartilage fibrillation is associated with a decrease in chondrocyte adhesion to fibronectin By Muriel Piperno,Pascal Reboul†, Marie-Pierre Hellio le Graverand,Mj Peschard †,Marliese Annefeld‡, M. Richard† and Eric Vignon Claude Bernard University. Centre Hospitalier Lyon Sud, 165 chemin du Grand Revoyet, 69495 Pierre Be ?nite; †Department of Biochemistry, INSERM-CNRS U189, Lyon Sud Medical School, BP 12, 6992
39.Treatment and Rehabilitation of Arthrofibrosis of the KneeScott E. Lawrance MS, PT, ATC, CSCS, K. Donald Shelbourne MD, in Clinical Orthopaedic Rehabilitation: a Team Approach (Fourth Edition), 2018
40.CALCIFICATION OF HUMAN ARTICULAR KNEE CARTILAGE IS PRIMARILY AN EFFECT OF AGING RATHER THAN OSTEOARTHRITIS. H Mitsuyama,* RM Healey,* RA Terkeltaub,# RD Coutts,* and D Amiel*
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