Гистопатология тканей кистевого сустава и некоторые клинико-морфологические корреляции у больных с последствиями переломов ладьевидной кости

Abstract

Introduction Posttraumatic osteoarthritis of the wrist (WOA) is of importance among the diseases of the proximal hand. There are few studies in which the dependence between clinical and morphological parameters in patients with posttraumatic osteoarthritis due to a non-united fracture of the scaphoid was studied. Purpose To identify the dependence between several clinical parameters on the one hand and morphological parameters of the wrist tissue condition, on the other hand, in patients with consequences of scaphoid nonunion. Materials and methods Material were 94 resected samples of the wrist tissues that included the scaphoid obtained from 55 patients in whom the WOA was associated with the consequences of scaphoid fracture nonunion. The following parameters were studied: anamnesis and symptoms, roentgenometric and morphological findings that were graded. Correlation dependence between them was also investigated. Results Pathological changes in the wrist tissues were characterized by qualitative and quantitative varieties. They were the consequences of traumatic blood supply disorders in the scaphoid and joint capsule. They manifested themselves as inflammatory, productive-reparative and dystrophic-destructive changes (DDC). Maximum values of Pearson’s association coefficient were revealed between the parameters: time since injury – scaphoid surface DDC in pseudoarthrosis zone (ra = + 0.438; p less 0.01); pain – scaphoid osteonecroses (ra = +0.320; p less 0.05); wrist contracture – hypertrophy of the villi of the wrist capsule synovial layer (ra = +0.320; p less 0.1). Conclusion Pathohistological and morphometrical studies allowed us to reveal some previously unknown differences and dependences important for understanding the pathogenesis, improvement of diagnosis and prediction of the WOA course which was a result of scaphoid fracture nonunion.