Chronic traumatic purely serous formsynovitis are relatively rare. In the initial period of chronic serous synovitis clinical manifestations are mild. Patients complain of fatigue, fatigue in walking, slight limitation of movement in the affected joint, the presence of aching pain. The articular cavity accumulates abundant effusion, develops so-called joint edema (hydrarthrosis), long-term existence of which is stretched ligaments, leading to his laxity, subluxation, and even dislocation.
In most cases, there are mixed types: chronic serous-fibrinoid, chronic vilezny and vilezno-hemorrhagic.
In chronic serous synovitis, or fibrinoidserous fibrous synovitis (usually results from repeated hemorrhage) in a lot of fibrin exudate, precipitated in the form of individual fibers and clumps, which hardens to form the intra-free body.
For chronic villous synovitis characterized by the presence of hypertrophic and sclerosed villi that can otshnurovyvatsya with the formation of the so-called rice bodies and hondromnyh bodies.
In chronic forms of synovitis risepathological changes and clinical manifestations of the disease is caused not so much the duration of the inflammatory process, as a violation of blood and lymph circulation in the joint capsule due to its fibrous degeneration.
Diagnosis of chronic serous synovitis notIt presents significant difficulties, but find the cause of the disease is not vsegdalegko. Anyway, synovitis as an independent nosological form is extremely rare. In the study of the pathogenesis of synovitis great diagnostic value, in addition to clinical symptoms, the study has a puncture. It is found that the synovial fluid of patients always sterile and being svezheizvlechennoy, has the same protective properties as blood plasma. When laboratory analysis is necessary to pay attention to the color, opacity, viscosity of synovial; On microscopic examination, it is important to know the amount and composition of cells, salt crystals, bacteria and others. The biochemical study of synovial fluid usually reveals a violation of vascular permeability and synovium. The protein concentration of the membranes is an indication of discrimination. The number of its in aseptic traumatic synovitis ranges from 3 to 7.8 g in the acute period due to increased vascular permeability protein level twice the normal levels, mainly due to globulin. For example, the amount of albumin in normal synovial fluid of 72%, and after operation and injury to 45%.
constant change leads to disruptionmetabolic processes in the synovium and synovial fluid dramatically decreases the amount of hyaluronic acid, which increases the viscosity of the synovium. Therefore, when synovitis viscosity varies within quite low (0.8 to 32 units). The reason for increasing the permeability of cell-cell membranes in chronic traumatic synovitis is the increased activity of lysosomal and mucolytic enzymes (lysozyme, hyaluronidase, hondroitinproteiny), which causes depolarization and a decrease in the concentration of hyaluronic acid. According to recent data, these enzymes are localized in synovial cells, macrophages, fibroblasts and other Released as a result of injury enzymes in turn act on the base material, causing it to disorganization and increased membrane permeability.; thus, there is a vicious circle that is very difficult to break without appropriate treatment. This is why chronic synovitis without proper early treatment can lead to the destruction of cartilage and cover the development of deforming arthrosis.
Thus, the clinical picture of chronicpost-traumatic synovitis should allocate the dominant symptoms: effusion in the joint cavity, the pain, the intensity of which depends on the nature of the injury and the amount of effusion; infiltration and induration of the joint capsule; violation of limb function, its neuromuscular system and blood supply, taking into account the activity of the inflammatory process in the joint; the second occurs inferior capsular ligament and the associated instability of the knee joint. All these symptoms are generally caused by certain pathological substrate, which is the trigger and subsequently - chronic irritant synovium.
The complex examination of patients with the aim ofdetermine the factors that support the chronic inflammation of the synovial membrane, most information should be considered, in addition to the clinical manifestations, results arthropneumography, arthroscopy, biopsy and cytology data, as well as the study of synovial fluid.