膝关节骨坏死:自发性和继发性两种类型的区别  

Difference between spontaneous and secondary osteonecrosis of knee joint

作　　者：马云青[1] 张洪[1] 孙大铭[1] 

机构地区：[1]解放军总医院第一附属医院骨科,北京100048

出　　处：《中国骨肿瘤骨病》2011年第2期143-147,共5页Chinse Journal Of Bone Tumor And Bone Disease

摘　　要：目的比较自发性和继发性膝关节骨坏死的临床特点、影像学特征并总结两者的区别。方法分析2004年1月至2008年1月诊治的25例(29膝)膝关节骨坏死病例的临床资料和随访结果,对自发性和继发性两种类型的膝关节骨坏死进行鉴别诊断分析。结果 8例诊断为自发性骨坏死病例均为老年女性,平均年龄63岁。临床表现为单侧膝关节突发剧痛,损伤局限在单侧股骨髁或胫骨平台,好发于股骨髁中部,软骨下骨剥脱为主要表现。17例继发性骨坏死病例中青年男性患者多见,平均年龄35岁。诱发因素明确,酗酒与激素为主要诱发因素。临床症状表现为轻微疼痛或隐痛,损伤范围广泛,累及股骨远端和胫骨近端的骨髓腔,较少累及关节面。MRI是临床重要的诊断手段,也是临床分类的重要依据。结论自发性和继发性膝关节骨坏死由于发病机制不同而引起不同的损伤病理变化导致两者在临床表现、损伤部位、范围及影像学表现的本质不同。Objective To summarize the difference between spontaneous and secondary osteonecrosis of knee joint through comparing the clinical and imaging features of the osteonecrosis in the knee joint. Methods The clinical materials and follow-up results of 25 patients （29 knees） with osteonecrosis of knee joint from January 2004 to January 2008 were analyzed. Differential diagnosis was applied to analyze the spontaneous and secondary osteonecrosis of knee joint. Results 8 patients confirmed spontaneous osteonecrosis of knee were all elder females. The mean age was 63 years. Clinical manifestation was severe sudden onset of pain in the unilateral knee joint. Lesions were restricted in the unilateral condyleoffemur or tibial plateau. It commonly appeared in the middle of condyleoffemur. The exfoliation of subchondral bone was its main manifestation. 17 patients had secondry osteonecrosis, which generally occurred in young male patients. The mean age was 35 years. The factors of induction were clear and definite. Alcoholic intemperance and hormone were its main factors of induction. The clinical manifestation was mild or dull pain. The lesions were larger and the marrow cavity between distal femur and proximal tibia was involved. Articular surface was less involved. Magnatic Resonance Imaging （MRI） was important in clinical diagnosis, and it was an important evidence for clinical classification. Conclusions Due to different pathogenetic mechanisms of spontaneous and secondary osteonecrosis, different pathological changes of lesions are induced. And pathological changes induce essential differences between spontaneous and secondary osteonecrosis in clinical manifestation, location and extent of leisions and MRI manifestation.

关 键 词：骨坏死 骨梗死 膝关节 自发性 继发性 核磁共振 

分 类 号：R684.3[医药卫生—骨科学]