膝关节骨髓水肿的病因学分类及诊治进展  

Etiological classification and progress in diagnosis and treatment of bone marrow edema in knee joint

作　　者：师锦玉 刘沛 李建垒 石腾博 杨鹏 曹向阳 SHI Jinyu;LIU Pei;LI Jianlei;SHI Tengbo;YANG Peng;CAO Xiangyang(College of Orthopedics and Traumatology,Henan University of Chinese Medicine,Zhengzhou 450046,China;不详)

机构地区：[1]河南中医药大学骨伤学院,河南郑州450046 [2]河南省洛阳正骨医院(河南省骨科医院)(郑州院区)膝关节外一科,河南郑州471002 [3]河南省中医药科学院智能医疗与生物工程研究所,河南郑州451163

出　　处：《山东医药》2025年第3期144-149,共6页Shandong Medical Journal

基　　金：河南省重大科技专项(221100310200);河南省工程研究中心建设项目[豫发改高技(2018)1030号];河南省医学科技攻关联合共建项目(LHGJ20230482)。

摘　　要：膝关节骨髓水肿(BME)是一种常见的膝关节病变,具有自限性,但若不及时治疗,可能导致关节软骨的进行性磨损,甚至发展为终末期骨关节炎,严重影响患者的生活质量。膝关节BME的病因复杂,通常可分为缺血性、机械性和反应性三类。膝关节缺血性BME多与微循环障碍相关,包括骨坏死、骨髓水肿综合征、剥脱性骨软骨炎以及复杂区域疼痛综合征等。膝关节机械性BME常由创伤或应力性损伤引起,包括骨挫伤、应力相关性BME以及应力性骨折等。膝关节反应性BME则与周围组织的炎症反应密切相关,包括膝关节炎性疾病、膝关节骨关节炎、术后BME以及肿瘤相关的BME等。膝关节BME的治疗首选保守治疗,包括药物、物理治疗等;若保守治疗无效,可考虑微创保护性手术,当软骨广泛退化并出现软骨下骨塌陷时,全膝关节置换术或单髁膝关节置换术是唯一有效的选择。Knee bone marrow edema(BME)is a common knee joint pathology characterized by its self-limiting nature.However,if left untreated,it can lead to progressive wear of articular cartilage and potentially evolve into end-stage osteoarthritis,significantly impairing the patients'quality of life.The etiology of knee BME is complex and can generally be categorized into ischemic,mechanical,and reactive types.Ischemic knee BME is often associated with microcirculatory disturbances,including conditions such as osteonecrosis,bone marrow edema syndrome,osteochondritis dissecans,and complex regional pain syndrome.Mechanical knee BME is typically caused by trauma or stress-related injuries,encompassing bone contusions,stress-related BME,and stress fractures.Reactive knee BME is closely linked to inflammatory responses in surrounding tissues,including inflammatory arthritis of the knee,knee osteoarthritis,postoperative BME,and tumor-associated BME.The primary treatment for knee BME is conservative management,which includes pharmacological interventions and physical therapy.If conservative measures fail,minimally invasive protective surgery may be considered.In cases where there is extensive cartilage degeneration and subchondral bone collapse,total knee arthroplasty or unicompartmental knee arthroplasty remains the only effective treatment option.

关 键 词：骨髓水肿 骨关节炎 膝关节疾病 全膝关节置换术 单髁膝关节置换术 

分 类 号：R684[医药卫生—骨科学]