Bildgebung postarthroskopischer Komplikationen nach Knieverletzungen

The most common joint injuries in professional and recreational sports participants and also in the total population are knee injuries. Arthroscopy is indicated if this modality will improve the patient outcome and potential long-term complications can be avoided. Although uncommon, complications following arthroscopy are mostly evaluated by magnetic resonance imaging (MRI). For planning further therapy strategies following postarthroscopic complications, e.g. if anterior cruciate ligament (ACL) reconstruction is required, digital radiographs and computed tomography (CT) are helpful. This article provides an overview of the different procedures for surgical treatment which are a prerequisite for the analysis of postarthroscopic images. In addition typical complications after treatment of meniscal and chondral injuries as well as after ACL reconstruction are described and typical signs in MRI, radiography and CT are explained in detail.     

酒精性和激素性股骨头坏死的发病与脂质代谢

背景:非创伤性股骨头坏死的发病机制存在各种理论学说,脂质代谢异常是其中一种假说,但是脂质代谢如何参与骨坏死的发病机制仍不清.目的:通过对激素性和酒精性骨股头坏死患者血脂改变及股骨头置换标本形态计量学观察分析,探讨脂质代谢改变在非创伤性骨坏死中的作用.方法:选择股骨头坏死住院患者162例,包括酒精性骨股头坏死57例,激素性骨股头坏死63例,创伤性骨股头坏死42例,其国际骨循环分期为(ARCO)Ⅱ～Ⅳ期.患者入院后常规抽空腹静脉血行三酰甘油、低密度脂蛋白等血脂检测.各组选取12例关节置换股骨头标本,股骨头冠状面正中剖开,在负重区和非负重区取材,对骨髓造血面积、脂肪细胞密度、脂肪细胞直径和脂肪细胞面积等行形态计量学观察.结果与结论:酒精性股骨头坏死患者血三酰甘油升高率显著高于激素性和创伤性股骨头坏死患者(P < 0.05).酒精性股骨头坏死患者血低密度脂蛋白降低率明显高于激素性和创伤性股骨头坏死(P < 0.05).与激素性骨坏死患者相比,酒精性股骨头坏死患者脂肪细胞面积和脂肪细胞直径大,但造血面积减小,且差异有显著性意义.推测脂质代谢改变在酒精性股骨头坏死晚期起重要调节作用,而在激素性股骨头坏死晚期作用不明显.     

Steroids and aseptic osteonecrosis (AON) in migraine patients

Osteonecrosis is a bony infarction caused by disruption of blood supply to the bone. Aseptic osteonecrosis should be rare with intermittent use of steroids in disabling and refractory migraine cases. We present 3 cases of patients who had severe migraine and developed aseptic osteonecrosis with short-term, intermittent pulse doses of corticosteroids. Migraine has been mentioned as a possible risk factor for aseptic osteonecrosis, and we speculate that severe migraine may be a risk factor for developing aseptic osteonecrosis. Furthermore, migraineurs who develop aseptic osteonecrosis may or may not have associated white matter changes in the brain. We noted a triad of severe migraine, osteonecrosis, and migraine-related white matter lesions in only 1 case. In severe cases of migraine, steroids should be used cautiously.     

Die Osteonekrose des Kniegelenks: Pathophysiologie, Klinik und aktuelle Therapie

The osteonecrosis of the knee joint was first described by Ahlbäck 1968. Indications to this clinical picture were given earlier by Milgram (1963), Rubens-Duval (1966), and Kolar (1968). The spontaneous or idiopathic osteonecrosis has to be differentiate from the secondary osteonecrosis, which exogenous or endogenous causes are well known. There is a sudden onset of pain in the knee joint. Most patients are about 60 years old. The sex ratio is 3:1 for females. As etiology are discussed a vascular and a traumatic genesis. The pathology of the ostenecrosis can be divided into four stages: Stage I is the flattering of the cartilage. During stage II a osteochondral flap attached to the subchondral bone can be seen. Stage III shows a bone defect, that is filled with fibrous cartilage. The stage IV then leads to the secondary arthritis. Clinical examination is often unspecific and leads to different diagnosis. X-ray, MRI and bone scan can be helpful for the radiological examination. The treatment of an osteonecrosis of the femur condyle includes conservative treatment as well as operative treatment such as the arthroscopic debridement combined with drilling or core decompression, the autogenous or allogenous osteochondral grafting, the high tibial osteotomy, the unicompartmental or total knee arthroplasty.     

酒精性和激素性股骨头坏死的发病与脂质代谢

背景：非创伤性股骨头坏死的发病机制存在各种理论学说,脂质代谢异常是其中一种假说,但是脂质代谢如何参与骨坏死的发病机制仍不清.目的：通过对激素性和酒精性骨股头坏死患者血脂改变及股骨头置换标本形态计量学观察分析,探讨脂质代谢改变在非创伤性骨坏死中的作用.方法：选择股骨头坏死住院患者162例,包括酒精性骨股头坏死57例,激素性骨股头坏死63例,创伤性骨股头坏死42例,其国际骨循环分期为（ARCO）Ⅱ～Ⅳ期.患者入院后常规抽空腹静脉血行三酰甘油、低密度脂蛋白等血脂检测.各组选取12例关节置换股骨头标本,股骨头冠状面正中剖开,在负重区和非负重区取材,对骨髓造血面积、脂肪细胞密度、脂肪细胞直径和脂肪细胞面积等行形态计量学观察.结果与结论：酒精性股骨头坏死患者血三酰甘油升高率显著高于激素性和创伤性股骨头坏死患者（P 〈 0.05）.酒精性股骨头坏死患者血低密度脂蛋白降低率明显高于激素性和创伤性股骨头坏死（P 〈 0.05）.与激素性骨坏死患者相比,酒精性股骨头坏死患者脂肪细胞面积和脂肪细胞直径大,但造血面积减小,且差异有显著性意义.推测脂质代谢改变在酒精性股骨头坏死晚期起重要调节作用,而在激素性股骨头坏死晚期作用不明显.     

中国系统性红斑狼疮伴发骨坏死相关因素的Mela分析

背景：系统性红斑狼疮是一种异质性疾病,除长期应用激素可引起骨坏死外,有研究指出临床表现的差异性也有可能是骨坏死的危险因素。目前国内外学者对在系统性红斑狼疮患者中发生骨坏死的致病因素存在不同观点。目的：对国内系统性红斑狼疮患者并发骨坏死的危险因素进行系统分析。方法：检索中国学术期刊全文数据库（CNKI）、中国生物医学文献数据库（CBMdisc）、万方数据库获得已公开发表的国内系统性红斑狼疮并发骨坏死相关危险因素的病例对照研究文献,筛选出符合评价标准的文献,采用RevMan5．0及Stata软件进行Meta分析,并计算各危险因素的合并比值比及95％置信区间。结果与结论：共纳入10篇病例对照研究,累计病例组332例、对照组986例。系统性红斑狼疮并发骨坏死的各危险因素的比值比及95％置信区间分别为：雷诺现象3．28（1．69-6．38）,口腔溃疡2．95（2．13-4．09）,肾脏受累1．21（0．83-1．74）,血管炎因素5．64（2．84-11．21）,高脂血症5．11（3．10-8．42）,抗磷脂抗体2．32（1．49-3．61）,关节受累2．02（1．33-3．07）。提示激素应用明确为系统性红斑狼疮并发骨坏死的独立危险因素,但并非惟一因素,血管炎、高脂血症、雷诺现象、口腔溃疡、抗磷脂抗体阳性及关节受累均为需要重视的国内系统性红斑狼疮患者并发骨坏死的危险因素。     

Relationships among severity of osteonecrosis, pain, range of motion, and functional mobility in children, adolescents, and young adults with acute lymphoblastic leukemia

BACKGROUND AND PURPOSE: Up to 38% of children receiving treatment for acute lymphoblastic leukemia (ALL) develop osteonecrosis, often without symptoms. Little is known about the association between the degree of osteonecrosis and functional mobility in this population. The purpose of this study was to examine relationships among the degree of osteonecrosis, pain, range of motion (ROM), and functional mobility in people with ALL. SUBJECTS: Thirty-three subjects aged 5 to 27 years with ALL and osteonecrosis participated. METHODS: The extent of osteonecrosis was determined by magnetic resonance imaging (MRI) of the hip and knee according to 2 classification systems, including the Association Research Circulation Osseous (ARCO) and a knee staging scale. Pain, hip and knee ROM, and the Timed Up and Down Stairs (TUDS) Test were used as measures. RESULTS: Correlations were observed between ARCO and hip pain (r=.34), between hip flexion ROM and hip pain (r=-.34), and between knee pain and time on the TUDS Test (r=-.35). DISCUSSION AND CONCLUSION: Physical therapists should consider that people with ALL may have hip or knee osteonecrosis without clinical symptoms. This notion supports the need for MRI in addition to a comprehensive examination of functional mobility.     

Avaskuläre Osteonekrose des Os naviculare pedis beim jungen Sportler

In a review article about the avascular osteonecrosis of the tarsal naviculare pedis we define the two pathologies—Morbus Köhler I and Müller-Weiss syndrome—and talk about their characteristic clinical examination, imaging findings, therapeutic management and rehabilitation. The follow up of two cases of young athletes will be discussed, reflecting that bony pathologies like stress fractures can mimic osteonecrosis.     

ECT在SARS患者愈后早期缺血性骨坏死的诊断价值分析

目的探讨ECT对SARS患者应用过大剂量类固醇激素治疗愈后引起骨坏死的早期诊断价值.方法对4例SARS愈后患者进行ECT、X线平片和MRI的骨坏死检查,对比分析三种检查方法对骨坏死的诊断价值.结果 4例病例在ECT及MRI上均能显现同一解剖部位早期骨坏死改变,并且先于X线平片.结论 ECT及MRI均能提供早期骨坏死的诊断.ECT可以在一次检查中发现全身多处病变.     

双膦酸盐类药物相关性颌骨坏死病例报告及最新进展文献复习

背景:双膦酸盐能抑制破骨细胞介导的骨吸收,广泛用于预防和治疗由于破骨细胞活性增强所致的骨骼疾病。目的:探讨双膦酸盐类药物致颌骨坏死的临床诊断和治疗方法。方法:检索中国生物医学文献数据库和Medline数据库2003/2011收录的双膦酸盐类药物致颌骨坏死的相关综述和论文报告,并分析和探讨其发病机制、临床表现及其预防和治疗。同时根据患者的病史、辅助检查和专科查体确诊1例乳腺癌骨转移患者应用双膦酸盐类药物致颌骨坏死的个案,采用手术为主的综合治疗手段对患者进行了治疗,临床治愈,疗效满意。结果与结论:共纳入双膦酸盐类药物致颌骨坏死的相关文献15篇。双膦酸盐类药物可以抑制破骨细胞,降低肿瘤细胞引起的骨转移灶的溶骨性破坏。由于在正常骨组织中,成骨细胞和破骨细胞维持动态平衡,但在口腔治疗过程中,双膦酸盐抑制了颌骨在病损后的破骨细胞的活动,使骨改建的病理生理过程无法完成;造成颌骨尤其是牙槽骨在牙槽手术后骨的修复不能进行,引起经久不愈的感染。     

Knochenmark?deme und Osteonekrosen nach Meniskektomie

Bone marrow edema and osteonecrosis are possible consequences following a meniscectomy. Magnetic resonance imaging (MRI) is a specific method to depict these changes at an early stage and in this case, fat-saturated T2 images are the most suitable. For diagnosis it is important to differentiate between bone marrow edema with and without signs of osteonecrosis. Etiological factors currently being discussed include the meniscus rupture itself, changes in the transmission of loads following meniscectomy, additive cartilage damage, thermal damage, the arthroscopic procedure itself, or preexisting spontaneous osteonecrosis of the knee joint (SONK). Osteonecrosis of the postoperative knee joint (ONPK) is an exceedingly rare but serious complication. Whether or not this can be attributed to the surgical procedure remains unclear. Preexisting SONK which is not diagnosed by MRI due to an inadequate time frame (<6 weeks) is the only differential diagnosis. Due to the forensic importance, arthroscopic surgeons should be well acquainted with both clinical pictures in order to have a line of reasoning at hand.     

载脂蛋白Al、B基因多态性与非创伤性股骨头坏死发病的危险性

背景：载脂蛋白Al和载脂蛋白B基因多态性影响载脂蛋白Al、B的异常从而导致血脂代谢紊乱,推测这些基因的多态性可能与股骨头坏死的发生有一定的关系。 目的：分析载脂蛋白Al、B基因多态性与中国北方汉族人群中非创伤性股骨头坏死易感性之间的关系。     

Analysis of needs of patients with idiopathic osteonecrosis of the femoral head: Using focus group interviews

Aim: The current needs of patients with idiopathic osteonecrosis of the femoral head were analyzed for the purpose of seeking effective support programs that would maintain and improve the quality of life of the patients. Methods: A focus group interview method was used to collect data. Interviewees included eight patients. They were asked about their opinions and needs with respect to medicine, health care, and welfare. Results: Overall, four needs were revealed as particularly significant: information needs, decision‐making in the absence of pre‐established treatment, psychological support, and sufficient medical healthcare institutions. Conclusion: These four needs are useful for the foundation of future support systems, whose main concerns will be: counseling support for patients with idiopathic osteonecrosis of the femoral head, currently adopted institutions, and resources that may be required in the future.     

激素性股骨头坏死成脂分化学说及治疗现状

背景：激素引起股骨头局部区域骨小梁和骨髓坏死,股骨头塌陷、变形,最终导致髋关节功能障碍,但是激素性股骨头坏死的病理机制及治疗仍未为人所破解,医学界存在多种病机学说争议,但是目前对病理机制的了解仍然不够深入,其研究一直是国际研究的热点及难点。目的：综述激素性股骨头坏死的成脂分化学说及治疗研究进展。方法：由第一作者用计算机检索中国期刊全文数据库CNKI及PubMed数据库（1988/2010）,英文检索词分别为＂Glucocorticoids,osteonecrosis of femoral head,bone marrow stromal stem cells,adipogenic differentiation,factors,treatment,choice＂,中文检索词为＂激素性股骨头坏死,成脂分化,治疗,研究进展＂,从激素性股骨头成脂分化及治疗现状2方面进行归纳概述。结果与结论：共检索到112篇文章,按纳入和排除标准对文献进行筛选,共纳入54篇文章。现代研究主要从细胞分子生物学层面研究,结果表明激素性股骨头坏死的部分生物学基础是骨细胞成脂分化异常,激素引起成脂分化因子的变化进而导致骨髓基质干细胞成脂分化,但是激素的作用于多个分化因子,单纯从某个因子来衡量激素性股骨头坏死病理机制可能有较大误差,激素使用过度是股骨头坏死核心原因。目前对激素性股骨头坏死病理机制及治疗方案的研究仍不深入。     

Radiologische Diagnostik und Differenzialdiagnostik der Osteonekrose

Imaging plays a major role in the diagnosis of osteonecrosis. In addition to conventional radiography, MR imaging represents the most relevant radiological modality in early detection of osteonecrosis, in the definition of the extent of necrotic areas, and in assessment of viability of bone. This article will review general imaging aspects of osteonecrosis in children and adults as well as the radiomorphology of bone infarction. Furthermore, the value of radiological modalities in imaging of the most important manifestations of osteonecrosis will be elucidated.     

Avascular osteonecrosis of the mandible following bisphosphonate therapy

Cancer patients receiving bisphosphonate therapy, both intravenously and orally, are predisposed to developing osteonecrosis of the jaw. We present a case of a 66-year-old man with metastatic prostate cancer who spontaneously developed avascular necrosis of the mandible after being on intravenous zoledronic acid for 1 year. Jaw osteonecrosis commonly presents with mild to severe jaw pain. Although most of the reported cases give a history of dental procedures, there have been cases of osteonecrosis developing spontaneously. In cases of established osteonecrosis of the jaw, there is little evidence to suggest that the discontinuation of bisphosphonate therapy aides in healing, as bisphosphonates have a very long half-life in the bone tissue. Treatment measures include evaluation by dental and oncological services, consideration for antibiotic therapy, and mainly a minimally to nonsurgical approach. In the absence of a definitive cure, the emphasis rests greatly on prevention.     

Developmental Dysplasia of the Hip: Controversies in Management

Purpose of ReviewMany aspects of developmental hip dysplasia (DDH) care and evaluation are still active areas of debate. Recent studies have provided more insight into these topics such as strategies for reducing osteonecrosis, assessing hip reduction after closed and open reduction, and the management of residual acetabular dysplasia.Recent FindingsThe presence of the ossific nucleus at the time of reduction does not alter the risk of osteonecrosis. The risk of osteonecrosis may be higher when hips are immobilized in excessive abduction. Limited sequence MRI may be the best choice for assessing hip reduction after closed and open reduction; however, new technologies are emerging such as 3D fluoroscopy and perfusion MRI. The treatment of residual acetabular dysplasia with bracing has been shown to be effective and the decision to perform a pelvic osteotomy is based on patient-specific factors.SummaryThe spectrum of DDH treatment has evolved over the past several decades. Recent studies have provided insights into strategies for osteonecrosis prevention, hip evaluation during after reduction, and the management of residual acetabular dysplasia. However, there is ample room for additional and more rigorous studies guiding advanced imaging for assessing hip reduction such as 3D fluoroscopy and perfusion MRI, as well as the management of residual acetabular dysplasia.     

股骨头缺血性坏死对股骨近端骨组织的影响

背景股骨头缺血坏死可导致患者运动功能障碍,常用的治疗方法是全髋关节置换术,但手术失败原因目前尚不清楚.有作者认为是股骨近端骨组织异常所至,但是缺乏深入研究.目的探讨股骨头缺血坏死患者的股骨近端骨改变.设计以患者为研究对象,非随机化同期对照研究.单位青岛大学医学院附属医院创伤外科.对象1999-09/2003-05青岛大学医学院创伤外科收治的股骨头缺血坏死患者18例,男12例,女6例;平均年龄(50±5)岁.同期骨关节炎患者18例,男10例,女8例;平均年龄(62±3)岁.方法对18例股骨头缺血坏死行全髋关节置换术患者的股骨头和股骨近端松质骨标本进行组织学检查,并用18例髋关节骨关节炎患者作为对照组,所有标本采用双盲方式进行检查.主要观察指标两组患者股骨颈、大转子、小转子、股骨干的坏死评分和坏死阳性率.结果股骨头缺血坏死患者小转子下方4 cm处存在广泛的骨坏死.股骨头缺血坏死组和对照组坏死评分总分分别为82分和16分;坏死阳性率分别为63.89%和19.44%,两组之间股骨近端的骨坏死程度相比较差异有非常显著性意义(P＜0.001).结论股骨近端的骨改变可能是股骨头缺血坏死行全髋关节置换早期失败的原因之一.     

双磷酸盐相关性颌骨坏死影像学研究进展

双磷酸盐是破骨细胞抑制剂,广泛应用于治疗癌症患者骨转移,但近来有患者接受双磷酸盐类药物治疗后发生颌骨坏死的报道.本文就双磷酸盐相关性颌骨坏死的发病机制、临床表现和影像学表现做一综述.     

股骨头坏死实验动物模型：分类与实验应用

背景：迄今没有一种理想的动物模型用于股骨头坏死相关研究,是其研究进展缓慢的一个重要原因。目的：比较各种方式及各种动物造模的优劣及特点,为股骨头坏死的研究模型选择提供参考。方法：应用计算机检索2006至2014年PubMed数据库、EMBASE数据库、万方数据知识服务平台、CNKI中国期刊全文数据库,英文检索词“OsteonecrosisoftheFemoralHead、Animalmodel、VivoExperiment、LeggCalvePerthesdisease、Osteoarthritis、ColapseoftheFemoralHead、Trauma、Corticosteroid、Alcohol、LiquidNitrogen”;中文检索词“股骨头坏死、动物模型、体内实验、Perthes病、骨性关节炎、股骨头塌陷、创伤、激素、酒精、液氮”,共48篇文献纳入。结果与结论：创伤性股骨头坏死模型模拟了临床上最常见的股骨头坏死的类型,对于Perthes病的模型建立较为成熟。激素性股骨头坏死的模型适合于病因、病理及综合性研究。物理方式建立的模型,可作为模拟临床外科治疗方法研究的动物模型。理想的动物模型需要在髋关节的解剖学、组织学、生物力学等方面与人类相似,其股骨头坏死的病理、病生及影像学进展能模拟整个人类股骨头坏死的过程,来源容易、性价比高、可重复性好。