膝关节特发性骨坏死(附8例报告)

目的 分析总结膝关节特发性骨坏死的临床特点及诊断和治疗方法.方法 回顾分析2006年4月至2008年10月诊治的8例膝关节特发性骨坏死患者资料.根据Aglietti的影像学分期,Ⅱ期1例、Ⅲ期1例、Ⅳ期2例、Ⅴ期4例.手术方法:Ⅴ期4例患者分别行人工全膝关节置换术和单髁置换术,Ⅳ期2例患者行全膝关节置换术,其余采取保守治疗.结果 随访2年,保守治疗患者中有1例进展为Ⅴ期,6例手术患者疼痛症状明显缓解,未见假体松动及骨质塌陷,疗效满意.结论 膝关节特发性骨坏死的临床诊断、治疗及分级主要依靠影像学辅助.早期病例主要以保守治疗为主,多进展缓慢.晚期病例需手术治疗,手术选择多样,其中全膝关节置换术远期疗效较好.

Spontaneous osteonecrosis of the knee (with 8 case reports)

Objective To analyze and summarize the clinical characteristics, diagnosis and treatment of spontaneous osteonecrosis of the knee （SPONK）. Methods A retrospective analysis was done on 8 cases of SPONK from April 2006 to October 2008. According to the radiographic staging criteria ofAglietti, 1 case was of stage Ⅱ, 1 of stage Ⅲ, 2 of stage Ⅳand 4 of stage Ⅴ, The 4 patients of stage V underwent total knee arthroplasty and unicompartment knee arthroplasty. The 2 patients of stage IV were performed total knee arthroplasty, and the rest patients received conservative treatment. Results During the 2 years of follow-up, 1 of the 2 patients who received conservative treatment progressed to stage Ⅴ. The 6 patients who received arthroplasty treatment reported significant pain relief, and no graft loosening or bone rapture, which manifested a satisfactory outcome. Conclusions The imaging techniques were very crucial in the diagnosis, treatment and staging of patients with SPONK. Patients of early stage receive conservative treatment, and progress slowly in SPONK symptoms. Patients of late stage should undergo a surgery. They are provided with different choices of surgery types, among which the total knee arthroplasty has a better effect in the long-term follow-up.