Marti C B, Rodriguez M, Zanetti M, Romero J
Department of Orthopedic Surgery, University of Zürich, Balgrist, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2000;8(2):83-8. doi: 10.1007/s001670050191.
Symptoms in patients suffering from spontaneous osteonecrosis of the knee (SONK) may be reduced by high tibial osteotomy (HTO). However, the fate of the necrotic lesion is unknown and needs further investigation. We conducted a prospective study to evaluate magnetic resonance imaging (MRI) changes after operative and nonoperative treatment. Ten consecutive patients suffering from SONK of the medial compartment were given two treatment options: either HTO (n = 6) or conservative treatment with partial weight bearing for 3 months (n = 4). We measured the greatest extent of well-defined subchondral low signal intensity abnormality, considered to represent necrosis, and the surrounding area of intermediate signal intensity, considered to represent perifocal bone marrow edema, on T1-weighted coronal MRI images before and after treatment. The MRI follow-up period was 17.5 months (range 12-27) in the HTO group and 14.5 months (range 8-25) in the nonoperative group. At follow-up the MRI evaluation revealed a decrease in the low signal intense areas (necrosis) in five of the six patients in the HTO group. Only one of the four nonoperative patients showed a decrease in the low signal intense area. The intermediate intense areas (edema) decreased in all patients in the HTO group and in three of four in the nonoperative group. The mean decrease in the area of perifocal edema was significantly greater in the HTO group than in the nonoperative group (P = 0.019). No statistically significant difference was found for the area of necrosis between the two groups (P = 0.171). A clinical improvement was observed in all patients of the HTO group but in only two of the four patients of the nonoperative group. We conclude that the decrease in perifocal bone marrow edema seems to be associated with improved patient comfort. The MRI appearance of the necrotic lesion does not alter with either treatment mode.
膝关节自发性骨坏死（SONK）患者的症状可能会通过高位胫骨截骨术（HTO）得到缓解。然而，坏死病灶的转归尚不清楚，需要进一步研究。我们进行了一项前瞻性研究，以评估手术和非手术治疗后的磁共振成像（MRI）变化。连续10例内侧间室SONK患者被给予两种治疗选择：HTO（n = 6）或部分负重保守治疗3个月（n = 4）。我们在治疗前后的T1加权冠状位MRI图像上测量了明确的软骨下低信号强度异常的最大范围，该异常被认为代表坏死，以及中等信号强度的周围区域，该区域被认为代表灶周骨髓水肿。HTO组的MRI随访期为17.5个月（范围12 - 27个月），非手术组为14.5个月（范围8 - 25个月）。随访时，MRI评估显示HTO组6例患者中有5例低信号强度区域（坏死）减小。4例非手术患者中只有1例低信号强度区域减小。HTO组所有患者以及非手术组4例中的3例中等强度区域（水肿）减小。HTO组灶周水肿面积的平均减小幅度显著大于非手术组（P = 0.019）。两组之间坏死面积无统计学显著差异（P = 0.171）。HTO组所有患者均观察到临床改善，而非手术组4例患者中只有2例改善。我们得出结论，灶周骨髓水肿的减轻似乎与患者舒适度的改善有关。坏死病灶的MRI表现不会因任何一种治疗方式而改变。
