Satku K, Kumar V P, Chong S M, Thambyah A
Department of Pathology, National University of Singapore, Singapore.
J Bone Joint Surg Br. 2003 Sep;85(7):983-8. doi: 10.1302/0301-620x.85b7.14580.
The natural history of spontaneous osteonecrosis of the medial tibial plateau remains controversial and incomplete. We have studied 21 patients (aged between 53 and 77 years) with clinical and scintigraphic features of spontaneous osteonecrosis of the medial tibial plateau who were observed prospectively for at least three years (37 months to 8.5 years). The mean duration of follow-up was 5.6 years. The mean duration of symptoms at presentation was 4.7 weeks (3 days to 12 weeks). Radiographs of the affected knee at the first visit were normal in 15 patients and mildly arthritic in six. The characteristic radiographic lesion of osteonecrosis was noted at presentation in five of the mildly arthritic knees and during the evolution of the disease in eight of the radiographically normal knees. During the follow-up, subchondral sclerosis of the affected medial tibial plateau was noted in 16 knees. There are three distinct patterns of outcome: 1) acute extensive collapse of the medial tibial plateau in two knees within three months of onset; 2) rapid progression to varying degrees of osteoarthritis in 12 knees, in eight within a year, in all within two years and deterioration of the pre-existing osteoarthritis in three; and 3) complete resolution in four knees, two of which were normal at presentation and two mildly osteoarthritic. The two patients with acute extensive collapse and three who had rapid progression to severe osteoarthritis required total knee arthroplasty. We conclude that osteonecrosis of the medial tibial plateau progresses in most cases to significant degenerative disease of the knee.
胫骨内侧平台自发性骨坏死的自然病程仍存在争议且尚不完整。我们研究了21例（年龄在53至77岁之间）具有胫骨内侧平台自发性骨坏死临床和骨闪烁显像特征的患者，对其进行了至少三年（37个月至8.5年）的前瞻性观察。平均随访时间为5.6年。就诊时症状的平均持续时间为4.7周（3天至12周）。首次就诊时，15例患膝的X线片正常，6例有轻度关节炎表现。5例轻度关节炎患膝在就诊时即发现了骨坏死的典型X线病变，8例X线片正常的患膝在疾病发展过程中出现了该病变。随访期间，16例患膝出现了胫骨内侧平台软骨下硬化。有三种不同的转归模式：1）发病后三个月内，2例患膝出现胫骨内侧平台急性广泛塌陷；2）12例患膝迅速发展为不同程度的骨关节炎，其中8例在一年内出现，所有病例均在两年内出现，3例原有骨关节炎病情恶化；3）4例患膝完全恢复，其中2例就诊时正常，2例有轻度骨关节炎。2例急性广泛塌陷的患者和3例迅速发展为严重骨关节炎的患者需要进行全膝关节置换术。我们得出结论，大多数情况下，胫骨内侧平台骨坏死会发展为膝关节明显的退行性疾病。
