Lazzarin P, Cesaro G, Puggina S, Perin B, Cremonini L, Padovani G, Sfriso P, Sartori M T
Servizio di Reumatologia, Azienda ULSS 17.
Reumatismo. 2004 Jul-Sep;56(3):202-10. doi: 10.4081/reumatismo.2004.202.
Osteonecrosis is a disease characterized by the death of marrow and bone tissues. All bones may be affected, most commonly those of the hip, knee, shoulder, ankle as well as the small bones of the hands and feet. When the disease involves a weight-bearing joint there is a significant risk that subarticular fracture may develop leading to disabling arthrosis and requiring, therefore, arthroplasty surgery. Osteonecrosis typically affects patients in their third, fourth and fifth decades of life and is associated with many factors including other diseases and co-morbidities. Multifocal osteonecrosis is defined according to the involvement of at least three separated anatomic sites. We describe the case of a young man with osteonecrosis of the shoulder and hip joints which required total arthroplasty. Among biochemical investigations, an increase in the plasminogen activator inhibitor type 1 (PAI-1) levels associated with mild hyperhomocysteinemia was present. Another finding was the HLA B27, without signs of spondyloarthropathies. In patients with osteonecrosis, especially if multifocal, a careful medical history, a complete physical examination and some biochemical investigations, particularly those related to thrombophilia and hypofibrinolysis, should be performed.
骨坏死是一种以骨髓和骨组织死亡为特征的疾病。所有骨骼都可能受到影响，最常见的是髋骨、膝盖、肩膀、脚踝以及手和脚的小骨头。当疾病累及负重关节时，存在显著风险，即可能发生关节下骨折，导致致残性关节炎，因此需要进行关节置换手术。骨坏死通常影响三四十岁和五十岁左右的患者，并且与许多因素相关，包括其他疾病和合并症。多灶性骨坏死根据至少三个不同解剖部位受累来定义。我们描述了一名患有肩关节和髋关节骨坏死并需要进行全关节置换术的年轻男子的病例。在生化检查中，发现纤溶酶原激活物抑制剂1（PAI - 1）水平升高并伴有轻度高同型半胱氨酸血症。另一个发现是HLA B27阳性，但无脊柱关节病迹象。对于骨坏死患者，尤其是多灶性骨坏死患者，应仔细询问病史、进行全面体格检查并进行一些生化检查，特别是与血栓形成倾向和纤维蛋白溶解功能减退相关的检查。
