Nakamae Atsuo, Engebretsen Lars, Bahr Roald, Krosshaug Tron, Ochi Mitsuo
Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, P.O. Box 4014, Ulleval Stadion, 0806 Oslo, Norway.
Knee Surg Sports Traumatol Arthrosc. 2006 Dec;14(12):1252-8. doi: 10.1007/s00167-006-0087-9. Epub 2006 Jun 20.
The purpose of this paper is to review the scientific literature on the natural history of bone bruises and the experimental studies regarding the histopathological effects of impaction load on articular cartilage and subchondral bone. Bone bruises with subchondral or osteochondral injuries, or geographic bone bruises seemed to be persistent for years after trauma on MRI. Biopsy samples of the articular cartilage overlying the bone bruise lesions showed degeneration or necrosis of chondrocytes and loss of proteoglycan. Experimental studies using a single impact load revealed chondrocytes death, alteration of the mechanical properties of cartilage explants and/or an increase in the thickness of subchondral bone. These data are indicative of a significant injury to normal articular cartilage homeostasis, and support the suggestion that severe bone bruise is a precursor of early degenerative changes. We recommend delaying return to full weightbearing status when a severe bone bruise is detected to prevent further collapse of subchondral bone and further aggravation of articular cartilage injury.
本文旨在回顾关于骨挫伤自然病史的科学文献，以及关于撞击负荷对关节软骨和软骨下骨组织病理学影响的实验研究。伴有软骨下或骨软骨损伤的骨挫伤，即地图状骨挫伤，在MRI上创伤后数年似乎仍持续存在。骨挫伤病变上方关节软骨的活检样本显示软骨细胞退变或坏死以及蛋白聚糖丢失。使用单次冲击负荷的实验研究显示软骨细胞死亡、软骨外植体力学性能改变和/或软骨下骨厚度增加。这些数据表明正常关节软骨内环境稳定受到显著损伤，并支持严重骨挫伤是早期退变改变先兆的观点。我们建议，当检测到严重骨挫伤时，应推迟恢复至完全负重状态，以防止软骨下骨进一步塌陷和关节软骨损伤进一步加重。
