Jäger Marcus, Tillmann Frank Peter, Thornhill Thomas S, Mahmoudi Marcus, Blondin Dirk, Hetzel Gerd Rüdiger, Zilkens Christoph, Krauspe Rüdiger
Department of Orthopaedics, Heinrich-Heine University Hospital Duesseldorf, Moorenstrasse 5, D-40225 Duesseldorf, Germany.
Arthritis Res Ther. 2008;10(5):R120. doi: 10.1186/ar2526. Epub 2008 Oct 3.
Bone marrow oedema (BME) and avascular osteonecrosis (AVN) are disorders of unclear origin. Although there are numerous operative and non-operative treatments for AVN, pain management in patients with AVN remains challenging. Prostaglandins play an important role in inflammatory responses and cell differentiation. It is thought that prostaglandin I2 ([PGI2] or synonoma prostacyclin) and its analogues promote bone regeneration on a cellular or systemic level. The purpose of this study was to assess the curative and symptomatic efficacy of the prostacyclin analogue iloprost in BME and AVN patients.
We are reporting on 50 patients (117 bones) affected by BME/AVN who were treated with iloprost. Pain levels before, during and 3 and 6 months after iloprost application were evaluated by a visual analogue scale (VAS). The short form(SF)-36 health survey served to judge general health status before and after treatment. Harris Hip Score (HHS) and Knee Society Score (KSS) were performed as functional scores and MRI and X-rays before and 3 and 6 months after iloprost application served as objective parameters for morphological changes of the affected bones.
We found a significant improvement in pain, functional and radiological outcome in BME and early AVN stages after iloprost application, whereas patients with advanced AVN stages did not benefit from iloprost infusions. Mean pain level decreased from 5.26 (day 0) to 1.63 (6 months) and both HHS and KSS increased during follow-up. Moreover, the SF-36 increased from 353.2 (day 0) to 560.5 points (6 months). We found a significant decrease in BME on MRI scans after iloprost application.
In addition to other drugs, iloprost may be an alternative substance which should be considered in the treatment of BME/AVN-associated pain.
骨髓水肿（BME）和缺血性骨坏死（AVN）的病因尚不清楚。尽管针对AVN有多种手术和非手术治疗方法，但AVN患者的疼痛管理仍然具有挑战性。前列腺素在炎症反应和细胞分化中起重要作用。据认为，前列腺素I2（[PGI2]或同义词前列环素）及其类似物在细胞或全身水平上促进骨再生。本研究的目的是评估前列环素类似物伊洛前列素对BME和AVN患者的治疗和症状疗效。
我们报告了50例（117块骨）受BME/AVN影响并接受伊洛前列素治疗的患者。在应用伊洛前列素之前、期间以及应用后3个月和6个月，通过视觉模拟量表（VAS）评估疼痛程度。简短健康调查问卷（SF-36）用于判断治疗前后的总体健康状况。采用Harris髋关节评分（HHS）和膝关节协会评分（KSS）作为功能评分，在应用伊洛前列素之前、3个月和6个月后进行MRI和X线检查，作为受影响骨骼形态变化的客观参数。
我们发现应用伊洛前列素后，BME和早期AVN阶段的疼痛、功能和放射学结果有显著改善，而晚期AVN阶段的患者未从伊洛前列素输注中获益。平均疼痛程度从5.26（第0天）降至1.63（6个月），随访期间HHS和KSS均增加。此外，SF-36从353.2（第0天）增加到560.5分（6个月）。我们发现应用伊洛前列素后MRI扫描显示BME显著减少。
除其他药物外，伊洛前列素可能是一种可考虑用于治疗BME/AVN相关疼痛的替代药物。
