Department of Orthopaedic Surgery, Centre de l'Appareil Locomoteur de Médicine du Sport et de Prévention, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg.
Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):448-62. doi: 10.1007/s00167-010-1052-1. Epub 2010 Feb 12.
The subchondral bone is involved in a variety of diseases affecting both the articular cartilage and bone. Osteochondral defects in distinct locations and of variable sizes are the final results of different etiologies. These include traumatic osteochondral defects, osteochondritis dissecans, osteonecrosis, and osteoarthritis. Traumatic osteochondral defects are caused by osteochondral fractures, separating an osteochondral fragment that includes articular cartilage and both subchondral and trabecular bone from the joint surface. In osteochondritis dissecans, the disease originates in the subchondral bone and secondarily affects the articular cartilage. Location, stage, size, and depth of osteochondral lesions play a role in the treatment of traumatic osteochondral defects and osteochondritis dissecans. Surgical options include fragment refixation, transplantation of osteochondral autografts, or bone restoration by impacted cancellous bone grafts combined with autologous chondrocyte transplantation. An insufficiency fracture of the subchondral bone may be the initiating factor of what was formerly believed to be a spontaneous osteonecrosis of the knee (SPONK). Recent histopathological studies suggest that each stage of SPONK reflects different types of bone repair reactions following a fracture of the subchondral bone plate. Osteoarthritis is a disease that does affect not only the articular cartilage, but also the subchondral bone. Reconstructive surgical techniques aim at preserving joint function, inducing fibrocartilaginous repair, and at correcting malalignment. This review summarizes the current status of the clinical treatment of traumatic osteochondral defects, osteochondritis dissecans, osteonecrosis, and osteoarthritis as they affect the subchondral bone region and its adjacent structures.
软骨下骨参与了多种影响关节软骨和骨骼的疾病。不同部位和大小的骨软骨缺损是不同病因的最终结果。这些包括创伤性骨软骨缺损、剥脱性骨软骨炎、骨坏死和骨关节炎。创伤性骨软骨缺损是由骨软骨骨折引起的，将包含关节软骨和软骨下骨及骨小梁的骨软骨碎片从关节表面分离出来。在剥脱性骨软骨炎中，疾病起源于软骨下骨，其次影响关节软骨。骨软骨病变的位置、阶段、大小和深度在治疗创伤性骨软骨缺损和剥脱性骨软骨炎中起作用。手术选择包括碎片固定、自体骨软骨移植或松质骨移植联合自体软骨细胞移植进行骨修复。软骨下骨的不全骨折可能是以前认为的膝关节自发性骨坏死（SPONK）的起始因素。最近的组织病理学研究表明，SPONK 的每个阶段都反映了软骨下骨板骨折后不同类型的骨修复反应。骨关节炎不仅影响关节软骨，还影响软骨下骨。重建性手术技术旨在保留关节功能、诱导纤维软骨修复，并纠正对线不良。这篇综述总结了目前创伤性骨软骨缺损、剥脱性骨软骨炎、骨坏死和骨关节炎的临床治疗现状，这些疾病都影响到软骨下骨区域及其相邻结构。
