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双磷酸盐在膝关节骨坏死中的可能有益作用。

Possible beneficial effect of bisphosphonates in osteonecrosis of the knee.

机构信息

Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital, 4031 Basel, Switzerland.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2010 Dec;18(12):1638-44. doi: 10.1007/s00167-010-1106-4. Epub 2010 Apr 8.

Abstract

UNLABELLED

Osteonecrosis (ON) in the knee occurs as a localized inflammatory disease in relation to spontaneous or non-traumatic ON. Conservative treatment possibilities are limited, and prognosis appears to be poor; in most cases, ON results in knee arthroplasty. Bisphosphonates are suggested to prevent bone resorption and collapse of necrotic bone. In this observational, prospective study we investigated the effect of bisphosphonate treatment in patients with spontaneous or arthroscopy-induced ON of the knee. Twenty-eight patients with osteonecrotic lesions and bone marrow oedema in the knee were included. In 22 patients (80%), ON was identified after arthroscopic surgery of the knee; six patients were diagnosed with spontaneous ON. Patients were initially given pamidronate 120 mg i.v. divided in 3-4 perfusions over 2 weeks, followed by oral bisphosphonate treatment with alendronate 70 mg weekly for 4-6 months. Bisphosphonate treatment resulted in a rapid pain relief, VAS decreasing from 8.2 ± 1.2 at baseline to 5.02 ± 0.6 after 4-6 weeks (p < 0.001). After 6 months, the VAS decreased by 80% (p < 0.001). At the 6-month follow-up, symptoms had resolved completely in 15 patients out of 28; in 6 patients, minimal symptoms (VAS 1-2) remained. In two patients, treatment effect was unsatisfactory, and surgical intervention was needed (arthroplasty). Bone marrow oedema on MRI resolved completely in 18 patients out of 28 with substantial reduction in the remaining. Furthermore, osteonecrotic area resolved completely or demarcation with sclerotic changes of the necrotic area could be observed. Bisphosphonate treatment in patients with osteonecrosis of the knee was associated with a rapid improvement in pain score and radiological consolidation of the area of osteonecrosis. Further randomized, controlled trials are warranted to confirm the potential beneficial role of bisphosphonates in the treatment of osteonecrosis of the knee.

LEVEL OF EVIDENCE

observational study, level IV.

摘要

未注明

膝关节骨坏死(ON)是一种与自发性或非创伤性 ON 相关的局部炎症性疾病。保守治疗的可能性有限,预后似乎较差;在大多数情况下,ON 会导致膝关节置换。双膦酸盐被认为可以预防骨吸收和坏死骨的塌陷。在这项观察性、前瞻性研究中,我们研究了双膦酸盐治疗膝关节自发性或关节镜诱导性 ON 患者的效果。28 例膝关节骨坏死伴骨髓水肿的患者纳入研究。22 例(80%)患者在膝关节关节镜手术后发现 ON;6 例患者诊断为自发性 ON。患者最初给予帕米膦酸 120mg 静脉滴注,分 3-4 次在 2 周内滴注,然后口服阿仑膦酸钠 70mg 每周,持续 4-6 个月。双膦酸盐治疗可迅速缓解疼痛,VAS 从基线时的 8.2±1.2 降至 4-6 周后的 5.02±0.6(p<0.001)。6 个月后,VAS 下降了 80%(p<0.001)。在 6 个月的随访中,28 例患者中有 15 例症状完全缓解;6 例患者仍有轻微症状(VAS 1-2)。2 例患者治疗效果不理想,需要手术干预(关节置换)。28 例患者中,18 例 MRI 上骨髓水肿完全消退,其余患者骨髓水肿明显减少。此外,坏死区的骨坏死面积完全或边界清晰,可见硬化改变。膝关节骨坏死患者接受双膦酸盐治疗后,疼痛评分迅速改善,骨坏死区的影像学愈合。需要进一步的随机对照试验来证实双膦酸盐在治疗膝关节骨坏死中的潜在有益作用。

证据水平

观察性研究,IV 级。

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