Greenhagen Robert M, Crim Brandon E, Shinabarger Andrew B, Burns Patrick R
Foot and Ankle Center of Nebraska, Omaha, Nebraska 68114, USA.
Foot Ankle Spec. 2012 Jun;5(3):180-4. doi: 10.1177/1938640012439605. Epub 2012 Mar 21.
Atraumatic avascular necrosis (AVN) is an unusual pathology to the foot. Risk factors include the use of corticosteroids, smoking, alcohol, rheumatologic disorders, hematologic disorders, and metabolic disorders. To the authors' knowledge, this study presents the first case of bilateral atraumatic AVN to the navicular and medial cuneiform in a patient with systemic lupus erythamatosus (SLE).
A 40-year-old man presented with a past medical history of SLE in which he developed AVN of the tarsal navicular and medial cuneiform. This occurred first on the subject's right foot and then while recovering from surgical intervention, on his left foot. Talonaviculocuneiform arthrodesis was performed with the use of distal tibial autograft on both extremities. The subject's American Orthopaedic Foot and Ankle Society midfoot score improved from 34 to 80 at 21 months on the right and 37 to 90 at 15 months to the left.
Patients with SLE carry a significant risk of developing AVN. Comorbidities such as vasculitis, corticosteroid use, cytotoxic medication, and peripheral neuropathy are known risk factors in the development of AVN. Unusual features such as multifocal AVN and unusual anatomic locations can occur with SLE. AVN of the foot is generally treated with surgical intervention. Treatments such as core decompression, open reduction and internal fixation, and arthrodesis have been recommended based on the symptoms and presentation.
The authors present a very rare presentation of bilateral osteonecrosis of the tarsal navicular and first cuneiform in a patient with SLE. The patient was treated with bilateral talonaviculocuneiform arthrodesis. The patient demonstrated considerable improvement to both extremities.
Therapeutic, Level IV.
创伤性无菌性骨坏死（AVN）在足部是一种不常见的病理情况。风险因素包括使用皮质类固醇、吸烟、酗酒、风湿性疾病、血液系统疾病和代谢紊乱。据作者所知，本研究报告了首例系统性红斑狼疮（SLE）患者双侧舟状骨和内侧楔骨发生创伤性无菌性骨坏死的病例。
一名40岁男性，有SLE病史，出现了舟状骨和内侧楔骨的AVN。首先发生在患者右足，然后在手术干预恢复过程中，左足也出现了。双侧均采用胫骨远端自体骨移植进行距舟楔关节融合术。该患者右足美国矫形足踝协会中足评分在21个月时从34分提高到80分，左足在15个月时从37分提高到90分。
SLE患者发生AVN的风险显著。血管炎、使用皮质类固醇、细胞毒性药物和周围神经病变等合并症是已知的AVN发生风险因素。SLE可能出现多灶性AVN和不寻常解剖部位等不寻常特征。足部AVN一般采用手术干预治疗。根据症状和表现，推荐采用髓芯减压、切开复位内固定和关节融合等治疗方法。
作者报告了一例SLE患者双侧舟状骨和第一楔骨骨坏死的非常罕见病例。患者接受了双侧距舟楔关节融合术治疗。患者双下肢均有明显改善。
治疗性，四级。
