Department of Orthopaedic Trauma Surgery, University of Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany.
Arch Orthop Trauma Surg. 2012 Dec;132(12):1781-8. doi: 10.1007/s00402-012-1617-1. Epub 2012 Oct 6.
In this pilot study, we investigated the therapeutic efficacy of intravenous Ibandronate compared to pain medication on the outcome of bone marrow edemas (BME) of the knee and talus.
Fifteen patients with a painful BME of the knee and 15 patients with a BME of the ankle, confirmed on MRI, were enrolled and treated with three ambulatory infusions of each 6 mg Ibandronate (group 1). A control group (group 2) of 10 patients with a BME of the knee and 10 patients with a BME of the talus was treated with pain medication and partial weight bearing. Patients were evaluated clinically at baseline and at 1, 3, 6 and 12 months after therapy start with a visual analog pain-scale (VAS) and specific joint scores (Larson knee- and Mazur ankle-score). BMEs were assessed with MRI at baseline and after 6 months in both groups.
In the knee group, the mean VAS pain score decreased from 8.5 at baseline to 1.2 at 12 months (p < 0.0001) in patients treated with Ibandronate and, respectively, from 8.1 to 4.0 in the control group (p < 0.001). In the ankle group, the mean VAS pain score decreased from 8.2 at baseline to 0.9 at 12 months (p < 0.0001) in patients treated with Ibandronate and, respectively, from 7.9 to 3.9 in the control group (p < 0.001). The mean Mazur ankle score increased from 51 to 91 points (p < 0.001) in group 1, and from 52 to 72 points in group 2 (p < 0.01). The mean Larson knee score increased from 54 to 89 points (p < 0.001) at 12 months in group 1, and from 51 to 70 points in group 2 (p < 0.01). For both joints, we observed a significant clinical improvement in the Ibandronate treatment group and in the control group, but functional results were significantly more improved in the Ibandronate treatment group. Only the Ibandronate treatment group showed a significant BME regression at the 6 months MRI follow-up.
Intravenous Ibandronate therapy showed significantly better clinical results and BME regression rates on MR-imaging compared to analgesic medication in combination with partial weight bearing in the treatment of BME of the knee and talus and shortens the natural course of the disease.
在这项初步研究中，我们研究了静脉注射伊班膦酸盐与止痛药物治疗膝关节和距骨骨髓水肿（BME）的疗效。
15 例膝关节 BME 和 15 例踝关节 BME 的患者（均经 MRI 证实）入组，并接受 3 次 6mg 伊班膦酸盐的门诊输注（第 1 组）。10 例膝关节 BME 和 10 例距骨 BME 的对照组（第 2 组）接受止痛药物和部分负重治疗。患者在治疗开始后 1、3、6 和 12 个月时，使用视觉模拟疼痛量表（VAS）和特定关节评分（Larson 膝关节和 Mazur 踝关节评分）进行临床评估。两组患者均在基线和 6 个月时进行 MRI 评估。
在膝关节组中，接受伊班膦酸盐治疗的患者的平均 VAS 疼痛评分从基线时的 8.5 分降至 12 个月时的 1.2 分（p<0.0001），而对照组的平均 VAS 疼痛评分从 8.1 分降至 4.0 分（p<0.001）。在踝关节组中，接受伊班膦酸盐治疗的患者的平均 VAS 疼痛评分从基线时的 8.2 分降至 12 个月时的 0.9 分（p<0.0001），而对照组的平均 VAS 疼痛评分从 7.9 分降至 3.9 分（p<0.001）。第 1 组的 Mazur 踝关节评分从 51 分增加到 91 分（p<0.001），第 2 组从 52 分增加到 72 分（p<0.01）。第 1 组的 Larson 膝关节评分从基线时的 54 分增加到 12 个月时的 89 分（p<0.001），第 2 组从 51 分增加到 70 分（p<0.01）。对于两个关节，我们观察到伊班膦酸盐治疗组和对照组均有显著的临床改善，但伊班膦酸盐治疗组的功能结果显著改善。只有伊班膦酸盐治疗组在 6 个月的 MRI 随访中显示出明显的 BME 消退。
与止痛药物联合部分负重治疗膝关节和距骨 BME 相比，静脉注射伊班膦酸盐治疗在治疗膝关节和距骨 BME 方面显示出更好的临床疗效和 BME 消退率，并缩短了疾病的自然病程。
