Marymont J V, Kaufman E E
Clin Orthop Relat Res. 1986 Mar(204):150-3.
Osteonecrosis (aseptic or avascular necrosis of bone) is an entity with many causes that can occur at a variety of sites. It is a known complication of corticosteroid therapy, either alone or combined with other drugs in the treatment of malignancy. Osteonecrosis associated with chemotherapy that does not include corticosteroids is rare; three such cases have been reported in the English literature. One received cyclophosphamide alone, another vinblastine and bleomycin, while the third received cyclophosphamide, methotrexate, and 5-fluorouracil. The authors report a 40-year-old woman who had a left radical mastectomy in 1978 and a right radical mastectomy in 1980 for infiltrating ductal adenocarcinoma of the breasts. She received melphalan following the first surgery and a combination of doxorubicin, cyclophosphamide, and 5-fluorouracil after the second operation. In 1984 she noted pain in both knees that slowly increased in severity. A bone scan revealed increased periarticular activity in the medial and lateral femoral condyles of both knees compatible with bilateral osteonecrosis. There was no evidence of metastatic carcinoma on the bone scan. The patient was treated surgically with drilling and autologous bone grafting. A bone biopsy at the time of surgery revealed osteonecrosis but no metastatic adenocarcinoma.
骨坏死（无菌性或缺血性骨坏死）是一种病因多样、可发生于多个部位的病症。它是皮质类固醇治疗已知的并发症，无论是单独使用皮质类固醇，还是在治疗恶性肿瘤时与其他药物联合使用。与不包含皮质类固醇的化疗相关的骨坏死较为罕见；英文文献中已报道过3例此类病例。1例单独接受环磷酰胺治疗，另1例接受长春花碱和博来霉素治疗，第3例接受环磷酰胺、甲氨蝶呤和5-氟尿嘧啶治疗。作者报告了一名40岁女性，她于1978年因乳腺浸润性导管癌接受了左乳根治性乳房切除术，1980年又接受了右乳根治性乳房切除术。她在第一次手术后接受了美法仑治疗，第二次手术后接受了阿霉素、环磷酰胺和5-氟尿嘧啶联合治疗。1984年，她注意到双膝疼痛，疼痛程度逐渐加重。骨扫描显示双膝股骨内外侧髁关节周围活动增加，符合双侧骨坏死表现。骨扫描未发现转移癌迹象。该患者接受了钻孔和自体骨移植手术治疗。手术时的骨活检显示为骨坏死，但未发现转移性腺癌。
