Haller J, Sartoris D J, Resnick D, Pathria M N, Berthoty D, Howard B, Nordstrom D
Department of Radiology, Veterans Administration Medical Center, San Diego, CA 92161.
AJR Am J Roentgenol. 1988 Aug;151(2):355-8. doi: 10.2214/ajr.151.2.355.
We encountered five otherwise healthy adults with alterations of the tarsal navicular bone compatible with spontaneous osteonecrosis. Four women had bilateral involvement and one man had unilateral involvement. The patients were 23-71 years old. The disorder was initially described by Mueller and Weiss and should not be confused with Koehler disease (osteochondrosis of the tarsal navicular in children). This group of patients was compared with five other patients (29-74 years old) with similar radiographic and clinical changes in whom an underlying disease (rheumatoid arthritis, renal failure, trauma, and lupus erythematosus) associated with osteonecrosis was known. Routine radiography in both groups defined characteristic abnormalities of the navicular bone (decreased size, a comma-shaped configuration, increased radiodensity, fragmentation, and medial or medial and dorsal osseous protrusion). MR in three patients confirmed alterations consistent with osteonecrosis. Three of the patients without underlying disease had bilateral involvement on plain films, with flat feet and hindfoot valgus deformity, leading to local pain and deformity. In a fourth patient, bilateral distribution was documented by MR as marrow alterations. Although no certain pathogenic explanation for spontaneous osteonecrosis of the tarsal navicular is known, trauma and chronic stress changes caused by physiologic pressure on the medial longitudinal arch in hindfoot valgus and increased tension forces of the plantar aponeurosis during weight-bearing (in pes planus) may be important. Discrimination of primary from secondary osteonecrosis of the tarsal navicular bone is not possible by radiologic means alone, although bilateral distribution, particularly in women, favors the diagnosis of spontaneous disease.
我们遇到了5名身体健康的成年人，他们的跗舟骨出现了与自发性骨坏死相符的改变。4名女性为双侧受累，1名男性为单侧受累。患者年龄在23至71岁之间。这种病症最初由米勒和魏斯描述，不应与科勒病（儿童跗舟骨骨软骨病）相混淆。将这组患者与另外5名患者（年龄在29至74岁之间）进行了比较，后者有类似的影像学和临床改变，且已知存在与骨坏死相关的基础疾病（类风湿关节炎、肾衰竭、创伤和红斑狼疮）。两组患者的常规X线检查均显示出舟骨的特征性异常（尺寸减小、逗号状形态、骨密度增加、碎裂以及内侧或内侧和背侧骨质突出）。3名患者的磁共振成像（MR）证实了与骨坏死相符的改变。3名无基础疾病的患者在X线平片上显示双侧受累，伴有扁平足和后足外翻畸形，导致局部疼痛和畸形。在第4名患者中，MR显示骨髓改变证实为双侧分布。尽管目前尚不清楚跗舟骨自发性骨坏死的确切致病原因，但后足外翻时内侧纵弓的生理压力引起的创伤和慢性应力变化，以及负重时（扁平足）足底腱膜张力增加可能很重要。仅通过影像学手段无法区分跗舟骨原发性骨坏死和继发性骨坏死，不过双侧分布，尤其是在女性中，有利于自发性疾病的诊断。
