Tosun Hacı Bayram, Uludağ Abuzer, Demir Sukru, Serbest Sancar, Yasar Mehmet Mete, Öznam Kadir
Orthopaedics, Medipol University, Istanbul, TUR.
Orthopaedics, Adiyaman University Faculty of Medicine, Adiyaman, TUR.
Cureus. 2020 Sep 20;12(9):e10547. doi: 10.7759/cureus.10547.
Background and objective Bone marrow edema (BME) is a rare condition caused by insufficient osseous blood supply and may result in severe pain that has adverse effects on patients' life. To date, various conservative treatments have been recommended for the treatment of BME, including analgesics, immobilization of the affected extremity, and iloprost infusion. The aim of this retrospective study was to investigate the effectiveness of parenteral iloprost therapy in the treatment of BME detected in different skeletal locations. Materials and methods This retrospective study included 23 patients (17 men and six women) with BME who were classified as stage I-III according to the Association Research Circulation Osseous (ARCO) classification. BME was localized to the proximal femur in 13 (56.5%), the distal femur in four (17.4%), tarsal bone in four (17.4%), and tibial plateau in two (8.7%) patients. The mean age of the patients was 46.7 years and all the patients were evaluated with the Visual Analog scale (VAS), Functional Mobility Scale (FMS), and MRI. Results A significant improvement was observed in the post-treatment VAS and FMS scores of all patients compared to their pre-treatment scores. Moreover, the edema regressed completely in 60.9% of the patients at three months of MRI control. No serious side effects were observed during the treatment in any of the patients. However, transient side effects including headache, arrhythmia, and flushing were observed in five patients. Conclusion The present study indicated that iloprost therapy is an effective and safe option in the treatment of BME patients, particularly in the reduction of severe pain that has adverse effects on patients' social life, regardless of ARCO staging. Moreover, this therapy could be particularly useful in reducing pain, improving functional recovery, and achieving complete regression of the edema on MRI in ARCO stage I-II patients.
背景与目的 骨髓水肿（BME）是一种由骨血供不足引起的罕见病症，可能导致严重疼痛，对患者生活产生不利影响。迄今为止，已推荐多种保守治疗方法来治疗BME，包括使用镇痛药、固定患侧肢体以及输注伊洛前列素。这项回顾性研究的目的是调查胃肠外伊洛前列素疗法对不同骨骼部位检测到的BME的治疗效果。材料与方法 这项回顾性研究纳入了23例BME患者（17例男性和6例女性），根据骨循环研究协会（ARCO）分类法分为I - III期。13例（56.5%）患者的BME位于股骨近端，4例（17.4%）位于股骨远端，4例（17.4%）位于跗骨，2例（8.7%）位于胫骨平台。患者的平均年龄为46.7岁，所有患者均采用视觉模拟量表（VAS）、功能活动量表（FMS）和磁共振成像（MRI）进行评估。结果 与治疗前相比，所有患者治疗后的VAS和FMS评分均有显著改善。此外，在MRI检查3个月时，60.9%的患者水肿完全消退。治疗期间未观察到任何患者出现严重副作用。然而，5例患者出现了包括头痛、心律失常和面部潮红在内的短暂副作用。结论 本研究表明，伊洛前列素疗法是治疗BME患者的一种有效且安全的选择，特别是在减轻对患者社交生活有不利影响的严重疼痛方面，无论ARCO分期如何。此外，这种疗法在减轻疼痛、改善功能恢复以及使ARCO I - II期患者的MRI水肿完全消退方面可能特别有用。
