Oesman Ihsan, Adhimukti Danarto Hari
Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Int J Surg Case Rep. 2020;77:126-128. doi: 10.1016/j.ijscr.2020.10.069. Epub 2020 Oct 28.
Osteonecrosis (ON) is characterized by cellular death of bone components due to interruption of blood supply that leads to bone ischemia and potential joint destruction. There are multiple risk factors and medical condition associated with ON, including systemic lupus erythematosus (SLE). The most common sites of ON are the femoral head, distal femur, proximal humerus, talus and lumbar spine. Very few cases of nontraumatic ON in distal tibia have been reported in the literature.
We present a case of 23-year-old female diagnosed with osteonecrosis of distal tibia and history of SLE. The patient also had history of avascular necrosis of right hip and underwent right total hip arthroplasty. We treated the patients with conservative treatment for intial management.
The risk of ON in SLE patients is likely due to the results of both the SLE itself and use of corticosteroids. Systemic inflammation in SLE reduces the development of osteoblasts, increases osteoclast maturation and activity and increases protohrombotic agents that can lead to rapid bone loss. Corticosteroids are the most consistent risk factor associated with the development of ON in SLE. Conservative medical management is effective in the early stages of the disease before bone collapse.
Despite advances in the diagnosis and treatment of SLE, symptomatic ON continues to be a significant comorbidity. Strategies to detect and manage early stage ON is necessary to prevent the progression of this serious complication.
骨坏死（ON）的特征是由于血液供应中断导致骨成分细胞死亡，进而引起骨缺血和潜在的关节破坏。与骨坏死相关的风险因素和医学状况有多种，包括系统性红斑狼疮（SLE）。骨坏死最常见的部位是股骨头、股骨远端、肱骨近端、距骨和腰椎。文献中报道的胫骨远端非创伤性骨坏死病例极少。
我们报告一例23岁女性，诊断为胫骨远端骨坏死且有系统性红斑狼疮病史。该患者还有右髋缺血性坏死病史并接受了右全髋关节置换术。我们对该患者进行了初始保守治疗。
系统性红斑狼疮患者发生骨坏死的风险可能是系统性红斑狼疮本身以及使用皮质类固醇的结果。系统性红斑狼疮中的全身炎症会减少成骨细胞的生成，增加破骨细胞的成熟和活性，并增加可导致快速骨质流失的促血栓形成因子。皮质类固醇是与系统性红斑狼疮患者发生骨坏死最相关的风险因素。在骨塌陷之前的疾病早期，保守药物治疗是有效的。
尽管系统性红斑狼疮的诊断和治疗取得了进展，但有症状的骨坏死仍然是一种重要的合并症。检测和管理早期骨坏死的策略对于预防这种严重并发症的进展是必要的。
