Levine B, Kanat I O
Department of Podiatric Surgery, Kern Hospital, Warren, Michigan.
J Foot Surg. 1988 Jan-Feb;27(1):75-9.
Various theoretical hypotheses have been proposed for the nontraumatic etiology of osteochondritis dissecans, subchondral bone cyst formation, and Legg-Calvé-Perthes disease. Although a direct relationship between these distinct clinical entities has sparse referral in the literature, their common theories of etiology and evolution have been extensively documented, although not correlated. The various etiologic theories of osteochondritis dissecans, Legg-Calvé-Perthes disease, and subchondral bone cyst formation have been individually presented. The conclusion drawn upon review of these theories would prove that all of the proposed etiologies for the above syndromes are remarkably similar. Furthermore, as referred to in the contents of this paper, the signs, symptoms, and roentgenographic findings also appear to be common to all three syndromes. Various clinicopathologic studies have demonstrated similar gross pathologic and histologic findings between osteochondritis dissecans, subchondral bone cysts formation, and Legg-Calvé-Perthes disease. The authors, therefore, contend that the most likely nontraumatic etiology of this condition is a common multifactorial causation with an identical pathogenesis. They propose a common etiology resulting in a pathologic process, originating in subchondral cyst formation. Eventually, a communication between the cysts and the joint will occur secondary to either the duration and progression of the cystic process, endogenous, or exogenous stress resulting in collapse of the articular surface. A complete or partially detached osteochondral fragment results from these forces. Osteochondritis dissecans and Legg-Calvé-Perthes disease may represent the same stage in the pathologic process. Degenerative joint disease is the final stage of this pathologic process. Further studies need to be performed to explore this relationship and the proposed pathogenesis.(ABSTRACT TRUNCATED AT 250 WORDS)
对于剥脱性骨软骨炎、软骨下骨囊肿形成以及Legg-Calvé-Perthes病的非创伤性病因，已经提出了各种理论假说。尽管这些不同的临床实体之间的直接关系在文献中鲜有提及，但它们常见的病因和演变理论已有大量记载，不过并未相互关联。剥脱性骨软骨炎、Legg-Calvé-Perthes病以及软骨下骨囊肿形成的各种病因理论已分别阐述。对这些理论进行综述后得出的结论将证明，上述综合征所有提出的病因都非常相似。此外，如本文内容所述，这三种综合征的体征、症状和X线表现似乎也相同。各种临床病理研究表明，剥脱性骨软骨炎、软骨下骨囊肿形成和Legg-Calvé-Perthes病之间在大体病理和组织学表现上相似。因此，作者认为这种情况最可能的非创伤性病因是具有相同发病机制的常见多因素病因。他们提出一种共同病因导致了一个病理过程，该过程始于软骨下囊肿形成。最终，由于囊肿过程的持续时间和进展、内源性或外源性应力导致关节面塌陷，囊肿与关节之间会出现连通。这些力量会导致一个完整或部分分离的骨软骨碎片。剥脱性骨软骨炎和Legg-Calvé-Perthes病可能代表病理过程中的同一阶段。退行性关节病是这个病理过程的最后阶段。需要进行进一步的研究来探索这种关系以及所提出的发病机制。（摘要截选至250字）
