Schiltenwolf M, Martini A K, Eversheim S, Mau H
Sektion Handchirurgie, Stiftung Orthopädische Universitätsklinik Heidelberg.
Handchir Mikrochir Plast Chir. 1996 Jul;28(4):215-9.
Femoral head necrosis is thought to be the consequence of decreased venous drainage. To confirm this pathogenetic model in lunatomalacia, the intraosseous pressure in 16 necrotic, 16 normal lunates and 16 normal capitates was measured. Intraosseous pressure was recorded in different functional positions: neutral position, extension, flexion, venous stasis, and exsanguinated conditions. Both in extension and in flexion, the intraosseous pressures of all bones exceeded those in neutral position; this corresponded to the increase in pressure during venous stasis. The increase in pressure in normal lunates and capitates could not be explained by mechanical deformation. Lunates showed a much higher increase in pressure than did capitates. Some necrotic lunates showed an intraosseous pressure during extension which exceeded the systolic blood pressure. This implies that mechanical deformation contributed to increased intraosseous pressure in necrotic lunates. The variation of intraosseous pressure suggests a physiological but unstable balance. An increase in pressure reduces the bloodflow and in addition to other promoting influences can lead to pathological conditions. The daily load of the wrist in extension is in accordance with the model of the origin of osteonecrosis on the venous side. The model that lunate necrosis is the consequence of impaired venous outflow can be accepted.
股骨头坏死被认为是静脉引流减少的结果。为了在月骨软化症中证实这一发病机制模型，测量了16个坏死月骨、16个正常月骨和16个正常头状骨的骨内压。在不同功能位置记录骨内压：中立位、伸展位、屈曲位、静脉淤滞位和放血状态。在伸展位和屈曲位时，所有骨头的骨内压均超过中立位时的骨内压；这与静脉淤滞时压力升高相对应。正常月骨和头状骨的压力升高无法用机械变形来解释。月骨的压力升高幅度比头状骨大得多。一些坏死月骨在伸展时的骨内压超过收缩压。这意味着机械变形导致了坏死月骨骨内压升高。骨内压的变化表明存在一种生理但不稳定的平衡。压力升高会减少血流量，除其他促进因素外，还可导致病理状况。腕关节在伸展时的日常负荷符合静脉侧骨坏死起源模型。月骨坏死是静脉流出受损的结果这一模型是可以接受的。
