唑来膦酸治疗早期膝关节自发性骨坏死疗效分析
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摘要
目的观察唑来膦酸对早期膝关节自发性骨坏死(spontaneous osteonecrosis of the knee,SONK的临床疗效,为早期SONK的治疗提供方法。方法早期SONK患者30例,予静脉注射唑来膦酸治疗。治疗后继续予骨化三淳、碳酸钙D3颗粒及免负重的基础治疗。治疗后2、4、12、24周采用视觉模拟评分(VAS)、膝关节量表西安大略麦马斯特大学骨性关节炎指数可视化量表(WOMAC)和国际膝关节文献委员会膝关节评价表(IKDC)评分评价患者的疼痛和膝关节功能,治疗后24周复查X线和MRI。结果 VAS评分平均减少了4. 68,WOMAC平均减少了43. 19以及IKDC评分平均增加了39. 24,以上差异有统计学意义(P <0. 001)。复查MRI,50%(15/30)患者的骨髓水肿情况得到完全改善,26. 67%(8/30)患者的骨髓水肿情况能够明显改善。但小部分患者(4/30)经治疗骨髓水肿未改善,甚至出现软骨塌陷,而选择单髁置换治疗。结论对于大部分早期的SONK患者(MontⅠ期及Ⅱ期),唑来膦酸钠在治疗后4周可以显著减轻患者的疼痛及改善膝关节功能,24周内持续发挥作用,且能够改善骨髓水肿情况、抑制或延缓骨坏死的进展。
Objective To observe the clinical effect of zoledronic acid on early spontaneous osteonecrosis of the knee( SONK),thus to provide early treatment of SONK. Methods Thirty patients with early SONK were treated with zoledronic acid. The clinical effect were evaluated using VAS,WOMAC and IKDC scores 2,4,12 and 24 weeks after treatment. X-ray and MRI were performed 24 weeks after treatment. Results The VAS was reduced by 4. 68,WOMAC was reduced by 43. 19 and IKDC was increased by 39. 24 after treatment( P < 0. 001). Bone marrow edema was completely cured,significantly improved in 15 patients( 50%) and 8 patients( 26. 67%),respectively. However,bone marrow was not improved in 4 patients,who received unicondylar replacement treatment. Conclusion For most patients with early SONK( Mont Stage Ⅰ and Ⅱ),zoledronate can significantly relieve pain and improve knee function after treatment. It can continue to play a role within 24 weeks. Particularly,it can improve bone marrow edema,inhibit or delay the progression of osteonecrosis.
Objective To observe the clinical effect of zoledronic acid on early spontaneous osteonecrosis of the knee( SONK),thus to provide early treatment of SONK. Methods Thirty patients with early SONK were treated with zoledronic acid. The clinical effect were evaluated using VAS,WOMAC and IKDC scores 2,4,12 and 24 weeks after treatment. X-ray and MRI were performed 24 weeks after treatment. Results The VAS was reduced by 4. 68,WOMAC was reduced by 43. 19 and IKDC was increased by 39. 24 after treatment( P < 0. 001). Bone marrow edema was completely cured,significantly improved in 15 patients( 50%) and 8 patients( 26. 67%),respectively. However,bone marrow was not improved in 4 patients,who received unicondylar replacement treatment. Conclusion For most patients with early SONK( Mont Stage Ⅰ and Ⅱ),zoledronate can significantly relieve pain and improve knee function after treatment. It can continue to play a role within 24 weeks. Particularly,it can improve bone marrow edema,inhibit or delay the progression of osteonecrosis.
引文
[1]Mont MA,Baumgarten KM,Rifai A,et al.Atraumatic osteonecrosis of the knee[J].J Bone Joint Surg Am,2000,82(9):1279-1290.
[2]Kraenzlin ME,Graf C,Meier C,et al.Possible beneficial effect of bisphosphonates in osteonecrosis of the knee[J].Knee Surg Sports Traumatol Arthrosc,2010,18(12):1638-1644.
[3]Pape D,Filardo G,Kon E,et al.Disease-specific clinical problems associated with the subchondral bone[J].Knee Surg Sports Traumatol Arthrosc,2010,18(4):448-462.
[4]strand J,Aspenberg P.Systemic alendronate prevents resorption of necrotic bone during revascularization.A bone chamber study in rats[J].BMC Musculoskelet Disord,2002,3(1):1-5.
[5]Kim HK,Randall TS,Bian H,et al.Ibandronate for prevention of femoral head deformity after ischemic necrosis of the capital femoral epiphysis in immature pigs[J].J Bone Joint Surg Am,2005,87(3):550-557.
[6]Nishii T,Sugano N,Miki H,et al.Does alendronate prevent collapse in osteonecrosis of the femoral head?[J].Clin Orthop Relat Res,2006,443(443):273-279.
[7]Lai KA,Shen WJ,Yang CY,et al.The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis.A randomized clinical study[J].J Bone Joint Surg Am,2005,87(10):2155.
[8]Jureus J,Lindstrand A,Geijer M,et al.Treatment of spontaneous osteonecrosis of the knee(SPONK)by a bisphosphonate[J].Acta Orthop,2012,83(51):511-514.
[9]Breer S,Oheim R,Krause M,et al.Spontaneous osteonecrosis of the knee(SONK)[J].Knee Surg Sports Traumatol Arthrosc,2013,21(2):340-345.
[10]White DK,Keysor JJ,Lavalley MP,et al.Clinically important improvement in function is common in people with or at high risk of knee OA:the MOST study[J].J Rheumatol,2010,37(6):1244-1251.
[11]Suter LG,Fraenkel L,Losina E,et al.Medical decision making in patients with knee pain,meniscal tear,and osteoarthritis[J].Arthritis Care Res,2009,61(11):1531-1538.
[12]许开喜,卞绍亚,陈新建,等.MRI对膝关节自发性骨坏死的诊断价值[J].江苏医药,2015,41(6):718-720.
[13]Meier C,Kraenzlin C,Friederich NF,et al.Effect of ibandronate on spontaneous osteonecrosis of the knee:a randomized,doubleblind,placebo-controlled trial[J].Osteoporos Int,2014,25(1):359-366.
[2]Kraenzlin ME,Graf C,Meier C,et al.Possible beneficial effect of bisphosphonates in osteonecrosis of the knee[J].Knee Surg Sports Traumatol Arthrosc,2010,18(12):1638-1644.
[3]Pape D,Filardo G,Kon E,et al.Disease-specific clinical problems associated with the subchondral bone[J].Knee Surg Sports Traumatol Arthrosc,2010,18(4):448-462.
[4]strand J,Aspenberg P.Systemic alendronate prevents resorption of necrotic bone during revascularization.A bone chamber study in rats[J].BMC Musculoskelet Disord,2002,3(1):1-5.
[5]Kim HK,Randall TS,Bian H,et al.Ibandronate for prevention of femoral head deformity after ischemic necrosis of the capital femoral epiphysis in immature pigs[J].J Bone Joint Surg Am,2005,87(3):550-557.
[6]Nishii T,Sugano N,Miki H,et al.Does alendronate prevent collapse in osteonecrosis of the femoral head?[J].Clin Orthop Relat Res,2006,443(443):273-279.
[7]Lai KA,Shen WJ,Yang CY,et al.The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis.A randomized clinical study[J].J Bone Joint Surg Am,2005,87(10):2155.
[8]Jureus J,Lindstrand A,Geijer M,et al.Treatment of spontaneous osteonecrosis of the knee(SPONK)by a bisphosphonate[J].Acta Orthop,2012,83(51):511-514.
[9]Breer S,Oheim R,Krause M,et al.Spontaneous osteonecrosis of the knee(SONK)[J].Knee Surg Sports Traumatol Arthrosc,2013,21(2):340-345.
[10]White DK,Keysor JJ,Lavalley MP,et al.Clinically important improvement in function is common in people with or at high risk of knee OA:the MOST study[J].J Rheumatol,2010,37(6):1244-1251.
[11]Suter LG,Fraenkel L,Losina E,et al.Medical decision making in patients with knee pain,meniscal tear,and osteoarthritis[J].Arthritis Care Res,2009,61(11):1531-1538.
[12]许开喜,卞绍亚,陈新建,等.MRI对膝关节自发性骨坏死的诊断价值[J].江苏医药,2015,41(6):718-720.
[13]Meier C,Kraenzlin C,Friederich NF,et al.Effect of ibandronate on spontaneous osteonecrosis of the knee:a randomized,doubleblind,placebo-controlled trial[J].Osteoporos Int,2014,25(1):359-366.