结缔组织病合并膝关节骨梗死三例报道

Three cases report of connective tissue disease complicated with knee joint bone infarction

结缔组织病患者因为长期大量应用激素,骨梗死并不少见,但多发生于髋关节,发生在膝关节较少见。由于结缔组织病常表现有关节疼或关节炎,发生在膝关节的骨梗死容易被误诊;同样,骨梗死的诊断也可能掩盖结缔组织病的病情活动。作者回顾性分析了3例结缔组织病合并膝关节骨梗死患者的临床表现、免疫学特征以及诊疗过程。患者均为年轻女性,其中2例为系统性红斑狼疮,1例为干燥综合征;均有长期应用激素和免疫抑制剂史,均有雷诺现象,骨梗死为多发或单发,抗骨质疏松和活血、改善骨代谢有一定的疗效,磁共振成像具有较高的诊断价值。临床上应结合其症状以及实验室和影像学检查结果进行综合分析,避免误诊。

Bone infarction is often found in patients with connective tissue disease due to long-term application of large amount of corticosteroids. For these patients, bone infarction more commonly occurs in hip joints rather than in knee joints. Aching joints and arthritis are routine presentations of connective tissue disease, which may easily result in the misdiagnosis of bone infarction in knee joints. Likewise, bone infarction may hinder the tracking of the development of connective tissue disease. The clinical manifestations, immunological characteristics and course of diagnosis and treatment of 3 cases of connective tissue disease complicated with bone infarction are retrospectively described in this paper. All are females, 2 of whom suffers from systemic lupus erythematosus, and the other Sjogren＇s syndrome. All of them are treated with corticosteroids and immunodepressants in a long term, exhibit Raynaud＇s phenomenon, and are complicated with multiple or single bone infarction. Management of anti-osteoporosis, blood circulation activation and bone metabolism promotion yields definite effect, and magnetic resonance imaging has a high value in diagnosis. A clinical comprehensive analysis on the basis of symptoms, laboratory results and imaging findings should be carried out to avoid the misdiagnosis.