膝骨关节病合并骨髓水肿的临床诊疗进展

Research progress on the diagnosis and treatment of knee osteoarthritis complicated by bone marrow edema

膝骨关节病是我国中老年人的常见病、多发病,疼痛作为其主要症状困扰着患者们的生活,近年来研究发现骨髓水肿是造成膝骨关节病患者疼痛的因素之一,明确骨髓水肿的病因病机对本病的诊断及治疗十分重要。但目前针对膝关节骨髓水肿病因病机的研究相对较少,膝关节骨髓水肿应围绕外因暴力损伤、内因关节内应力平衡改变及骨应力阈值降低展开;骨髓水肿的诊断主要依靠核磁影像进行,分型及评价标准均于核磁影像基础上展开;本病的治疗重心位于软骨损伤的修复及疼痛的缓解,也有部分临床工作者针对骨髓水肿病因尤其是骨质疏松进行治疗取得了一定疗效,祖国医学立足痹病,应用活血化瘀、补益肝肾、健脾补肾等治法取得了一定疗效,中西医结合标本并重疗效更佳,此外还涌现了部分手术、手法及理疗等治疗方法。通过文献的阅读及临床观察研究我们发现骨质疏松对于骨髓水肿的研究有较大临床意义,其中骨质疏松以及体格检查、实验室检查等指标与骨髓水肿的相关性待进一步研究,分型及评价标准需进一步完善;而针对骨髓水肿有效诊疗方案的制定将是亟待解决的重点问题。

Knee osteoarthritis is a common and frequently-occurring disease in middle-aged and elderly people in China,and pain as one of major symptoms troubles the lives of patients.In recent years,some studies have showed that bone marrow edema is one of the factors causing pain in patients with knee osteoarthritis.Therefor it is quite important to clarify the etiology and the pathogenesis of bone marrow edema for its diagnosis and treatment.Currently the related researches mostly focus on the violent external injury,and the chages internal joint stress balance and reduction of bone stress threshold,and the diagnosis of bone marrow edema mainly depends on magnetic resonance imaging technique,also the classification and evaluation criteria.Most clinicians focus the treament on repairing cartilage damage and relieving pain at present,meanwhile,some clinicians have achieved certain results by treating the pathogenesis of bone marrow edema,especially the osteoporosis.Tonifying liver and kidney,strengthening the spleen and tonifying the kidney has achieved a certain effect in Chinese traditional medicine,moreover,some surgical,manipulative and physiotherapeutic treatment methods have also emerged.Through clinical observation and literature research,it is found that osteoporosis has great clinical significance for the research about bone marrow edema and should be further studied,and the correlation between osteoporosis and bone marrow edema is needed be further studied.The formulation of effective diagnosis and treatment schene for bone marrow edema will be a key issue to be solved urgently.