【摘要】 背景:骨性关节炎是骨科最常见的慢性疾病之一。近期研究表明软骨下骨的病变在骨性关节炎的发生发展中具有重要地位,并可能先于并加剧软骨的病变。软骨下骨的病变以异常重建为主要特征,表现为软骨下骨髓病变和软骨下骨囊肿等。当前针对软骨下骨囊肿的研究还不充分,探究软骨下骨囊肿的成因及临床意义有助于从软骨下骨的角度为骨性关节炎的诊治提供新的思路。目的:综述近年骨性关节炎软骨下骨囊肿的成因假说、病理学特征、临床意义、临床诊断及治疗的研究进展。方法:2位共同第一作者应用计算机检索2019年1月及以前PubMed、Embase数据库,英文检索式:(osteoarthritis OR osteoarthrosis OR osteoarthropathy)AND(subchondralcyst OR pseudocyst OR intraosseous cyst OR bone cyst),语言设定为"英语",共检索到1 224篇文献,58篇符合纳入标准,另手工检索11篇文献,最终纳入69篇文献。结果与结论:(1)软骨下骨髓病变可能是软骨下骨囊肿的"前置病变",二者属同一病理变化的不同阶段;(2)软骨下骨囊肿的形成可能与炎性骨吸收后继发反应性成骨有关;(3)软骨下骨囊肿与关节软骨的退变、关节疼痛显著相关;(4)非类固醇抗炎药、抗骨吸收药、软骨下骨成形术、关节置换术中植骨等可能对软骨下骨髓病变/软骨下骨囊肿有治疗作用,但仍需大样本临床试验证明。更多还原

【Abstract】 BACKGROUND: Osteoarthritis is one of the most common chronic diseases in orthopedics. Pathological changes in subchondral bone, characterized mainly as abnormal remodeling, manifested as subchondral bone marrow lesions and subchondral bone cysts, have been revealed their significance in the pathogenesis and progression of osteoarthritis by recent studies. Pathological changes in subchondral bone may precede which in cartilage and even aggravate it. Given the paucity of studies on subchondral bone cyst, an insight into subchondral bone cyst’s pathogenesis and clinical significance may contribute to novel diagnosis and therapy of osteoarthritis in terms of subchondral bone. OBJECTIVE: To summarize the advances in researches on the etio-pathogenic hypothesis, pathological traits, clinical significance, clinical diagnosis and therapy of subchondral bone cysts in osteoarthritis. METHODS: Computer-based searches of PubMed and Embase databases before January 2019 with the mesh terms of "(osteoarthritis OR osteoarthrosis OR osteoarthropathy) AND(subchondral cyst OR pseudocyst OR intraosseous cyst OR bone cyst)" were conducted by two co-first authors. Articles’ language was set as "English". A total of 1 224 articles were retrieved after excluding the duplicate ones. 58 articles were eligible for the inclusion criteria to which 11 articles were retrieved manually in addition, thus 69 articles were included eventually. RESULTS AND CONCLUSION:(1) Subchondral bone marrow lesions may be the "predisposed change" of subchondral bone cyst, two of which belong to the respective stage of one pathological process.(2) Subchondral bone cyst may result from the inflammatory bone absorption and subsequent reactive bone formation.(3) Subchondral bone cyst is evidently correlated with cartilage degeneration and joint pain.(4) Non-steroidal anti-inflammatory drugs, anti-absorptive drugs, subchondroplasty, and bone grafting during arthroplasty may ameliorate subchondral bone marrow lesions or subchondral bone cyst. Further large sample clinical trials are warranted.更多还原