Re: [外電] Roy Does Not Have "Bone-on-Bone" Kne …

看板BLAZERS (波特蘭拓荒者)作者AsDfJJJ (RipCity Since 1970)時間15年前 (2010/11/17 08:25)推噓7(7推 0噓 3→)

留言10則, 8人參與討論串2/3 (看更多)

前文恕刪。縮址上篇推文有 http://www.blazersedge.com/2010/11/15/1816820/brandon-roy-does-not-have-bone -on-bone-knee-arthritis My disclosure: I am an Orthopaedic Surgeon, currently a Sports Medicine Fellow affiliated with a D1 University program. I have not spoken to any of the Blazers medical staff and I have not seen Brandon’s radiographic imaging. I have provided the following information for educational purposes only. 我的簡歷：我是一位整型外科醫師，目前是 D1 大學計畫中運動醫學協會的成員之一。我還沒有跟阿拓醫療團隊的人說過也還沒看過ROY的 X光片。僅是為了教學目的提供以下資訊。 There has been a lot anxiety in the BEdge world recently with the continued trend of knee injuries to the players, most recently and concerning being that to Brandon Roy. In a recent Jason Quick interview with Brandon, "the problem is bone-on-bone there," Roy said. "Dr. Roberts calls it 'arthritic knee." 最近網站上的人們對於球員不停地出現膝蓋傷勢問題感到很大的焦慮，尤其是ROY。 JQ最近訪談ROY，ROY說：「問題是骨頭碰骨頭，Roberts醫生稱之為『（膝蓋的）關節炎』」。 Here is the problem with that statement. "Bone-on-bone" can refer to a considerable range in the severity of arthritis. The common perception is that literally the femur bone is grinding on the tibia bone. In some severe cases that is an accurate description. 對於該描述有一些問題想探討。「骨頭碰骨頭」可以有相當程度的關聯性在不同嚴重性的關節炎的範圍之中。普遍認知是照字面上意思來說是股骨在脛骨上碾磨，在某些嚴重的情形下這樣說是正確的。 However, this is not always the case and this is especially true when dealing with young individuals. Part of the problem lies with physicians like myself who "dumb-down" our explanation so that the patient can understand the concept of arthritis. It is hard enough to try and describe the difference between an Outerbridge grade 2 vs Outerbridge grade 3 chondral lesion to one our non-orthopaedic colleagues, but to try and explain that to a layperson is even more difficult. So we just say that the bone is rubbing on bone, people can visualize that and understand immediately that it is a bad condition. 然而這並不是唯一的情況，而且這在處理年輕人的病時更是如此。部份問題在於醫生（像我自己）會「簡化」我們的解釋好讓病患可以理解關節炎的觀念。對於要向非整型外科的同事描述清楚Outerbridge二級和三級軟骨損害差異有其困難度存在，要向門外漢講解清楚更是不容易。所以我們先說骨頭和骨頭互相摩擦，人們就可以想像並立刻瞭解到這是個不好的狀況。 Here is what normal cartilage should look like during an arthroscopy of the knee: http://tinyurl.com/2wfvpe6 這張圖（後面的連結就是）就是關節內視鏡中正常的軟骨應該看起來的情況。 Here is what a grade II lesion looks like:http://tinyurl.com/356aktk 這張圖是第二級損傷的樣子 Here is what a grade III lesion looks like:http://tinyurl.com/3xa82hl 這張是第三集損傷的情形 Here is what a grade IV lesion looks like:http://tinyurl.com/32szv65 這張是第四級損傷 As you can see, there is a big difference between these cartilage lesions. 如同你們所看到的，這些軟骨損傷有很大不同的差異程度。 What does Brandon Roy have? I don’t know. Since I have never examined Brandon nor seen his MRI, I can only speculate to the best of my ability based upon the information that is released to the public. We all know that Brandon has cartilage damage. If he had a grade IV injury, it is very likely that surgical intervention would be required. The problem with these lesions is that their depth causes significant loading on to the rim of remaining cartilage and this leads to rapid progression to osteoarthritis. 那麼ROY是哪一種呢？我也不知道。因為我還沒看過ROY也沒看過他的MRI，我只能從目前公開的資訊中盡我最大的能力去推測。我們都知道ROY軟骨受到損傷，假使他是第四級損傷，那很可能需要動個外科手術。問題在於這些損傷的深度會在剩餘軟骨的邊緣造成顯著的負重，而且這會導致骨關節炎的加速進行。 These lesions are often managed with either microfracture or osteoarticular transfer system (OATS) if small. Larger lesions can not be microfractured. These either can have mosaicplasty (multiple osteoarticular pegs) or autologous chondrocyte implantation (ACI) where they harvest cartilage cells and grow them in a lab for reimplantion at a later time. Since none of Brandon’s surgeons have recommended surgical treatment, this is unlikely. 假使這些損傷不大，通常會用微創手術或是骨關節的轉移系統來處理。如果是較嚴重的情形是無法作微創手術的。這些損傷可作軟骨鑲嵌（多重骨關節的骨栓）或是自體軟骨的移植（ACI），他們取出軟骨細胞並在實驗室培養為了以後可以重新植入。因為ROY的醫生中沒有人建議手術，所以不太可能這麼作。 Does Brandon have a grade I lesion(s)? Maybe. Grade I is defines as softening or blistering of the cartilage. This is an early form of arthritis and is commonly associated with pain and swelling. Because the articular surface is still intact, this condition is not associated with mechanical symptoms such as locking or clicking unless another intra-articular lesion is associated such as a meniscal tear. I am not aware if Brandon has any of these complaints. But none the less, the treatment is conservative and surgery is not indicated. 那ROY是第一級損傷嗎？可能吧，第一級損傷定義為軟骨軟化或是不舒服。這是關節炎的早期狀況，通常會伴隨著疼痛和腫脹。因為關節表面仍然是完整的，這種情形並不需要用機械性的症狀來處理，像是拴住或是裁斷（註：？）等等，除非是另外關節內的損傷像是半月板撕裂傷。我並不知道ROY有這些抱怨投訴，但儘管如此，治療需要保守的估計，手術則是不需要。 Does Brandon have a grade II injury? Or even a grade III lesion? Maybe. As long as these lesions do not cause significant mechanical symptoms, they can be treated conservatively with rest, ice and NSAIDs. An acute inflammatory episode may benefit from a course of intra-articular steroid injection, but multiple doses are not recommended in the young due the chondrotoxic effects of steroids. The most common surgical treatment for these lesions is irrigation and debridement. Some surgeons will go ahead and remove the damaged cartilage entirely and perform either microfracture, OATS or ACI but that is left to the discretion of the surgeon. 那麼ROY是第二級或是第三級嗎？也有可能。只要這些損傷沒有引致明顯的機械性症狀，可以謹慎地用冰塊和非類固醇抗發炎劑(NSAIDs,Nonsteroidal anti-inflammatory drugs) 來處理。一個嚴重的發炎過程可以從一個關節內類固醇注射來獲得控制，但不建議在年輕時注射多劑因為類固醇的chondrotoxic（注：查不到）影響。最常見的手術療程為沖洗和清創手術。某些醫生會整個移除受傷的軟骨或是作微創手術、或是OATS和ACI，但這取決於醫生的審慎考慮。 Brandon has had multiple arthroscopies and (I assume partial menisectomies) within the last few years. All the press releases did not refer to problems with the cartilage back then. However, accelerated cartilage wear can be expected with less menisci to provide shock absorption in the knee. And here is another issue. We don’t know how much menisci remain in both knees and which ones were debrided. The lateral meniscus carries most of the load in the lateral compartment. The medial meniscus shares more of the load with the articular cartilage. This is why lateral menisectomy accelerates degeneration more so than a medial menisectomy. Also, if more than 50% of the meniscus remains, it is still mostly functional. ROY近幾年已經作過多次關節的內視鏡（我假設也有作部份的半月板切除）。所有的新聞報導皆未指出軟骨是否回得來（？）。然而加速軟骨的磨損可能會造成越來越少的半月板來吸收衝擊的影響。還有另外一個問題，我們並不知道還有多少半月板留在ROY的膝蓋裡，哪一隻應該要作清創手術。橫向的半月板用橫向的區間承受大部分負重。中間的半月板用關節的軟骨分擔多數的負荷。這是為何側向的半月板切除會加速退化比起中間的半月板切除。而且假使超過 50%的半月板還留著的話，通常還是能正常的運作的。 So my final point is this. We (and I mean us fans) don’t have enough information to truly know exactly what is going on in Brandon’s knee. However, I do know enough to know that if Brandon indeed have "bone-on-bone" in his knee, he would not be playing and would either be booked for surgery or contemplating medical retirement (e.g. Darius Miles). 所以我最後的重點是，我們（我指的是阿拓迷）並沒有足夠的資訊來確切瞭解到ROY 的膝蓋到底是發生什麼事了。然而我們可以瞭解ROY是否有「骨頭碰骨頭」的情形，他不會上場而且也沒有預定手術和深思熟慮的引退醫療（像Darius Miles一樣）。 Does this make more sense? 不曉得這樣是不是更清楚了呢？ -- 這篇有滿多專業單字的，我是查google字典，有任何意見都很歡迎提出喔。 -- ※ 發信站: 批踢踢實業坊(ptt.cc) ◆ From: 123.110.6.138