摘要膝关节自发性骨坏死(spontaneous osteonecrosis of the knee，SONK)是一种病因不明的膝关节疾病。1968年Ahlb-ck等首次报告了该疾病，虽然该病被发现已经50多年，但目前关于该病的病因及发病机制尚不明确，主要有两种理论：血管源性理论和创伤源性理论。血管源性理论认为SONK是股骨髁的血供中断导致局部缺血坏死，而创伤源性理论认为SONK的成因是股骨髁在机械应力作用下发生了软骨下骨不全骨折(subchondral insufficiency fracture of the knee，SIFK)。目前越来越多研究结果支持创伤源性理论：在对早期SONK患者的股骨髁进行病理组织学分析发现仅骨中存在软骨下骨骨折，而没有骨坏死病理表现。还有研究认为SONK与低骨密度、内侧半月板损伤等有关。SONK典型临床表现为膝关节突然发作的严重疼痛，股骨内髁局部压痛，好发于55岁以上患者，女性患者的发病率几乎是男性的3~5倍。对于膝关节自发性骨坏死，有多种治疗方案可供选择。这些治疗策略从非手术和药物治疗到关节保留手术和关节置换手术。由于该病发病率较低，目前尚未探索出最佳的治疗策略。主流的研究认为应根据疾病的发展阶段及病变大小选择不同的治疗方法，采取个体化管理。本文将该病的治疗策略综述如下。
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