前文恕删。缩址上篇推文有 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. 我的简历：我是一位整型外科医师，目前是 D1 大学计画中运动医学协会的成员之一。 我还没有跟阿拓医疗团队的人说过也还没看过ROY的 X光片。仅是为了教学目的提供以 下资讯。 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." 最近网站上的人们对於球员不停地出现膝盖伤势问题感到很大的焦虑，尤其是ROY。 JQ最近访谈ROY，ROY说：「问题是骨头碰骨头，Roberts医生称之为『（膝盖的） 关节炎』」。 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. 对於该描述有一些问题想探讨。「骨头碰骨头」可以有相当程度的关联性在不同严重性 的关节炎的范围之中。普遍认知是照字面上意思来说是股骨在胫骨上碾磨，在某些严重 的情形下这样说是正确的。 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. 然而这并不是唯一的情况，而且这在处理年轻人的病时更是如此。部份问题在於 医生（像我自己）会「简化」我们的解释好让病患可以理解关节炎的观念。对於要向非 整型外科的同事描述清楚Outerbridge二级和三级软骨损害差异有其困难度存在，要向 门外汉讲解清楚更是不容易。所以我们先说骨头和骨头互相摩擦，人们就可以想像 并立刻了解到这是个不好的状况。 Here is what normal cartilage should look like during an arthroscopy of the knee: http://tinyurl.com/2wfvpe6 这张图（後面的连结就是）就是关节内视镜中正常的软骨应该看起来的情况。 Here is what a grade II lesion looks like:http://tinyurl.com/356aktk 这张图是第二级损伤的样子 Here is what a grade III lesion looks like:http://tinyurl.com/3xa82hl 这张是第三集损伤的情形 Here is what a grade IV lesion looks like:http://tinyurl.com/32szv65 这张是第四级损伤 As you can see, there is a big difference between these cartilage lesions. 如同你们所看到的，这些软骨损伤有很大不同的差异程度。 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. 那麽ROY是哪一种呢？我也不知道。因为我还没看过ROY也没看过他的MRI，我只能从目前 公开的资讯中尽我最大的能力去推测。我们都知道ROY软骨受到损伤，假使他是第四级 损伤，那很可能需要动个外科手术。问题在於这些损伤的深度会在剩余软骨的边缘造成 显着的负重，而且这会导致骨关节炎的加速进行。 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. 假使这些损伤不大，通常会用微创手术或是骨关节的转移系统来处理。如果是较严重的 情形是无法作微创手术的。这些损伤可作软骨镶嵌（多重骨关节的骨栓）或是 自体软骨的移植（ACI），他们取出软骨细胞并在实验室培养为了以後可以重新植入。 因为ROY的医生中没有人建议手术，所以不太可能这麽作。 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是第一级损伤吗？可能吧，第一级损伤定义为软骨软化或是不舒服。这是关节炎的 早期状况，通常会伴随着疼痛和肿胀。因为关节表面仍然是完整的，这种情形并不需要 用机械性的症状来处理，像是拴住或是裁断（注：？）等等，除非是另外关节内的损伤 像是半月板撕裂伤。我并不知道ROY有这些抱怨投诉，但尽管如此，治疗需要保守的估计， 手术则是不需要。 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. 那麽ROY是第二级或是第三级吗？也有可能。只要这些损伤没有引致明显的机械性症状， 可以谨慎地用冰块和非类固醇抗发炎剂(NSAIDs,Nonsteroidal anti-inflammatory drugs) 来处理。一个严重的发炎过程可以从一个关节内类固醇注射来获得控制，但不建议在年轻 时注射多剂因为类固醇的chondrotoxic（注：查不到）影响。最常见的手术疗程为 冲洗和清创手术。某些医生会整个移除受伤的软骨或是作微创手术、或是OATS和ACI， 但这取决於医生的审慎考虑。 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近几年已经作过多次关节的内视镜（我假设也有作部份的半月板切除）。所有的新闻 报导皆未指出软骨是否回得来（？）。然而加速软骨的磨损可能会造成越来越少的半月板 来吸收冲击的影响。还有另外一个问题，我们并不知道还有多少半月板留在ROY的膝盖里 ，哪一只应该要作清创手术。横向的半月板用横向的区间承受大部分负重。中间的半月板 用关节的软骨分担多数的负荷。这是为何侧向的半月板切除会加速退化比起中间的 半月板切除。而且假使超过 50%的半月板还留着的话，通常还是能正常的运作的。 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). 所以我最後的重点是，我们（我指的是阿拓迷）并没有足够的资讯来确切了解到ROY 的膝盖到底是发生什麽事了。然而我们可以了解ROY是否有「骨头碰骨头」的情形， 他不会上场而且也没有预定手术和深思熟虑的引退医疗（像Darius Miles一样）。 Does this make more sense? 不晓得这样是不是更清楚了呢？ -- 这篇有满多专业单字的，我是查google字典，有任何意见都很欢迎提出喔。 --

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