Pill Stephan G, Ganley Theodore J, Milam R Alden, Lou Julia E, Meyer James S, Flynn John M
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
J Pediatr Orthop. 2003 Jan-Feb;23(1):102-8.
Magnetic resonance imaging (MRI) offers promise as a noninvasive method to determine the potential of an osteochondritis dissecans (OCD) lesion to heal without surgical intervention. The purpose of this study was to compare the value of MRI, plain radiographs, and clinical findings in predicting the success of nonoperative treatment of juvenile OCD lesions. Twenty-seven lesions in 24 patients (mean age 12.2 y) with OCD of the distal femur diagnosed based on MRI were identified. A radiologist or orthopaedist, blinded to the clinical status of the patients, correlated the MRIs with patient outcome. MRIs were assessed for lesion size, location, and four criteria evaluating signal intensity changes and articular surface defects to determine lesion stability. Older, more skeletally mature patients with at least one sign of instability on MRI were most likely to have nonoperative treatment fail. Nonoperative treatment failed most often in patients with large lesions in weightbearing areas, as seen on lateral radiographs. However, location based on anteroposterior radiographs was not statistically significant for predicting treatment outcome. Although no single factor was uniformly predictive of successful nonoperative treatment, younger, skeletally immature patients with no MRI criteria of instability were most amenable to nonoperative treatment.
磁共振成像（MRI）有望成为一种非侵入性方法，用于确定剥离性骨软骨炎（OCD）病变在无需手术干预的情况下自行愈合的可能性。本研究的目的是比较MRI、X线平片和临床检查结果在预测青少年OCD病变非手术治疗成功率方面的价值。基于MRI诊断出24例（平均年龄12.2岁）股骨远端OCD患者的27处病变。一名放射科医生或骨科医生在不知患者临床状况的情况下，将MRI表现与患者预后进行关联。评估MRI的病变大小、位置以及评估信号强度变化和关节面缺损的四个标准，以确定病变的稳定性。年龄较大、骨骼成熟度较高且MRI上至少有一个不稳定迹象的患者，非手术治疗最有可能失败。如侧位X线片所示，负重区域有大病变的患者非手术治疗最常失败。然而，根据前后位X线片确定的位置对预测治疗结果无统计学意义。尽管没有单一因素能始终如一地预测非手术治疗的成功，但年龄较小、骨骼未成熟且MRI无不稳定标准的患者最适合非手术治疗。
