膝关节青少年剥脱性骨软骨炎：病灶周围硬化边缘作为愈合的预后因素
Juvenile osteochondritis dissecans of the knee: perifocal sclerotic rim as a prognostic factor of healing.
作者信息
Ramirez Ana, Abril Juan Carlos, Chaparro Manuel
机构信息
Hospital Universitario Niño Jesús, Madrid, Spain.
出版信息
J Pediatr Orthop. 2010 Mar;30(2):180-5. doi: 10.1097/BPO.0b013e3181cfcd2e.
BACKGROUND
Management of osteochondritis dissecans of the femoral condyle in children remains uncertain. The aim of this study was to determine the presence of a perilesional sclerotic ring in radiologic examination and to establish its value for prognosis.
METHODS
We retrospectively reviewed 85 patients diagnosed with osteochondritis dissecans. The population was distributed according to the grade of perilesional radiologic sclerosis: stage 0, patients who did not show a sclerotic rim in the anteroposterior and the lateral views; stage I, patients with marginal sclerosis only in 1 radiologic view; stage II, patients with sclerosis in both views. Patients were also distributed in different age groups: group 1, children under 12 years of age; group 2, children between 12 and 15 years of age; and group 3, children more than 15 years of age. These groups were correlated with the stage of perilesional sclerosis. Radiologic results were analyzed according to the Hughston scale after conservative or surgical treatment of the lesion.
RESULTS
Lesions without perilesional sclerosis (stage 0) were cured in all the cases, with good results by means of conservative treatment (P<0.05). In patients with stage I or II perilesional sclerosis, the percentage of healing was smaller; in these cases, surgical treatment improved the results compared with those in which conservative treatment was used (P<0.05). Children under 12 years of age showed less perilesional sclerosis and more tendencies to spontaneous healing than those more than 15 years of age. In these patients, radiologic sclerosis is greater (P<0.05).
CONCLUSIONS
The presence of a sclerotic rim in the osteochondritis dissecans lesions of the knees in children is considered a prognostic indicator of the process. Lesions without sclerosis show a tendency toward spontaneous recovery with conservative treatment. Lesions with perilesional sclerosis show worse evolution, and treatment with perforations is still essential for enhancement of healing.
LEVEL OF EVIDENCE
Prognostic study, Level II (retrospective study).
背景
儿童股骨髁剥脱性骨软骨炎的治疗方法仍不明确。本研究旨在确定在放射学检查中是否存在病灶周围硬化环，并确定其对预后的价值。
方法
我们回顾性分析了85例诊断为剥脱性骨软骨炎的患者。根据病灶周围放射学硬化程度进行分组：0期，前后位和侧位片均未显示硬化边缘的患者；I期，仅在1个放射学视图中出现边缘硬化的患者；II期，两个视图均出现硬化的患者。患者也被分为不同年龄组：1组，12岁以下儿童；2组，12至15岁儿童；3组，15岁以上儿童。这些组与病灶周围硬化阶段相关。在对病变进行保守或手术治疗后，根据休斯顿量表分析放射学结果。
结果
所有无病灶周围硬化（0期）的病变均治愈，通过保守治疗取得了良好效果（P<0.05）。在病灶周围硬化为I期或II期的患者中，愈合百分比更低；在这些病例中，与采用保守治疗的患者相比，手术治疗改善了结果（P<0.05）。12岁以下儿童的病灶周围硬化较少，比15岁以上儿童更倾向于自发愈合。在这些患者中，放射学硬化更明显（P<0.05）。
结论
儿童膝关节剥脱性骨软骨炎病变中硬化边缘的存在被认为是该病程的预后指标。无硬化的病变通过保守治疗有自发恢复的趋势。病灶周围硬化的病变显示出更差的进展，而钻孔治疗对于促进愈合仍然至关重要。
证据水平
预后研究，II级（回顾性研究）。
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