Polousky John D
Rocky Mountain Youth Sports Medicine Institute, Rocky Mountain Hospital for Children, CO, USA.
Sports Med Arthrosc Rev. 2011 Mar;19(1):56-63. doi: 10.1097/JSA.0b013e31820b94b9.
Juvenile osteochondritis dissecans (JOCD) has been a recognized entity for more than 100 years. Despite our long recognition of OCD, the natural history and most effective therapies are poorly understood. Although conclusive evidence of an exact cause is lacking, there is widespread agreement that JOCD is related to repetitive trauma. Patients with JOCD present with vague pain and occasionally, mechanical symptoms. The diagnosis of JOCD can be confirmed on plain radiographs. Magnetic resonance imaging has emerged as the study of choice to evaluate the stability of the lesion and integrity of the overlying articular cartilage. Treatment decisions are based on the stability of the lesion. Stable JOCD lesions should be treated initially with activity modification and possibly, immobilization. Unstable lesions and stable lesions not responding to an initial course of nonoperative therapy should be surgically treated. Surgical treatment is based on the radiographic and arthroscopic characteristics of the lesion. Multiple techniques from simple arthroscopic drilling and fixation to salvage techniques for cartilage restoration are discussed.
青少年剥脱性骨软骨炎（JOCD）已被认可超过100年。尽管我们对骨软骨炎（OCD）早有认识，但对其自然病程和最有效的治疗方法却知之甚少。虽然缺乏确切病因的确凿证据，但人们普遍认为JOCD与重复性创伤有关。JOCD患者表现为隐痛，偶尔伴有机械性症状。JOCD的诊断可通过X线平片得以证实。磁共振成像已成为评估病变稳定性及上方关节软骨完整性的首选检查方法。治疗决策基于病变的稳定性。稳定的JOCD病变最初应通过调整活动并可能进行固定来治疗。不稳定病变以及对初始非手术治疗疗程无反应的稳定病变应接受手术治疗。手术治疗基于病变的影像学和关节镜特征。本文讨论了从简单的关节镜钻孔和固定到软骨修复挽救技术等多种技术。
