Seeley Mark A, Knesek Michael, Vanderhave Kelly L
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109, USA.
J Pediatr Orthop. 2013 Jul-Aug;33(5):511-8. doi: 10.1097/BPO.0b013e318288b7a0.
Acute patellar dislocation (APD) is a common injury in the pediatric patient population and may be associated with a spectrum of soft tissue and osteochondral injuries. This study describes the incidence of osteochondral fracture and associated injury patterns in a pediatric population after first-time APD and assesses functional outcomes after treatment.
One hundred twenty-two patients, aged 11 to 18 years, who were evaluated after first-time APD over a 10-year period were identified, 46 of whom had confirmed osteochondral injury on magnetic resonance imaging (MRI). Demographic data, including knee affected, mechanism of injury, recurrent dislocation, operations performed, and condition at last follow-up, were retrieved from the medical record. Operative reports and MRI were used to characterize the location of osteochondral injury. The functional outcome of each patient with an osteochondral fracture was assessed using the Pedi-IKDC questionnaire.
Forty-six patients, mean age 14.6 years (range, 11 to 18 y), were included. Osteochondral fracture occurred at the patella in 35 patients (76%), the lateral femoral condyle in 11 patients (24%), and at both locations in 3 patients (6.5%). In 21 patients (44%), MRI confirmed osteochondral injury despite the plain radiograph interpretation as negative for fracture. Twenty-six patients (68%) subsequently underwent surgery after injury. Injury to the medial patellofemoral ligament was identified on MRI in 97.8% of patients (45/46). Fifteen patients (32.6%) underwent a concomitant medial repair at the time of surgery. Osteochondral injury to the distal femur on average had a lower International Knee Documentation Committee score than patellar injuries (72.3±18 vs. 91.1±10.2, P<0.003). Femoral osteochondral injury involving the weight-bearing surface (75.27±18.19) scored lower than non-weight-bearing surface injuries (93.22±7.47; P<0.001).
The incidence of osteochondral injury associated with APD is high. Osteochondral fractures may initially go unrecognized on plain radiographs. Patients with weight-bearing lateral femoral condyle injuries had lower short-term functional scores, suggesting that outcomes depend on location of injury.
Level IV, diagnostic and therapeutic study.
急性髌骨脱位（APD）在儿科患者群体中是一种常见损伤，可能与一系列软组织和骨软骨损伤相关。本研究描述了首次急性髌骨脱位后儿科人群中骨软骨骨折的发生率及相关损伤模式，并评估了治疗后的功能结局。
确定了122例年龄在11至18岁之间、在10年期间首次急性髌骨脱位后接受评估的患者，其中46例在磁共振成像（MRI）上证实存在骨软骨损伤。从病历中获取人口统计学数据，包括受累膝关节、损伤机制、复发性脱位、所进行的手术以及最后随访时的状况。手术报告和MRI用于确定骨软骨损伤的位置。使用儿童国际膝关节文献委员会（Pedi-IKDC）问卷评估每例骨软骨骨折患者的功能结局。
纳入46例患者，平均年龄14.6岁（范围11至18岁）。35例患者（76%）髌骨发生骨软骨骨折，11例患者（24%）股骨外侧髁发生骨软骨骨折，3例患者（6.5%）两处均发生骨折。21例患者（44%）MRI证实存在骨软骨损伤，尽管X线平片解读为骨折阴性。26例患者（68%）受伤后随后接受了手术。97.8%的患者（45/46）MRI显示髌股内侧韧带损伤。15例患者（32.6%）在手术时同时进行了内侧修复。股骨远端的骨软骨损伤平均国际膝关节文献委员会评分低于髌骨损伤（72.3±1 /span>18对91.1±10.2，P<0.003）。累及负重面的股骨骨软骨损伤评分（75.27±18.19）低于非负重面损伤（93.22±7.47；P<0.001）。
与急性髌骨脱位相关的骨软骨损伤发生率较高。骨软骨骨折最初可能在X线平片上未被识别。负重侧股骨髁损伤的患者短期功能评分较低，表明结局取决于损伤位置。
IV级，诊断和治疗性研究。
