膝关节多灶性青少年剥脱性骨软骨炎：病例系列

Multifocal juvenile osteochondritis dissecans of the knee: a case series.

作者信息

Backes Jeffrey R, Durbin Thomas C, Bentley Jared C, Klingele Kevin E

机构信息

*Mount Carmel Medical Center †Nationwide Children's Hospital ‡Department of Orthopaedics, The Ohio State University, Columbus, OH.

出版信息

J Pediatr Orthop. 2014 Jun;34(4):453-8. doi: 10.1097/BPO.0000000000000121.

DOI:10.1097/BPO.0000000000000121

PMID:24248591

Abstract

BACKGROUND

This retrospective case series reports on a group of patients with multifocal juvenile osteochondritis dissecans (MJOCD) of the knee and discusses demographic data, lesion location, stage, and treatment results.

METHODS

Records of patients identified with MJOCD of the knee at a single institution were retrospectively reviewed. Demographic, radiographic, and surgical results were recorded. Lesions were descriptively classified and lesions undergoing surgical treatment were staged. Results of operative and nonoperative treatment were recorded.

RESULTS

Fifty-nine lesions were identified in 28 patients who met the inclusion criteria. There were 22 males (78%) and 6 females (21%). Average age was 11.8 years (males, 6 to 17; females, 10 to 14). Thirty-six (61%) lesions were on the medial femoral condyle (MFC), 19 (32%) on the lateral femoral condyle, 2 (3%) on the trochlea, 1 (2%) on the patella, and 1 (2%) on the anteromedial tibial plateau. Forty-four (74%) lesions required operative treatment. Of the 32 stable lesions managed surgically, 25 (78%) achieved healing with operative treatment. All 12 unstable lesions identified were managed surgically with 5 (41%) healed after the initial operation. Lesions located on the MFC had a significantly higher rate of healing (89%) compared with lateral femoral condyle lesions (37%) (P<0.0001).

CONCLUSIONS

MJOCD of the knee defines a subset of patients with >1 identified lesion occurring in the same or the contralateral knee. Prevalence of MJOCD of the knee is unknown. A high percentage of these patients require surgical intervention with only one quarter of stable lesions healing with conservative treatment. Healing rates of stable lesions after surgery was nearly twice that of unstable lesions undergoing surgical intervention. Lesions located on the MFC healed at a statistically significant greater rate than other locations within the knee. Sex, age, and associated discoid menisci had no effect on healing prognosis.

LEVEL OF EVIDENCE

Level IV-case series.

摘要

背景

本回顾性病例系列报告了一组患有膝关节多灶性幼年型骨软骨炎剥脱（MJOCD）的患者，并讨论了人口统计学数据、病变位置、分期及治疗结果。

方法

对在单一机构确诊为膝关节MJOCD的患者记录进行回顾性分析。记录人口统计学、影像学及手术结果。对病变进行描述性分类，并对接受手术治疗的病变进行分期。记录手术及非手术治疗结果。

结果

28例符合纳入标准的患者共发现59处病变。男性22例（78%），女性6例（21%）。平均年龄11.8岁（男性6至17岁；女性10至14岁）。36处（61%）病变位于股骨内侧髁（MFC），19处（32%）位于股骨外侧髁，2处（3%）位于滑车，1处（2%）位于髌骨，1处（2%）位于胫骨前内侧平台。44处（74%）病变需要手术治疗。在32处接受手术治疗的稳定病变中，25处（78%）经手术治疗后愈合。所有12处确诊的不稳定病变均接受手术治疗，其中5处（41%）在初次手术后愈合。与股骨外侧髁病变（37%）相比，位于MFC的病变愈合率显著更高（89%）（P<0.0001）。

结论

膝关节MJOCD定义了一组在同侧或对侧膝关节出现1处以上确诊病变的患者。膝关节MJOCD的患病率未知。这些患者中很大一部分需要手术干预，只有四分之一的稳定病变通过保守治疗愈合。稳定病变手术后的愈合率几乎是接受手术干预的不稳定病变的两倍。位于MFC的病变愈合率在统计学上显著高于膝关节内的其他位置。性别、年龄及合并盘状半月板对愈合预后无影响。