外侧股骨髁骨软骨炎伴外侧盘状半月板的预测因素。
Predictive factors for osteochondritis dissecans of the lateral femoral condyle concurrent with a discoid lateral meniscus.
机构信息
Department of Orthopaedic Surgery, Shimada Hospital, 100-1 Kashiyama, Habikino, Osaka, 583-0875, Japan.
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2018 Mar;26(3):799-805. doi: 10.1007/s00167-017-4451-8. Epub 2017 Feb 14.
PURPOSE
Osteochondritis dissecans (OCD) of the lateral femoral condyle is relatively rare, and it is often reported in combination with discoid lateral meniscus. However, little is known about the mechanism underlying this connection. Predictive factors for OCD coinciding with discoid lateral meniscus in Japanese children and adolescents were assessed.
METHODS
During 2000-2015, 152 knees in 133 patients aged 5-15 years were diagnosed with symptomatic complete discoid lateral meniscus. Patients were evaluated using radiography and magnetic resonance imaging (MRI). OCD was radiographically graded using the Brückl classification. Based on Ahn's MRI classifications, discoid lateral meniscus was divided into four types of meniscal shift: no shift (N), anterocentral (AC), posterocentral (PC), or central (C). Relationships between OCD and patient sex, age and Ahn's shift type were analysed.
RESULTS
OCD of the lateral femoral condyle was associated with discoid lateral meniscus in 22 (14.5%) of 152 knees. OCD was classified as Brückl's stage 1 in 5 knees, stage 2 in 12, stage 3 in 3, stage 4 in 1, and stage 5 in 1. OCD was found in 12 of 96 knees (12.5%) with type N meniscal shift, 4 of 24 knees (16.7%) with type AC, 0 of 21 knees (0%) with type PC, and 6 of 11 knees (54.5%) with type C. Multivariate logistic regression analysis showed that males had a significantly increased odds ratio (OR) [14.8; 95% confidence interval (CI) 2.6-83.4]. Those aged 5-11 years had a significantly higher OR (12.5; 95% CI 2.8-55.9) than those aged 12-15 years. The OR for type C coinciding with OCD was significantly elevated (13.4; 95% CI 2.3-78.7).
CONCLUSIONS
Concurrent OCD was found in 22 (14.5%) of 152 knees with discoid lateral meniscus. Male sex, young age (5-11 years), and having a type C meniscal shift of the discoid lateral meniscus as shown by MRI were found to be predictive factors for OCD of the LFC.
LEVEL OF EVIDENCE
III.
目的
外侧股骨髁的剥脱性骨软骨炎（OCD）相对少见，常与外侧盘状半月板同时报告。然而，对于这种关联的发生机制知之甚少。评估了日本儿童和青少年中与外侧盘状半月板同时发生的 OCD 的预测因素。
方法
2000 年至 2015 年期间，133 名 5-15 岁患者的 152 个膝关节被诊断为症状性完全外侧盘状半月板。对患者进行了影像学和磁共振成像（MRI）检查。OCD 使用 Brückl 分类进行影像学分级。根据 Ahn 的 MRI 分类，外侧盘状半月板分为四种半月板移位类型：无移位（N）、前中央（AC）、后中央（PC）或中央（C）。分析了 OCD 与患者性别、年龄和 Ahn 移位类型之间的关系。
结果
152 个膝关节中有 22 个（14.5%）与外侧盘状半月板同时存在 OCD。OCD 在 5 个膝关节中被归类为 Brückl 1 期，12 个膝关节中为 2 期，3 个膝关节中为 3 期，1 个膝关节中为 4 期，1 个膝关节中为 5 期。在 N 型半月板移位的 96 个膝关节中有 12 个（12.5%）存在 OCD，AC 型的 24 个膝关节中有 4 个（16.7%），PC 型的 21 个膝关节中无 OCD（0%），C 型的 11 个膝关节中有 6 个（54.5%）存在 OCD。多变量逻辑回归分析显示，男性的比值比（OR）显著增加（14.8；95%置信区间（CI）2.6-83.4）。5-11 岁年龄组的 OR（12.5；95%CI 2.8-55.9）明显高于 12-15 岁年龄组。MRI 显示 C 型与 OCD 同时存在时，OR 显著升高（13.4；95%CI 2.3-78.7）。
结论
外侧盘状半月板的 152 个膝关节中，22 个（14.5%）存在并发 OCD。男性、年龄较小（5-11 岁）和外侧盘状半月板 MRI 显示 C 型半月板移位是外侧股骨髁 OCD 的预测因素。
证据水平
III。
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