利用磁共振成像技术观察正常人体膝关节骨骺成熟的空间顺序

The Spatial Order of Physeal Maturation in the Normal Human Knee Using Magnetic Resonance Imaging.

作者信息

Margalit Adam, Cottrill Ethan, Nhan Derek, Yu Lingjia, Tang Xin, Fritz Jan, Lee R Jay

机构信息

Department of Orthopaedic Surgery, The Johns Hopkins Hospital.

Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD.

出版信息

J Pediatr Orthop. 2019 Apr;39(4):e318-e322. doi: 10.1097/BPO.0000000000001298.

DOI:10.1097/BPO.0000000000001298

PMID:30451813

Abstract

BACKGROUND

The spatial order of physeal maturation around the distal tibia has been shown to place adolescent patients at risk for certain transitional injuries, such as Tillaux or triplane fractures. Less is known about physeal maturation around the knee. The purpose of this study was to establish the spatial order of physeal maturation in the normal human knee using magnetic resonance imaging (MRI).

METHODS

We retrospectively collected all knee MRI scans from patients presenting to our institution from January 2004 to January 2014. Patients who were suspected on the basis of clinical or radiographic findings of having abnormal knee physeal development or injury were excluded. We then applied a previously described MRI staging system of knee physeal maturation to the MRI scans of the remaining patients at 8 defined knee locations. Associations between the stage of maturation and mean chronological age were then evaluated across the 8 knee locations. Interrater and intrarater reliabilities were assessed.

RESULTS

A total of 165 knee MRI scans (from 98 boys, 67 girls) met the inclusion criteria. Significant differences were found between each stage of physeal maturation and the mean chronological ages at all 8 knee locations for both boys and girls (each, P<0.001). Interestingly, within each stage of physeal maturation, no significant difference was found in the mean chronological ages at any of the 8 knee locations, suggesting that physeal development occurs uniformly in the normal human knee for both boys and girls. Interrater and intrarater reliability were nearly perfect at all locations.

CONCLUSIONS

The spatial order of physeal maturation in the normal human knee was uniform across 8 knee locations for both boys and girls. This uniformity may help to explain why transitional injuries do not follow a recognizable pattern in the knee. Furthermore, the uniformity aids with surgical decision making, because minimal growth modulation or disturbance is likely when early physeal closure is present in a portion of the physis.

LEVEL OF EVIDENCE

Level III.

摘要

背景

胫骨远端骨骺成熟的空间顺序已表明会使青少年患者面临某些过渡性损伤的风险，如蒂洛克斯骨折或三平面骨折。关于膝关节周围骨骺成熟的情况了解较少。本研究的目的是使用磁共振成像（MRI）确定正常人类膝关节骨骺成熟的空间顺序。

方法

我们回顾性收集了2004年1月至2014年1月在我院就诊患者的所有膝关节MRI扫描图像。排除根据临床或影像学检查结果怀疑膝关节骨骺发育异常或受伤的患者。然后，我们将先前描述的膝关节骨骺成熟MRI分期系统应用于其余患者在8个明确膝关节位置的MRI扫描图像。接着评估8个膝关节位置成熟阶段与平均实际年龄之间的关联。评估了评分者间和评分者内的可靠性。

结果

共有165例膝关节MRI扫描图像（来自98名男孩，67名女孩）符合纳入标准。在男孩和女孩的所有8个膝关节位置，骨骺成熟的每个阶段与平均实际年龄之间均存在显著差异（均为P<0.001）。有趣的是，在骨骺成熟的每个阶段，8个膝关节位置中任何一个位置的平均实际年龄均无显著差异，这表明男孩和女孩的正常人类膝关节骨骺发育是均匀发生的。所有位置的评分者间和评分者内可靠性几乎完美。