Department of Orthopedic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Radiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
J Orthop Surg Res. 2023 Aug 26;18(1):627. doi: 10.1186/s13018-023-04130-8.
The aim of this study was to investigate the risk factors of neglected osteochondral fractures in primary acute traumatic patellar dislocation in the pediatric population.
A total of 113 patients with primary acute traumatic patellar dislocation for whom coincident osteochondral fractures could not be confirmed by X-ray examination at initial diagnosis between January 2010 and February 2022 were retrospectively analyzed. Medical history, physical examination, and radiographic images were recorded in detail. The greatest dimension of the suprapatellar pouch (SP) effusion on radiograph was measured. Computed tomography and magnetic resonance imaging were used to confirm the presence of neglected osteochondral fractures and measure the fragment size. Potential risk factors were calculated and correlated with reference to the neglected osteochondral fractures and fragment size using multivariate linear regression analysis.
Weight, walking ability, effusion grade, and SP measurement had a significant correlation with neglected osteochondral fractures in primary acute traumatic patellar dislocation (p = 0.046; p < 0.001; p = 0.048; p < 0.001). The cutoff point was 53.5 kg for weight and 18.45 mm for SP measurement. In the neglected fractures group, SP measurement was statistically significant with larger fragment size (beta value = 0.457; p < 0.001), and the cutoff point was 26.2 mm.
SP effusion is not only associated with an increased risk of neglected osteochondral fractures in primary acute traumatic patellar dislocation but also with larger fragment size. Knee radiograph, medical history, and physical examination can predict the need for further imaging examination and even surgery in primary acute traumatic patellar dislocation.
本研究旨在探讨儿童原发性急性创伤性髌骨脱位中，漏诊骨软骨骨折的危险因素。
回顾性分析 2010 年 1 月至 2022 年 2 月期间，113 例经初次 X 线检查未能确诊的原发性急性创伤性髌骨脱位患者的病例资料，记录其病史、体格检查和影像学资料。测量膝关节髌上囊积液最大直径（SP）。采用 CT 和 MRI 证实是否存在漏诊的骨软骨骨折，并测量骨折块大小。采用多元线性回归分析，计算并比较各潜在危险因素与漏诊骨软骨骨折及骨折块大小的相关性。
体重、行走能力、关节积液分级和髌上囊积液测量值与原发性急性创伤性髌骨脱位漏诊骨软骨骨折显著相关（p=0.046；p<0.001；p=0.048；p<0.001）。体重的截断值为 53.5kg，髌上囊积液测量值的截断值为 18.45mm。在漏诊骨折组中，髌上囊积液测量值与较大的骨折块大小具有统计学意义（β值=0.457；p<0.001），截断值为 26.2mm。
髌上囊积液不仅与原发性急性创伤性髌骨脱位漏诊骨软骨骨折的风险增加相关，而且与较大的骨折块大小相关。膝关节 X 线、病史和体格检查可预测原发性急性创伤性髌骨脱位患者是否需要进一步影像学检查，甚至手术治疗。
