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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Operative And Non-operative Management Of Osteochondritis Dissecans In The Knee Of Skeletally Immature Patients: Rates Of Persistent Knee Pain, Osteoarthritis, And Arthroplasty At Mean 14- Years Follow-up
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Operative And Non-operative Management Of Osteochondritis Dissecans In The Knee Of Skeletally Immature Patients: Rates Of Persistent Knee Pain, Osteoarthritis, And Arthroplasty At Mean 14- Years Follow-up

机译：骨骼发育不全患者膝盖的骨软骨炎剥离术的手术和非手术管理：平均14年随访中持续的膝关节疼痛，骨关节炎和置换术的发生率

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Objectives: The purpose of this study was to report long-term follow-up of skeletally immature OCD lesions treated operatively and non-operatively and determine risk factors for persistent knee pain at final follow-up. Methods: A large, geographic database of over 500,000 patients was reviewed in this case series to identify and confirm patients with OCD of the knee. Presenting radiographs and MRI were reviewed. Clinical course including operative management, persistent knee pain, and conversion to TKA were obtained and analyzed through review of clinical and operative notes. Results: 95 skeletally immature patients (70 males, 25 females) with OCD lesions diagnosed at a mean age of 13 years (range: 7-16) were followed for a mean of 14 years (range: 2-40). 53 patients (56%) were treated operatively and 42 patients (44%) were treated non-operatively. At final follow up, 13 patients with a mean age of 30 years noted persistent knee pain, 8 (15%) treated operatively versus 5 (12%) treated non-operatively. Risk factors for knee pain were female gender, patellar lesion location, and unstable lesions (Table 1). Four patients (8%) treated operatively and two (5%) treated non-operatively developed symptomatic osteoarthritis at a mean of 28.6 years following diagnosis. One patient treated operatively and two treated non-operatively converted to TKA at a mean of 37 years following diagnosis. Mean age at TKA was 52 years, significantly younger than that observed for primary TKA at our institution (p = 0.004). Conclusion: Patients with skeletally immature OCD lesions have an estimated 14% rate of persistent knee pain, 6% risk of symptomatic osteoarthritis, and 3% risk of conversion to TKA at a mean of 14 years following time of diagnosis. Female patients, patellar lesions, and unstable lesions demonstrated increased risk of persistent knee pain at final follow-up. Patients with OCD of the knee convert to TKA at a significantly younger age than that of the general primary TKA population. Table 1. Risk factors for penistent ;met pain at the time of final follow-up Variable HR (95% Confidence Interval) p-value Treatment ?Non-Operative Reference ?Operative 1.16(0.35 - 3.83) 0.81 Age at diagnosis ?<10 Reference ?≥10 10.3(0.11-9.63) 0.98 Gender ?Female Reference ?Male 0.24(0.07-0.81) 0.02 Location ?MFC Reference ?LFC 2.91(0.57-14.97) 0.2 ?Patella 5.30(1.37-20.48) 0.02 ?Trochlea 0.00(0.00-0.00)~(a) <0.01~(a) AP Radiograph Lesion Width ?<20mm Reference ?≥20mm 1.74(0.23-12.97) 0.59 AP Radiograph Lesion Depth ?<5mm Reference ?≥5mm 0.68(0.08-6.00) 0.73 Lateral Radiograph Lesion Width ?<20mm Reference ?≥20mm 1.75(0.31-10.01) 0.53 Lateral Radiograph Lesion Depth ?<5mm Reference ?≥5mm 2.14(0.38-11.95) 0.38 Lesion Contour ?Concave Reference ?Convex 0.45(0.08-2.54) 0.37 Disruption of subchondral bone ?No Reference ?Yes 0.73(0.15-3.54) 0.7 Intra-articular displace fragment ?No Reference ?Yes 0.85(0.10-7.48) 0.88 Adjacent Focal Articular Cartilage Defects ?No Reference ?Yes 0.85(0.10-7.48) 0.88 Stability ?Stable Reference ?Unstable 10.58(1.26-88.63) 0.03 ~(a)Of then =2 lesions present on the trochlea, none developed symptomatic Knee pain.
机译：目的：本研究的目的是报告经手术和非手术治疗的骨骼未成熟OCD病变的长期随访情况，并确定最终随访时持续性膝关节疼痛的危险因素。方法：本案例系列回顾了超过500,000名患者的大型地理数据库，以识别和确认患有OCD的患者。提出射线照相和MRI。通过回顾临床和手术笔记，获得并分析了包括手术管理，持续性膝关节疼痛和转换为TKA在内的临床过程。结果：95例骨骼肌未成熟患者（男70例，女25例）被诊断为平均年龄13岁（范围：7-16岁），平均随访14年（范围：2-40岁）。 53例（56％）经手术治疗，42例（44％）非手术治疗。在最后的随访中，平均年龄为30岁的13例患者出现持续性膝关节疼痛，其中8例（15％）为手术治疗，而5例（12％）为非手术治疗。膝盖疼痛的危险因素是女性、,骨病变位置和不稳定的病变（表1）。诊断后平均28.6年，手术治疗的4例患者（8％）和非手术治疗的2例患者（5％）出现了症状性骨关节炎。诊断后平均37年，一名接受手术治疗的患者和两名接受非手术治疗的患者转化为TKA。 TKA的平均年龄为52岁，比我们机构原发性TKA的平均年龄显着年轻（p = 0.004）。结论：在诊断后平均14年内，骨骼未成熟OCD病变的患者估计持续性膝关节疼痛的发生率为14％，症状性骨关节炎的风险为6％，转化为TKA的风险为3％。女性患者，tell骨病变和不稳定病变显示出在最终随访中持续膝关节疼痛的风险增加。膝部OCD患者比普通原发性TKA人群的年龄要年轻得多。表1.最终随访时持续疼痛的风险因素可变HR（95％置信区间）p值治疗？非手术参考？手术1.16（0.35-3.83）0.81诊断年龄？<10参考？≥1010.3（0.11-9.63）0.98性别？女性参考？男性0.24（0.07-0.81）0.02位置？MFC参考？LFC 2.91（0.57-14.97）0.2？P骨5.30（1.37-20.48）0.02？Trochlea 0.00（ 0.00-0.00）〜（a）<0.01〜（a）AP射线照相病变宽度α<20mm参考值≥20mm1.74（0.23-12.97）0.59 AP射线照相病变深度α<5mm参考值≥5mm0.68（0.08-6.00）0.73横向X射线照片病灶宽度？<20mm参考？≥20mm1.75（0.31-10.01）0.53横向X射线照片病灶深度？<5mm参考？≥5mm2.14（0.38-11.95）0.38病变轮廓？凹参考？凸0.45（0.08-2.54）0.37软骨下骨破裂？无参考？是0.73（0.15-3.54）0.7关节内移位片段？无参考？是0.85（0.10-7.48）0.88相邻的局灶性软骨缺损？无参考？是0.85（0.10-7） .48）0.88稳定性？稳定参考？不稳定10.58（1.26-88.63）0.03〜（a）当时= 2出现在滑车上的病变，没有一个出现症状性膝关节疼痛。

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