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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Non-operative Treatment Outcomes of Stable Juvenile Osteochondritis Dissecans Lesions of the Knee
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Non-operative Treatment Outcomes of Stable Juvenile Osteochondritis Dissecans Lesions of the Knee

机译：稳定的少年解剖性骨软骨炎的非手术治疗结果

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Objectives: Osteochondritis dissecans (OCD) of the knee most commonly occurs in skeletally-immature pre-adolescent or adolescent patients. Stable juvenile OCD lesions are initially treated via non-operative methods, with varying rates of successful healing reported in the literature. Unloader bracing has been introduced as a relatively new method designed to reduce weight-bearing stress and promote healing for femoral condyle lesions, although the outcomes of unloader bracing compared to other forms of non-operative treatment have not been established. Methods: A retrospective case series was designed to include all patients initially treated non-operatively for stable juvenile OCD of the femoral condyle at a single institution from 2002-2014. Following IRB approval, patient medical records were reviewed for demographic and clinical data, including symptom duration, prior conservative treatment, non-operative treatment modality prescribed and clinical outcome. Results: 223 knees of 196 patients (146/196 (74%) male) underwent non-operative treatment for stable OCD of the medial or lateral femoral condyle. Mean age at presentation 11.5 +/- 1.7 years (range 6-16 years). 27/196 patients (14%) were diagnosed with bilateral OCD at presentation, while 169/196 (86%) presented with unilateral OCD. 180/223 knees (81%) were medial femoral condyle lesions, while 39/223 (17%) were lateral femoral condyle lesions and 4/223 (2%) bicondylar. Reported symptom duration was 10.4 +/- 8.8 months (range 0.1 - 38 months). 222/223 (99.6%) knees presented with knee pain, 68/223 (30%) with one or more mechanical symptoms (swelling, giving-way, locking, clicking). 87/223 (39%) had undergone previous non-operative treatment for an average of 2.1 months. On exam at presentation, 130/223 (58%) had tenderness to palpation noted over the associated femoral condyle or ipsilateral joint line. Treatment was based on physician preference. 121/223 (54%) were treated with unloader bracing with activity restriction and physical therapy for a minimum of 3 months, while 102/223 (46%) were treated with other (i.e. “non-unloader”) conservative therapy. In the non-unloader group, all patients were treated with activity restriction with physical therapy and 32% (33/102) had additional non-unloader bracing or immobilization. Treatment of 26/121 (21%) knees in the unloader group included weight-bearing restrictions compared with 30/102 (29%) knees in the non-unloader group. Unloader bracing was associated with healing in 57/121 (47%) knees, while non-unloader treatment led to healing in 60/102 (59%) (p=0.082). Surgical intervention was pursued for 64/121 (53%) knees in the unloader group, at mean 11.0 months after presentation (range 1.9 - 62 months), all of which included OCD drilling and 12/121 (10%) of which included OCD fixation. Subsequent surgical intervention was pursued for 42/102 (41%) knees in the non-unloader group, at mean 6.6 months after presentation (range 0.2 - 40 months), all of which required OCD drilling and 11/102 of which included (11%) OCD fixation. Conclusion: Non-operative treatment for stable OCD of the knee in skeletally-immature patients led to healing in approximately half (52%) of cases. No significant difference was seen between outcomes of patients treated with non-operative methods that included unloader bracing versus non-unloader bracing or other modalities.
机译：目的：膝关节骨软骨炎（OCD）最常见于骨骼不成熟的青春期前或青春期患者。最初通过非手术方法治疗稳定的少年OCD病变，文献报道成功治愈率各不相同。尽管还没有确定与其他形式的非手术治疗相比，卸荷支架的结果尚未确定，但卸荷支架已被引入作为一种相对较新的方法，旨在减轻承重应力并促进股骨dy病变的愈合。方法：设计了一个回顾性病例系列，纳入了2002年至2014年间在单个机构中最初接受非手术治疗的稳定的con突少年OCD的所有患者。在IRB批准后，对患者的病历进行了人口统计学和临床​​数据审查，包括症状持续时间，先前的保守治疗，规定的非手术治疗方式和临床结局。结果：196例患者的223膝（男146/196，占74％）接受了非手术治疗，以稳定内侧或外侧股骨O的OCD。呈现时的平均年龄11.5 +/- 1.7岁（范围6-16岁）。 27/196例患者（14％）被诊断为双侧强迫症，而169/196例患者（86％）被诊断为单侧强迫症。股骨内侧lesions病变为180/223膝（81％），股骨外侧dy病变为39/223（17％），双con为4/223（2％）。报告的症状持续时间为10.4 +/- 8.8个月（范围0.1-38个月）。 222/223（99.6％）膝盖出现膝关节疼痛，68/223（30％）出现一种或多种机械症状（肿胀，屈服，锁定，clicking嗒）。 87/223（39％）以前曾接受非手术治疗，平均时间为2.1个月。在就诊时，有130/223（58％）的触诊触及相关的股骨dy或同侧关节线。治疗基于医生的偏爱。 121/223（54％）接受有活动限制和物理疗法的卸甲支架治疗至少3个月，而102/223（46％）接受其他（即“非卸甲”）保守治疗。在非卸载者组中，所有患者均接受了通过物理疗法进行活动受限的治疗，其中32％（33/102）的患者进行了额外的非卸载者支撑或固定。在卸荷器组中，对26/121（21％）膝的治疗包括负重限制，而在非卸荷器组中，膝的治疗为30/102（29％）。卸载者支撑与57/121（47％）膝关节的愈合有关，而非卸载者治疗导致60/102（59％）膝的愈合（p = 0.082）。在卸除器组中，在出现后平均11.0个月（范围1.9-62个月）内，对64/121（53％）个膝盖进行了手术干预，全部包括OCD钻孔，而12/121（10％）包括OCD固定。在非卸载者组中，平均术后6.6个月（范围0.2-40个月），随后对42/102（41％）膝进行了手术干预，所有这些都需要进行OCD钻孔，其中11/102包括（11） ％）OCD固定。结论：骨骼不成熟患者的非手术治疗稳定的膝盖OCD导致大约一半（52％）的病例愈合。用非手术方法治疗的患者的预后之间没有显着差异，包括卸载支架与非卸载支架或其他方式。

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