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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Retrospective Cohort Study of 207 Cases of Osteochondritis Dissecans of the Knee
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Retrospective Cohort Study of 207 Cases of Osteochondritis Dissecans of the Knee

机译：膝关节骨质骨质症患者207例回顾性队列研究

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Objectives: Describe the clinical characteristics, image findings, and outcomes of patients with juvenile osteochondritis dissecans (JOCD) of the knee. To our knowledge, this is the largest single-surgeon cohort of JOCD patients. Methods: Retrospective cohort study of knee JOCD patients assessed by a single pediatric orthopaedic surgeon at a tertiary care center between 2005-2015. All diagnoses were confirmed by magnetic resonance imaging (MRI). Patients with patellar dislocations or osteochondral fractures were excluded. Demographic data, sports played, comorbidities, surgical procedures, and clinical data were extracted from charts. Images were analyzed to identify the location and size of lesions. Chi-square or Fisher’s exact tests were used to compare discrete variables, and Mann-Whitney U and Kruskal Wallis tests to compare continuous variables between groups. P-values of <0.05 were considered significant. Results: Sample consisted of 180 patients (207 knees), 124 boys and 56 girls. Average age at diagnosis was 12.8 years (7.5-17.5). Majority were active in sports (80.8%), primary soccer (36.7%) and basketball (29.4%). JOCD was present bilaterally in 27 patients (15%), 14 knees had bifocal OCD (6.8%), and only 1 patient had bifocal lesions in both knees. Most common location was medial femoral condyle (56.3%) followed by lateral femoral condyle (23.1%), trochlea (11.4%), patella (9%), and tibia (0.5%). In the sagittal view, most common location was the middle third of the condyles (48.7%). Surgery was performed in 72 knees (34.8%), with an average age at surgery of 14.1 years (9.3-18.1). Bilateral JOCD was present in 13 surgical patients (18.8%), but only 3 patients had bilateral surgery. Two operative patients had bifocal JOCD (2.7%) and surgery on both lesions. Location distribution did not differ between surgical and non-surgical lesions. The average normalized area of non-surgical JOCD lesions was 6.8 (0.1-18), whereas surgical lesions averaged a significantly higher area of 7.7 (0.5-17) (p=0.023). Average BMI was 21.6 versus 20.2 for surgical and non-surgical patients, respectively, significantly higher for those who underwent surgery (p=0.002). Most common procedure was fixation with 1.6 mm bioabsorbable nails (54.2%), using an average of 4 nails (1-9). Only 2 cases were fixed using metallic headless screws. Other surgical treatments were drilling (13.9%), microfracture (13.9%), microfracture + fixation (6.9%), removal of loose body/chondroplasty (6.9%), and allograft transplantation (4.2%). Fixation was achieved all-arthroscopic in 43.1% of the cases, and 61.3% of the lesions that were fixed underwent curettage of the subchondral bone. Revision surgery was required in 14 knees (19.4%). The most common revision procedures were microfracture, removal of hardware, chondroplasty and allograft implantation, where some revisions had combined procedures. Most surgical patients had postoperative MRIs (55 knees), with an average radiological follow-up of 14.5 months (range 2.1-55.4). Conclusion: JOCD occurs more frequently in young adolescent athlete boys, affecting the middle third of the medial femoral condyle. In our cohort, 1/3 of the patients had surgery, where bigger lesions and higher BMI were risk factors for operative treatment. At short-term follow up, the success rate following surgery was above 80%.
机译：目的：描述膝关节的幼年骨质症患者（JOCD）患者的临床特征，图像发现和结果。据我们所知，这是最大的单外科医生队列的JOCD患者。方法：在2005 - 2015年间三级护理中心评估的膝关节官方外科医生评估的膝关节官方患者的回顾性队列研究。通过磁共振成像（MRI）确认所有诊断。排除髌骨脱位或骨细胞骨折的患者。从图表中提取了人口统计数据，体育运动，组合，手术程序和临床数据。分析图像以识别病变的位置和大小。 Chi-Square或Fisher的确切测试用于比较离散变量，以及Mann-Whitney U和Kruskal Wallis测试，以比较组之间的连续变量。 P值为<0.05被认为是显着的。结果：样品由180名患者（207名膝盖），124名男孩和56名女孩组成。诊断的平均年龄为12.8岁（7.5-17.5）。大多数人都积极参与体育（80.8％），初级足球（36.7％）和篮球（29.4％）。 JOCD在27名患者（15％）中双侧存在，14名膝关节有双焦点（6.8％），膝盖只有1例患者患有双焦点。最常见的位置是内侧股骨髁（56.3％），然后是侧向股骨髁（23.1％），Trochlea（11.4％），髌骨（9％）和胫骨（0.5％）。在矢状的视图中，大多数常见位置是髁的中三分之一（48.7％）。手术在72个膝盖（34.8％）中进行，手术平均为14.1岁（9.3-18.1）。双侧Jocd在13例外科患者（18.8％）中存在，但只有3名患者患有双侧手术。两名手术患者在两种病变上有双焦型JOCD（2.7％）和手术。外科和非手术病变之间的位置分布没有差异。非手术JOCD病变的平均归一化面积为6.8（0.1-18），而手术病变平均为7.7的显着更高（0.5-17）（p = 0.023）。对于手术和非手术患者，平均BMI为21.6与20.2患者，对于接受手术的人显着提高（P = 0.002）。最常见的方法用平均4个指甲（1-9），用1.6mm生物可吸收的指甲（54.2％）固定。使用金属无头螺钉仅固定2例。其他手术治疗钻孔（13.9％），微折衷（13.9％），微折衷+固定（6.9％），除去松散的身体/软骨成形术（6.9％），以及同种异体移植移植（4.2％）。固定在43.1％的病例中达到全关节镜，61.3％的病变是固定的骨髓神经骨的弯曲。 14个膝盖需要修改手术（19.4％）。最常见的修正程序是微折衷，消除硬件，软骨成形术和同种异体移植植入，其中一些修订具有组合程序。大多数手术患者有术后MRIS（55个膝盖），平均放射动态随访14.5个月（2.1-55.4）。结论：jocd在年轻的青少年运动员男孩中更频繁地发生，影响内侧股骨髁的中间三分之一。在我们的队列中，1/3的患者进行了手术，其中更大的病变和更高的BMI是手术治疗的危险因素。短期跟进，手术后的成功率高于80％。

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