髌骨剥脱性骨软骨炎的MRI表现

目的探讨髌骨剥脱性骨软骨炎的MRI表现。方法回顾性分析经临床或手术确诊的18例髌骨剥脱性骨软骨炎的MRI资料,其中5例行关节镜手术,将手术结果与MRI资料对照分析。结果 18例中,病灶均位于髌骨关节面中下部,大小约11×11×7mm,其中软骨下骨质缺损区16例,软骨下囊变4例,反应性骨髓水肿8例,骨质缺损区上面覆盖的关节软骨异常14例,关节内游离体2例,合并股骨髁发育不良者7例,髌骨高位者8例,滑膜炎者4例。在5例行关节镜手术的病例中,MRI所显示的软骨异常均为手术结果所证实。结论髌骨剥脱性骨软骨炎的主要MRI表现是:髌骨关节面中下部软骨下骨质缺损区及其表面覆盖的软骨信号异常。     

瘤源性低磷软骨病临床误诊分析

<正>瘤源性低磷软骨病是由于新形成的骨基质不能以正常的方式进行矿化的一种罕见的代谢性骨病。目前缺乏统一命名,有称肿瘤性低磷血软骨病、肿瘤相关性软骨病、肿瘤相关性低磷抗D骨软化症、瘤源性骨质软化症等。病因有多种,其中有一型是由于肿瘤所致,这种肿瘤分泌一些体液因子导致肾小管回吸收磷障碍而发病。患者的主要临床表现为进行性肌无     

膝剥脱性骨软骨炎关节镜下特征及镜下软骨修整和移植术

目的探讨关节镜诊断和治疗膝关节剥脱性骨软骨炎（OCD）的方法和疗效。方法42例膝股骨负重面软骨剥脱患者,关节镜下行自体骨软骨移植4例,行钻孔术12例,行清理术26例。结果42例患者术后均随访8～48个月,术前Lysholm评分平均为45.2分（36～58分）,术后平均为81.2分（52～99分）,总优良率83.3%。结论膝关节剥脱性骨软骨炎的治疗应根据患者不同年龄,软骨缺损范围,关节镜下选择不同的术式,可取得较满意疗效。     

Surgical management of osteochondritis dissecans of the knee

Osteochondritis dissecans of the knee primarily affects subchondral bone, with a secondary effect on the overlying articular cartilage. This process can lead to pain, effusions, and loose body formation. While stable juvenile lesions often respond well to nonoperative management, unstable juvenile lesions, as well as symptomatic adult lesions, often require operative intervention. Short-term goals focus on symptomatic relief, while long-term expectations include the hope of preventing early-onset arthritis. Surgical options include debridement, loose body removal, microfracture, arthroscopic reduction and internal fixation, subchondral drilling, osteochondral autograft or allograft transplantation, and autologous chondrocyte implantation. Newer single-stage cell-based procedures have also been developed, utilizing mesenchymal stem cells and matrix augmentation. Proper treatment requires evaluation of both lesional (size, depth, stability) and patient (age, athletic level) characteristics.     

Osteochondritis dissecans after rotational acetabular osteotomy for dysplastic hip

We encountered a rare case of osteochondritis dissecans of the femoral head after rotational acetabular osteotomy that recovered with conservative treatment 4 years after the detection of characteristic radiological findings.     

Radiography of the elbow for evaluation of patients with osteochondritis dissecans of the capitellum

Objective This study was performed to determine the ability of a routine radiographic examination of the elbow to detect osteochondritis dissecans of the capitellum and associated intra-articular loose bodies.Design and patients The study group consisted of 15 patients with osteochondritis dissecans of the capitellum confirmed by surgery or magnetic resonance imaging. Seven of the 15 patients had associated intra-articular loose bodies confirmed by surgery. All 15 patients had anteroposterior and lateral radiographs and magnetic resonance imaging of their symptomatic elbow. Nine of the 15 patients had subsequent elbow surgery. We reviewed the original interpretations of the radiographic examinations of the elbow of all 15 patients to determine whether osteochondritis dissecans of the capitellum and associated intra-articular loose bodies had been identified prospectively. We also reviewed the elbow radiographs of all 15 patients to determine whether osteochondritis dissecans of the capitellum and associated intra-articular loose bodies could be identified retrospectively.Results Osteochondritis dissecans of the capitellum was detected during the initial interpretations of the radiographic examinations of the elbow in seven of 15 patients. Osteochondritis dissecans of the capitellum was detected during retrospective review of the elbow radiographs in 10 of 15 patients. Intra-articular loose bodies were detected during the initial interpretations of the radiographic examinations of the elbow in three of seven patients. Intra-articular loose bodies were detected during retrospective review of the elbow radiographs in four of seven patients.Conclusions A routine radiographic examination of the elbow has limited sensitivity for detecting osteochondritis dissecans of the capitellum and associated intra-articular loose bodies.     

Osteochondritis dissecans in association with legg-calve-perthes disease

Summary In a study including about 450 children with Legg-Calve-Perthes disease nine patients were noted to have osteochondritis dissecans as a late complication. The average age at onset of the Legg-Calve-Perthes disease in the eight where this information was known was 8.4 years with three in the five to seven year range and five in the seven to twelve year range. Eight of the children were males and three of them had bilateral Legg-Calve-Perthes disease one of which also had bilateral osteochondritis dissecans. A variety of treatment was used in this group. Six were treated with some form of weight relieving programme for an average of 25 months and two were treated with proximal femoral osteotomy and early weight bearing.Osteochondritis dissecans should refer to the persistent articular surface defect remaining after primary healing of the Legg-Calve-Perthes disease since similar deficiencies often occur during early epiphyseal reconstitution but are temporary. Gossling has indicated the need for clarification of this temporal relationship by stating that osteochondritis dissecans is a permanent sequela.Osteochondritis dissecans is a rare complication of Legg-Calve-Perthes disease when it is an incidental finding in the course of investigation of adult hip disability. It is less rare when there is long term routine follow up of treated patients with Legg-Calve-Perthes disease with the obvious inference that the problem is not routinely disabling for long periods. Finally, it is to be noted that there is a different mechanism for the formation of osteochondritis dissecans after Legg-Calve-Perthes disease than other more common situations.

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Résumé Sur 450 enfants atteints de maladie de Legg-Perthes-Calvé, neuf ont présenté une ostéochondrite disséquante à titre de complication tardive. L'âge moyen au début de la maladie, chez les huit enfants pour qui ces informations sont connues, est de 8,4 ans, (dont trois entre 5 et 7 ans et cinq entre 7 et 12 ans). Huit sont des garçons et trois d'entre eux ont présenté une maladie de Legg-Perthes-Calvé bilatérale; parmi ces derniers, un fut également atteint d'une ostéochondrite disséquante bilatérale. Divers traitements avaient été utilisés dans ce groupe: six malades avaient été traités par mise en décharge, d'une manière quelconque, et durant 25 mois en moyenne; deux avaient subi une ostéotomie de l'extrémité supérieure du fémur, avec reprise précoce de l'appui.Le terme d'ostéochondrite disséquante devrait être réservé aux pertes de substance de la surface articulaire persistant après la guérison de la maladie de Legg-Perthes-Calvé, puisque de telles lésions surviennent souvent au début de la reconstitution épiphysaire, mais ne sont que transitoires. Gossling a insisté sur la nécessité de préciser cette relation évolutive, en disant que l'ostéochondrite disséquante constitue une «séquelle permanente».L'ostéochondrite disséquante est une complication «rare» de la maladie de Legg-Perthes-Calvé lorsqu'elle représente une découverte fortuite au cours du bilan d'une affection de la hanche chez l'adulte. Elle est moins «rare» lors de la surveillance systématique à long terme des sujets traités pour une maladie de Legg-Perthes-Calvé, en sachant qu'elle est habituellement parfaitement tolérée pendant de longues années. Enfin, il faut noter que le mécanisme de formation de l'ostéochondrite disséquante secondaire à la maladie de Legg-Perthes-Calvé diffère de ceux qui sont en cause dans des circonstances plus habituelles.

     

Reassessment of the MR criteria for stability of osteochondritis dissecans in the knee and ankle

 Objective. T2-weighted MR images has been reported to be an accurate method for assessing osteochondritis dissecans. We reviewed our MR experience to confirm the accuracy of the published criteria of instability. We also assessed the value of each of four MR signs of instability. Design. We reviewed the original MR interpretations, arthroscopic reports, and MR examinations of 40 patients with osteochondritis dissecans of the talar dome or femoral condyles. Arthroscopy was used as the gold standard for stability. The MR examinations were reviewed retrospectively for a high-signal-intensity line or cystic area beneath the lesion, a high-signal-intensity line through the articular cartilage, or a focal articular defect. Patients. All patients who had undergone MR imaging for osteochondritis dissecans from 1990 to 1993 were reviewed. Forty patients were identified who had arthroscopy after the MR examination. There were 30 male and 10 female patients with an average age of 25.7 years. Thirty-one lesions were in a femoral condyle and nine were in the talar dome. Results and conclusions. The original MR interpretations correctly identified 35 of the 36 unstable lesions and all 4 stable lesions, giving a sensitivity of 0.97 and specificity of 1.0. There was a 98% agreement between the original and retrospective diagnoses. A high-signal-intensity line was seen beneath 72% of the 36 unstable lesions. The other three signs were noted in 22–31% of the unstable lesions. Fifty-six percent of the unstable lesions showed only one sign of instability. MR imaging is a highly sensitive method for detection of unstable osteochondritis dissecans. The presence of any one sign indicates instability, the most frequent sign being an underlying high-signal-intensity line. Because we examined only four stable lesions, our 95% confidence interval of 0.40–1.0 for a specificity of 1.0 gives only a limited estimate of the specificity of MR.     

Internal fixation for osteochondritis dissecans of the knee

Eight knees of seven patients with osteochondritis dissecans of the knee underwent internal fixation of the fragments. The affected location was the medial femoral condyle in four knees, the lateral femoral condyle in one knee and the patellar groove in three knees. At the time of surgery, patient age ranged from 13 to 20 years (mean 16.9 years). Open reduction and internal fixation of the unstable fragments was performed with autologous bone pegs in one knee. In the other seven knees, the procedures were carried out with biodegradable poly-L-lactide pins. At a mean follow-up of 5 years (range 4–6.8 years), seven fragments were united, whereas one knee required arthroscopic removal of the loose fragment. Neither effusion nor synovitis was noticed in any of the patients treated with biodegradable pins. The technique is simple and provides satisfactory results, suggesting a valid option for the treatment of osteochondral defects where possible.