儿童与青少年膝关节剥脱性骨软骨炎的治疗与预后
简介
膝关节剥脱性骨软骨炎（OCD）在儿童及青少年患者中处理复杂，治疗高度依赖病变特征（大小、稳定性、碎裂程度）。本文综述了该病的当前认识、治疗选择及预后。关键发现：治疗路径首先由病变稳定性决定，稳定病变（尤其骨骼未成熟者）应先行3-6个月非手术治疗，包括最初4-6周免负重及至少3个月避免高冲击或重复应力；非手术治疗失败者可行经关节或逆行钻孔促进愈合。不稳定病变可…
英文摘要
PURPOSE OF REVIEW: Osteochondritis dissecans (OCD) of the knee is a complex condition in pediatric and adolescent patients, and management relies heavily on lesion characteristics including size, stability, and fragmentation. The purpose of this review is to inform readers of the current understanding, treatment options, and outcomes of the disorder in pediatric and adolescent patients. RECENT FINDINGS: While management of OCD of the knee is tailored highly to patient- and lesion-specific factors, broad management pathways are dictated first by lesion stability, and further by salvageability of unstable lesions. Lesion appearance on MRI and arthroscopy are critical in informing appropriate management. Stable lesions, especially in skeletally immature patients, should undergo 3-6 months of nonoperative management, with an initial 4-6 week period of nonweightbearing and avoidance of high impact or repetitive stress for a minimum of 3 months. Patients with stable lesions who fail nonoperative treatment are candidates for retro- or trans-articular drilling of the lesion to promote healing. Unstable lesions may be amenable to salvage approaches including arthroscopic or open fixation with metallic screws, bioabsorbable implants, autograft, and suture bridge constructs. When not salvageable, osteochondral autograft transfer, osteochondral allograft transplantation, or autologous chondrocyte implantation is recommended and pursued depending on lesion size and subchondral involvement. All techniques have good potential for success in healing, patient reported outcomes, and return to activity when applied in the appropriate circumstances. Significant heterogeneity exists in management and outcomes of OCD of the knee, largely attributed to the varying presentation and treatment modalities. Management pathway should be patient-specific, however there is a paucity of robust comparative trials within specific populations.