量化儿童剥脱性骨软骨炎的危险因素：一项倾向性匹配的回顾性队列研究
简介
基于TriNetX数据库纳入18,493例儿童及青少年OCD患者的大规模倾向匹配队列研究发现，体操（RR=4.96）、排球（RR=2.96）及原发凝血功能障碍（如原发性血小板增多症RR=3.20、血管性血友病因子缺乏RR=2.90）显著增加OCD发病风险，膝关节为最常见部位（49%），年发病率从2017年至2024年由15/10万升至23/10万。该结果提示…
英文摘要
BACKGROUND: Osteochondritis dissecans (OCD) is a developmental orthopaedic condition in pediatric patients characterized by disruption of epiphyseal cartilage vascular supply leading to secondary subchondral bone changes and potential joint degeneration. While repetitive trauma is implicated, emerging evidence suggests a contributing role of biological and hereditary risk factors. PURPOSE: To quantify the relative risk (RR) of OCD with specific biological comorbidities and athletic participation in a large representative pediatric and adolescent population. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: We queried the TriNetX US Collaborative Network for patients aged ≤25 years between 2017 and 2024. Using International Classification of Diseases (ICD-10) diagnosis codes, we identified patients with potentially associated medical conditions (eg, hypopituitarism, vitamin D deficiency, coagulopathies, obesity, and nicotine dependence) and participation in common youth sports. The RR of OCD development for each condition and sport was calculated after propensity matching on age and sex. Annual incidence and prevalence were also assessed. RESULTS: We identified 18,493 patients with OCD (mean age at first ICD diagnosis: 13.4 ± 3.45 years; 59% male). The most common OCD location was the knee (49%). From 2017 to 2024, the annual incidence rose from 15 to 23 per 100,000. Gymnastics (RR, 4.96; [95% CI, 3.14-7.83]), volleyball (RR, 2.96 [95% CI, 1.84-4.74]), and cheerleading (RR, 2.83 [95% CI, 1.47-5.47]) were associated with the highest OCD risk among included sports. Among medical comorbidities, primary thrombophilia (RR, 3.20 [95% CI, 1.57-6.51]), von Willebrand Factor deficiency (RR, 2.90 [95% CI, 1.41-5.95]), and Factor V Leiden (RR, 2.70 [95% CI, 1.31-5.58]) carried the highest risk. Hypopituitarism (RR, 1.71 [95% CI, 1.21-2.41]) and body mass index ≥35kg/m2 (RR, 1.14 [95% CI, 1.01-1.29]) were also significantly associated. Nicotine dependence was associated with decreased risk (RR, 0.72 [95% CI, 0.57-0.91]). CONCLUSION: This large-scale analysis provides updated epidemiologic trends and quantifies risk factors associated with pediatric OCD. Age, sex, specific medical conditions, and athletic participation were linked to increased OCD risk, and novel associations between OCD and coagulopathies were identified.