Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome.
Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome.
复制标题
股骨髁不全骨折：相关的临床和形态学发现以及对结果的影响。
DOI：
10.1007/s00256-015-2234-1
复制
发表时间：
2015
影响因子：
2.1
通讯作者：
Link,ThomasM
中科院分区：
文献类型：
--
作者：
Plett,SaraK;Hackney,LaurenA;Heilmeier,Ursula;Nardo,Lorenzo;Yu,Aihong;Zhang,ChiyuanA;Link,ThomasM
目的确定股骨髁功能不全骨折（FCIF）病变的特点及其与临床进展的风险的相对关联。Materials and MethodsThis符合HIPAA的回顾性研究是由我们的机构审查委员会批准。在排除创伤后骨折、骨髓梗死、剥脱性骨软骨炎或潜在肿瘤患者后，纳入73例患者（年龄范围，19-95岁）。两名委员会认证的肌肉骨骼放射科医生对形态学检查结果进行分类，包括病变直径、相关骨髓水肿模式和相关软骨/半月板损伤。对电子病历的症状、风险因素和纵向结局进行了评价，包括全膝关节置换术（TKA）。影像学特征与临床表现相关，结果组的比较采用回归模型进行调整agains.ResultsThe大多数患者FCIF是女性（64.4%，47/73），平均10岁以上的男性（66.28 ± 15.86年与56.54 ± 10.39年，p= 0.005）。FCIF最常见的部位是股骨内侧髁的中心承重面;覆盖全层软骨缺损（75.7%，53/70）和同侧股骨损伤（94.1%，64/68）经常相关。临床结局各不相同，23.9%（11/46）需要TKA。除了就诊时膝关节活动度降低外，腕关节蠕虫评分、邻近软骨缺损和对侧踝关节损伤与TKA进展显著相关（p< 0.05）。除了在出现时膝关节活动范围的丧失之外，软骨丧失和关节损伤的程度与临床进展显著相关。
ObjectiveTo determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression.Materials and methodsThis HIPAA-compliant retrospective study was approved by our Institutional Review Board. Seventy-three patients (age range, 19–95) were included after excluding patients with post-traumatic fractures, bone marrow infarct, osteochondritis dissecans, or underlying tumor. Two board-certified musculoskeletal radiologists classified morphologic findings including lesion diameter, associated bone marrow edema pattern, and associated cartilage/meniscus damage. Electronic medical charts were evaluated for symptoms, risk factors, and longitudinal outcomes, including total knee arthroplasty (TKA). Imaging characteristics were correlated with clinical findings, and comparison of outcome groups was performed using a regression model adjusted for age.ResultsThe majority of patients with FCIF were women (64.4 %, 47/73), on average 10 years older than men (66.28 ± 15.86 years vs. 56.54 ± 10.39 years,p= 0.005). The most common location for FCIF was the central weight-bearing surface of the medial femoral condyle; overlying full thickness cartilage loss (75.7 %, 53/70) and ipsilateral meniscal injury (94.1 %, 64/68) were frequently associated. Clinical outcomes were variable, with 23.9 % (11/46) requiring TKA. Cartilage WORMS score, adjacent cartilage loss, and contralateral meniscal injury, in addition to decreased knee range of motion at presentation, were significantly associated with progression to TKA (p< 0.05).ConclusionsFCIF are frequently associated with overlying cartilage loss and ipsilateral meniscal injury. The extent of cartilage loss and meniscal damage, in addition to loss of knee range of motion at the time of presentation, are significantly associated with clinical progression.