Stability of Post Traumatic Osteochondritis Dissecans of the Knee: MR Imaging Findings

膝關節創傷後病人分割性骨軟骨炎之穩定性：核磁共振影像

洪猷崇(Yu-Chung Hung) ； 黃榮貴(Jon-Kway Huang)

《中華放射線醫學雜誌》 30卷4期 (2005/08) Pp. 199-204

摘要

分割性骨軟骨炎是指軟骨及其下方一小骨與母骨之分離，核磁共振影像對於膝創傷之評估已廣為熟知。為了分析年輕病人膝關節創傷後之分割性骨軟骨炎穩定性，和包括其發生率，位置，其它關連性受傷，與一般X光和臨床症狀的相關性，我們回溯性的評估膝關節創傷病人之磁振造影影像。從2002年1月到2003年10月，218個膝關節創傷病人，年齡從15到50歲，從事磁振造影檢查。在他們之中，有18個病人發現20個分割性骨軟骨炎（盛行率8.3%），其中有2個病人各有2個病變，20個分割性骨軟骨炎病人，10個為穩定分割性骨軟骨炎，10個為非穩定分割性骨軟骨炎。於10個非穩定分割性骨軟骨炎中，5個位於於後內側股骨髁，10個穩定分割性骨軟骨炎的病人，其平均年齡為29，10個非穩定分割性骨軟骨炎的病人，其平均年齡則為28。10個非穩定分割性骨軟骨炎，有5個伴隨有韌帶或半月板的受傷。而於10個穩定分割性骨軟骨炎中，則有4個伴隨有韌帶或半月板的受傷。12個病人其一般X光為正常，但在其餘的6個一般X光異常的病人中，卻有高達5個病人(90%)在磁振影像中顯示其不穩定性。大多數的病人在臨床上則以非特異性的膝關節疼痛和腫脹來表現，而非穩定和穩定性分割性骨軟骨炎的病人則有相同的比例出現有關節鎖緊和突然無力的症狀。穩定性與非穩定性分割性骨軟骨炎的病人其症狀的持續的時間分別為10個月與26個月。3個接受關節鏡與手術的病人在核磁共振影像均呈現非穩定分割性骨軟骨炎。
磁振影像能清楚分辨創傷性分割性骨軟骨炎的穩定性，與關節鏡或手術所見相同，除了呈現較長時間的症狀外，非穩定性分割性骨軟骨炎易好發於年青病人後內側股骨髁。

關鍵字

膝關節 ； 核磁共振影像 ； 分割性骨軟骨炎 ； 創傷

並列摘要

An Osteochondritis Dissecans (OCD) involves the separation of a segment of articular cartilage along with its underlying bone. MRI had been proved its value for evaluating traumatic knee. In order to evaluate the stability of OCD of traumatic knee of patients and compared to its incidence, location, associate injuries, radiographic and clinical correlation, we retrospectively evaluate the MR images of osteochondral injuries of knee of traumatic patients. From 2002 Jan to 2003 Oct, 218 patient aged from 15 to 50 years old had MR examination after a traumatic insult. Of them, 18 (8.3%) patients had 20 OCD (two patients had two lesions), of which 10 were stable and 10 were unstable. Five (50%) unstable OCD were located at posterior medial femoral condyle. The average age of patient with unstable OCD was 28, and that of stable OCD was 29. Five unstable OCD patients and 4 stable OCD patients had associate ligamental or meniscal injuries. 12 patients had negative plain films, but of those 6 radiographically positive patients there was a high incidence (90%) of unstable OCD. The symptoms and signs, most often pain and swelling, were often non-specific. Locking and ”giving way” sensations were also non-specific for stable and unstable groups. The mean duration of symptom/sign of stable and unstable OCD was 13 month and 24 month respectively. Three patients who had received arthroscopy and operation were all proved to be compatible with the MR imaging findings of unstable OCD.
MRI can clearly depict the stability of traumatic OCD with good correlation to radiographic and surgical findings. Aside from longer duration of symptom/sign, unstable OCD tends to be located at posterior medial femoral condyle of younger patients.

並列關鍵字

Knee ； MR imaging ； Osteochondritis dissecans ； Trauma