Autologous osteochondral mosaicplasty for capitellar osteochondritis dissecans in teenaged patients
Autologous osteochondral mosaicplasty for capitellar osteochondritis dissecans in teenaged patients
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DOI：
10.1177/0363546506286343
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发表时间：
2006-08-01
影响因子：
4.8
通讯作者：
Minami, Akio
中科院分区：
文献类型：
--
作者：
Iwasaki, Norimasa;Kato, Hiroyuki;Minami, Akio
背景：自体骨软骨镶嵌成形术是一种为关节缺损提供透明修复的新技术。尽管最近的研究报道了这种手术方法成功治疗膝关节和踝关节关节缺损，但很少有人关注镶嵌成形术治疗肱骨小头剥脱性骨软骨炎的手术疗效。 目的：阐明镶嵌成形术治疗晚期小头剥脱性骨软骨炎青少年患者的临床结果。证据级别，4。方法：8 名患有晚期剥脱性小头骨软骨炎的青少年患者接受了镶嵌成形术。所有患者都是右侧受影响的棒球运动员，这也是他们投掷的一侧。手术技术包括从股骨髁外侧周获得小型圆柱形骨软骨移植物，并将其移植到准备好的骨软骨缺损处。平均随访24个月，对所有患者进行临床和影像学评估。结果：8例患者中7例无肘部疼痛，其余患者偶尔有轻微疼痛。 Timmerman 和 Andrews 描述的平均临床评分（最高 200 分）术后从 140 分显着改善至 183 分。除一名患者外，所有患者均具有优异或良好的临床结果。放射学检查显示，所有患者均发现移植物并入，软骨下皮质轮廓正常。磁共振成像显示病灶术前异质性已消失，信号强度恢复正常。 8 名患者中的 6 名（包括全部 3 名投手）重返竞技水平的棒球比赛。结论：镶嵌成形术治疗青少年棒球运动员小头剥脱性骨软骨炎晚期病变可以提供满意的临床和影像学结果。
Background: Autologous osteochondral mosaiciplasty is a new technique to provide hyaline repair for articular defects. Although recent studies have reported the successful treatment of articular defects in the knee and ankle joints with this surgical procedure, little attention has been given to the surgical efficacy of mosaicplasty in the treatment of osteochondritis dissecans of the humeral capitellum.Purpose: To clarify the clinical outcomes of mosaiciplasty for teenaged patients with advanced lesions of capitellar osteochondritis dissecans.Study Design: Case series; Level of evidence, 4.Methods: Eight teenaged patients with advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. All patients were baseball players who were affected on the right side, which was also their throwing side. The surgical technique involves obtaining small-sized cylindrical osteochondral grafts from the lateral periphery of the femoral condyles and transplanting them to prepared osteochondral defects. At a mean follow-up of 24 months, all patients were evaluated clinically and radiographically.Results: Seven of the 8 patients were free from elbow pain, and the remaining patient had mild pain occasionally. The mean clinical score described by Timmerman and Andrews (a maximum of 200 points) significantly improved from 140 points to 183 points postoperatively. All patients except one had excellent or good clinical results. Radiographically, the graft incorporation and a normal contour of the subchondral cortex were found in all patients. Magnetic resonance imaging showed that the preoperative heterogeneity of the lesion had disappeared and the signal intensity returned to normal. Six of the 8 patients, including all 3 pitchers, returned to competitive-level baseball.Conclusion: Mosaicplasty for advanced lesions of capitellar osteochondritis dissecans in teenaged baseball players can provide satisfactory clinical and radiographic results.