Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum
Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum
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DOI：
10.2106/jbjs.f.00622
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发表时间：
2007-06-01
影响因子：
5.3
通讯作者：
Ogino, Toshihiko
中科院分区：
文献类型：
--
作者：
Takahara, Masatoshi;Mura, Nariyuki;Ogino, Toshihiko
背景：肱骨小头剥脱性骨软骨炎的治疗指征尚不清楚。本研究的目的是分析的结果，并确定最有用的分类选择treatment.Methods：106例剥脱性肱骨小头骨软骨炎的病例进行了回顾性研究。初次就诊时，患者的平均年龄为15.3岁。肱骨小头生长板开放18例，闭合88例。36例患者接受了非手术治疗。55例患者单独进行了骨折块取出，12例患者采用骨移植物进行了骨折块固定，3例患者采用股骨外侧髁骨软骨栓移植物进行了关节面重建。平均随访时间为7.2年。结果在手肘疼痛，恢复运动，影像学检查结果进行了分析和compared.Results：剥脱性骨软骨炎病变与开放的肱骨小头骨骺板和肘关节活动范围良好，导致了良好的结果。持续的肘关节应力导致疼痛和影像学检查结果最差。对于肱骨小头骨骺板闭合的患者，手术治疗效果明显优于肘关节休息（p < 0.01）。骨折块固定或重建的结果明显好于单纯骨折块取出（p < 0.05）。单独切除的结果取决于肱骨小头缺损的大小。在疼痛方面的结果是密切相关的体育活动和影像学findings.Conclusions：我们认为，剥脱性肱骨小头骨软骨炎可以分为稳定或不稳定。肘部休息后完全愈合的稳定病变在最初表现时具有以下所有结果：开放的肱骨小头生长板，软骨下骨的局部扁平或射线可透性，以及良好的肘部运动。不稳定病变，手术提供了明显更好的结果，有以下结果之一：肱骨小头伴生长板闭合，骨折，或肘关节活动受限>= 20度。对于较大的不稳定病变，碎片固定或关节面重建比简单切除效果更好。证据等级：预后II级。证据等级的完整描述见作者说明。
Background: Indications for the treatment of osteochondritis dissecans of the humeral capitellum have remained unclear. The aims of this study were to analyze the outcomes and to determine the most useful classification for the choice of treatment.Methods: The cases of 106 patients with osteochondritis dissecans of the capitellum were studied retrospectively. At the time of the initial presentation, the mean age of the patients was 15.3 years. The capitellar growth plate was open in eighteen patients and closed in eighty-eight. Thirty-six patients were treated nonoperatively. Fifty-five patients underwent fragment removal alone, twelve underwent fragment fixation with a bone graft, and three underwent reconstruction of the articular surface with use of osteochondral plug grafts from the lateral femoral condyle. The mean follow-up period was 7.2 years. The outcomes in terms of pain in the elbow, return to sports, and radiographic findings were analyzed and compared.Results: An osteochondritis dissecans lesion with an open capitellar physis and a good range of elbow motion resulted in a good outcome. Continued elbow stress resulted in the worst outcome in terms of pain and radiographic findings. In patients with a closed capitellar physis, surgery provided significantly better results than elbow rest (p < 0.01). Fragment fixation or reconstruction provided significantly better results than fragment removal alone (p < 0.05). The results of removal alone were dependent on the size of the defect in the capitellum. The outcome in terms of pain was closely associated with sports activity and radiographic findings.Conclusions: We believe that osteochondritis dissecans of the capitellum can be classified as stable or unstable. Stable lesions that healed completely with elbow rest had all of the following findings at the time of the initial presentation: an open capitellar growth plate, localized flattening or radiolucency of the subchondral bone, and good elbow motion. Unstable lesions, for which surgery provided significantly better results, had one of the following findings: a capitellum with a closed growth plate, fragmentation, or restriction of elbow motion of >= 20 degrees. For large unstable lesions, fragment fixation or reconstruction of the articular surface leads to better results than simple excision.Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.