Peterson R K, Savoie F H, Field L D
Mississippi Sports Medicine and Orthopaedic Center, Jackson, USA.
Instr Course Lect. 1999;48:393-8.
Osteochondritis dissecans of the elbow remains one of the leading causes of permanent elbow disability in adolescents and young adults engaged in throwing sports or gymnastics. The insidious onset of lateral elbow pain and restriction of full extension should alert the physician and prompt further investigation. Early recognition and appropriate treatment may allow for the prevention of long-term sequelae. Conservative care following early detection provides the best opportunity for a complete recovery. Surgical management at this point consists primarily of excision or removal of the osteochondral fragment with drilling or burring of the base of the lesion. Prognosis is fair with approximately half of all patients experiencing chronic pain or limitation of motion in the elbow. Research efforts are currently focusing on the treatment of established articular surface defects. Newer procedures such as the transplantation of osteochondral, perichondral, and periosteal tissues, chondrocyte transplantation, and the biochemical manipulation of the chondrocyte environment may provide us with exciting new approaches to an old problem. Osteochondritis dissecans of the elbow continues to present a difficult challenge to the treating physician. The current literature provides very little guidance for the clinician but active and innovative investigations into the treatment of articular cartilage defects may soon provide the answers.
肘关节剥脱性骨软骨炎仍然是从事投掷运动或体操的青少年和年轻成年人永久性肘关节残疾的主要原因之一。外侧肘部疼痛的隐匿发作和完全伸展受限应引起医生的警觉并促使进一步检查。早期识别和适当治疗可能有助于预防长期后遗症。早期发现后进行保守治疗为完全康复提供了最佳机会。此时的手术治疗主要包括切除或移除骨软骨碎片，并对病变底部进行钻孔或打磨。预后一般，约一半的患者会出现肘部慢性疼痛或活动受限。目前的研究工作主要集中在已形成的关节面缺损的治疗上。诸如骨软骨、软骨膜和骨膜组织移植、软骨细胞移植以及软骨细胞环境的生化调控等新方法，可能会为我们解决这个老问题提供令人兴奋的新途径。肘关节剥脱性骨软骨炎继续给治疗医生带来严峻挑战。目前的文献为临床医生提供的指导很少，但对关节软骨缺损治疗的积极和创新性研究可能很快会给出答案。
