Nobuta Shingo, Ogawa Kazuhiro, Sato Katsumi, Nakagawa Tomowaki, Hatori Masahito, Itoi Eiji
Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai, Miyagi 981-8563, Japan.
Ups J Med Sci. 2008;113(2):201-8. doi: 10.3109/2000-1967-232.
The choice of surgical or non-surgical treatments for osteochondritis dissecans (OCD) of the humeral capitellum is still controversial. The purpose of this study was to assess the efficacy of fragment fixation for OCD of the humeral capitellum.
We reviewed 28 patients with OCD of the humeral capitellum after a mean follow up of 17 months. All patients were men and mean age was 14 years. Twenty-seven patients had a history of repetitive overuse of the elbow with baseball pitching, one with tennis. Mean duration of overuse of the elbow was four years. All patients had elbow pain and difficulty in throwing, with a mean duration of symptoms for 17 months. The mean arc of flexion before surgery ranged from 11 degrees to 126 degrees. Radiographs of the elbow showed a radiolucent cystic area of the humeral capitellum in one patient, a non-displaced split type fragment in 12 patients, and a slightly displaced split type fragment in 15 patients. Fragment fixation surgery was performed in all patients by lateral arthrotomy including drilling and fixation of the fragment with a double wiring technique using flexible wire or thread under direct vision. Sport activities using upper extremities were restricted for four to six months until the lesion healed in radiograph.
Post-operatively, 25 patients had no pain and three decreased pain. Average arc of flexion was one to 132 degrees, an improvement of 16 degrees compared with the pre-operative arc. Radiographic findings showed complete healing of the lesion in 11 patients, partial healing in 12, unchanged in three, and loose body formation in two. By Tivnon's evaluation of the elbow function, results were excellent in 19 patients, good in five, fair in two, and poor in two. The ratio of complete or partial healing of the lesion was 100 percent in 16 patients in whom the thickness of the lesion was less than 9 mm on pre-operative radiograph, and 58 percent in 12 patients in whom the lesion thickness was 9 mm or more, which showed a significant difference (p<0.01).
Fragment fixation for OCD of the humeral capitellum was effective in patients whose lesion thickness was less than 9 mm. Fixation by flexible wire or thread and revascularization by drilling for the fragment were considered to be insufficient for large lesions with a thickness of 9 mm or more.
肱骨小头剥脱性骨软骨炎（OCD）的手术或非手术治疗选择仍存在争议。本研究的目的是评估肱骨小头OCD的碎片固定疗效。
我们回顾了28例肱骨小头OCD患者，平均随访17个月。所有患者均为男性，平均年龄14岁。27例患者有棒球投球导致肘部反复过度使用的病史，1例有网球运动史。肘部过度使用的平均持续时间为4年。所有患者均有肘部疼痛和投掷困难，症状平均持续17个月。术前屈曲平均弧度为11度至126度。肘部X线片显示，1例患者肱骨小头有透亮囊性区域，12例患者有未移位的劈裂型碎片，15例患者有轻度移位的劈裂型碎片。所有患者均通过外侧关节切开术进行碎片固定手术，包括在直视下使用柔性钢丝或丝线采用双钢丝技术钻孔并固定碎片。上肢的体育活动限制4至6个月，直到X线片显示病变愈合。
术后，25例患者无疼痛，3例疼痛减轻。平均屈曲弧度为1度至132度，比术前弧度改善了16度。X线检查结果显示，11例患者病变完全愈合，12例部分愈合，3例无变化，2例有游离体形成。根据Tivnon对肘部功能的评估，19例患者结果为优，5例为良，2例为可，2例为差。术前X线片显示病变厚度小于9mm的16例患者中，病变完全或部分愈合的比例为100%，病变厚度为9mm或以上的12例患者中，这一比例为58%，差异有统计学意义（p<0.01）。
肱骨小头OCD的碎片固定对病变厚度小于9mm的患者有效。对于厚度为9mm或以上的大病变，采用柔性钢丝或丝线固定以及对碎片钻孔进行血运重建被认为是不够的。
