Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Kita 15, Nishi 7, Sapporo 060-8638, Japan.
J Bone Joint Surg Am. 2010 Sep;92 Suppl 1 Pt 2:208-16. doi: 10.2106/JBJS.J.00214.
Although autologous osteochondral mosaicplasty is widely used as a procedure for osteochondritis dissecans lesions, the effectiveness of this procedure in elbow lesions remains unclear. Our aim was to clarify the surgical efficacy of mosaicplasty for teenage athletes with advanced lesions of capitellar osteochondritis dissecans.
From 2001 to 2006, nineteen teenage male patients who were competitive athletes and had advanced lesions of capitellar osteochondritis dissecans underwent mosaicplasties. The mean age of the patients was 14.2 years. The surgical technique involved obtaining small-sized cylindrical osteochondral grafts with a mean diameter of 3.5 mm from the lateral periphery of the femoral condyle at the level of the patellofemoral joint and transplanting the grafts (mean, 3.3 grafts) to prepared osteochondral defects. The patients were evaluated clinically and radiographically at a mean of forty-five months after surgery.
Eighteen patients were free from elbow pain, and one had mild pain occasionally. The mean total arc of elbow motion and standard deviation increased significantly from 112° ± 17° preoperatively to 128° ± 12° postoperatively (p < 0.005). The mean clinical score described by Timmerman and Andrews (with a maximum of 200 points) improved significantly from 131 ± 23 points preoperatively to 191 ± 15 points postoperatively (p < 0.0001). All patients except one had an excellent or good clinical result. All donor knees were graded as excellent on the basis of the Lysholm knee scoring system. All patients except two returned to a competitive level of the sport they had previously played. Neither loose-body formation nor secondary osteoarthritic changes were found in any patient.
The current midterm results indicate that mosaicplasty can provide satisfactory clinical outcomes for teenage athletes with advanced capitellar osteochondritis dissecans lesions.
虽然自体马赛克软骨成形术被广泛应用于治疗剥脱性骨软骨炎病变，但该手术方法在肘部病变中的疗效尚不清楚。我们的目的是明确马赛克成形术治疗青少年运动员进展性肱骨滑车剥脱性骨软骨炎的手术疗效。
2001 年至 2006 年，19 名青少年男性运动员患有进展性肱骨滑车剥脱性骨软骨炎接受了马赛克成形术。患者的平均年龄为 14.2 岁。手术技术包括从髌股关节水平的股骨髁外侧获得平均直径为 3.5mm 的小尺寸圆柱状骨软骨移植物，并将移植物（平均 3.3 个移植物）移植到准备好的骨软骨缺损处。术后平均 45 个月时对患者进行临床和影像学评估。
18 例患者肘部无痛，1 例偶有轻度疼痛。肘部总活动度的平均值和标准差从术前的 112°±17°显著增加到术后的 128°±12°（p<0.005）。Timmerman 和 Andrews 描述的临床评分（最高 200 分）从术前的 131±23 分显著提高到术后的 191±15 分（p<0.0001）。除 1 例患者外，所有患者的临床结果均为优秀或良好。所有供膝均根据 Lysholm 膝关节评分系统评为优秀。除 2 例患者外，所有患者均恢复到之前从事的运动的竞技水平。所有患者均未发现游离体形成或继发性骨关节炎改变。
目前的中期结果表明，马赛克成形术可为患有进展性肱骨滑车剥脱性骨软骨炎的青少年运动员提供满意的临床疗效。
