Ahmad Christopher S, Vitale Mark A, ElAttrache Neil S
Department of Orthopaedic Surgery, Columbia University, New York, NY, USA.
Instr Course Lect. 2011;60:181-90.
The combination of excessive radiocapitellar compressive forces and the limited vascularity of the capitellum are responsible for the development of osteochondritis dissecans. Repetitive compressive forces are generated by throwing or racket swinging motions or from constant axial compressive loads on the elbow, which are common in athletes such as gymnasts. Symptoms include activity-associated pain and stiffness. Physical examination findings show tenderness over the radiocapitellar joint and, commonly, loss of extension. Plain radiographs may show flattening and sclerosis of the capitellum, lucencies, and possibly intra-articular loose bodies. MRI can detect bone edema early in the disease process and further delineate the extent of the injury. The management of osteochondritis dissecans lesions is primarily based on the demands of the patient, the size and location of the lesion, and the status and stability of the overlying cartilage. Possible treatments include transarticular drilling; removing detached fragments or loose bodies, followed by drilling; and mosaicplasty. Radiocapitellar plica can cause chondromalacic changes on the radial head and capitellum, with symptoms including painful clicking and effusions. Arthroscopic plica resection is indicated when nonsurgical treatment fails.
桡骨头与肱骨小头间过度的压缩力以及肱骨小头有限的血供共同导致了剥脱性骨软骨炎的发生。重复性压缩力由投掷或挥拍动作产生，或由肘部持续的轴向压缩负荷引起，这在体操运动员等运动员中很常见。症状包括与活动相关的疼痛和僵硬。体格检查发现桡骨头与肱骨小头关节处有压痛，通常还有伸展受限。X线平片可能显示肱骨小头扁平、硬化、透亮区，以及可能存在的关节内游离体。MRI能够在疾病早期检测到骨水肿，并进一步明确损伤范围。剥脱性骨软骨炎病变的治疗主要依据患者的需求、病变的大小和位置以及上方软骨的状态和稳定性。可能的治疗方法包括经关节钻孔；切除分离的碎片或游离体，随后进行钻孔；以及镶嵌成形术。桡骨头与肱骨小头皱襞可导致桡骨头和肱骨小头的软骨软化改变，症状包括疼痛性弹响和积液。非手术治疗失败时，需进行关节镜下皱襞切除术。
