Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
Clin Orthop Relat Res. 2013 Apr;471(4):1137-43. doi: 10.1007/s11999-012-2462-9.
The stability of an osteochondritis dissecans (OCD) lesion of the humeral capitellum may be determined by intraoperative probing with unstable lesions being displaceable. Although preoperative imaging is used to diagnose and determine treatment of these lesions, it is unclear whether unstable lesions on imaging correspond to those found intraoperatively.
QUESTIONS/PURPOSES: We therefore examined the concordance between preoperative imaging and intraoperative instability and examined the imaging features of the patients who healed without surgery.
We retrospectively reviewed 61 patients who underwent OCD of the humeral capitellum surgery or nonoperative treatment. All patients had plain radiography, MRI, and/or CT scans. The presence or absence of stability was determined intraoperatively by the International Cartilage Repair Society OCD classification. We determined the sensitivity, specificity, and predictive value of various imaging findings to predict instability.
The following preoperative imaging features were associated with intraoperative instability: a displaced fragment, epiphyseal closure of the capitellum, or a lateral epicondyle observed on radiographs; irregular contours of the articular surface or a high signal interface on T2-weighted MRI; and a displaced fragment observed on CT. Unstable lesions were more common when the epiphysis of the capitellum was closed. Intralesional segmentation was sensitive for detecting an unstable lesion, whereas displaced type on the radiographs and displaced fragment on the CT were specific. The following imaging findings were not seen in nonoperative patients: displaced type and closure of the epiphyseal line on radiographs, irregular contours of the articular surface, articular defects, and T2 high signal intensity interface between the fragments and their bed on the MRI or a displaced fragment on the CT.
Although we found high sensitivity for some preoperative findings on imaging, none reached 100% of sensitivity. Preoperative MRI related to the intraoperative assessment of stability.
Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
肱骨头骨骺骨软骨炎（OCD）病变的稳定性可以通过术中探查来确定，不稳定的病变可移位。尽管术前影像学用于诊断和确定这些病变的治疗，但尚不清楚影像学上的不稳定病变是否与术中发现的病变相对应。
问题/目的：因此，我们检查了术前影像学与术中不稳定性之间的一致性，并检查了未经手术愈合的患者的影像学特征。
我们回顾性分析了 61 例肱骨头骨骺骨软骨炎手术或非手术治疗的患者。所有患者均行 X 线平片、MRI 和/或 CT 扫描。术中采用国际软骨修复学会 OCD 分类法确定稳定性的存在或不存在。我们确定了各种影像学表现预测不稳定的敏感性、特异性和预测值。
以下术前影像学特征与术中不稳定有关：X 线片上观察到的移位碎片、骨骺闭合、或外侧髁；T2 加权 MRI 上关节表面不规则轮廓或高信号界面；CT 上观察到的移位碎片。当骨骺闭合时，不稳定的病变更常见。病灶内分段对检测不稳定病变具有较高的敏感性，而 X 线片上的移位类型和 CT 上的移位碎片具有较高的特异性。非手术患者未见以下影像学表现：X 线片上的移位类型和骨骺线闭合、关节表面不规则轮廓、关节缺损、碎片与其床之间的 T2 高信号强度界面以及 CT 上的移位碎片。
虽然我们发现一些术前影像学表现具有较高的敏感性，但没有一项达到 100%的敏感性。术前 MRI 与术中稳定性评估相关。
III 级，诊断研究。欲了解完整的证据水平描述，请参见作者指南。
