Kosaka Masahiro, Nakase Junsuke, Takahashi Ryohei, Toratani Tatsuhiro, Ohashi Yoshinori, Kitaoka Katsuhiko, Tsuchiya Hiroyuki
*Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University †Department of Orthopaedic Surgery, Kijima Hospital, Kanazawa, Japan.
J Pediatr Orthop. 2013 Oct-Nov;33(7):719-24. doi: 10.1097/BPO.0b013e3182924662.
Osteochondritis dissecans (OCD) of the capitellum is an intra-articular lesion and one of the leading causes of permanent elbow disability. The treatment of advanced capitellar OCD remains challenging because of the limited potential of the articular cartilage for self-repair. The purpose of this study was to investigate the outcome of surgical treatment for OCD of the capitellum.
From 2000 to 2010, 32 male patients who had advanced lesions of capitellar OCD were treated operatively. The mean age of the patients was 14.4 years at the time of surgery. Twenty-nine patients played baseball and 3 played other sports. The lesions were of the centralized type in 9 patients, the lateral type in 4 patients, and the widespread type in 19 patients. For the surgical procedure, osteochondral peg fixation was selected for 13 patients and osteochondral autograft transplantation for 19 patients. Clinical outcome was measured with the elbow rating system including range of motion, and the number of patients who returned to active sports participation within 1 year after surgery was determined.
The mean total arc of elbow motion increased from 123±17 degrees preoperatively to 132±14 degrees postoperatively. The mean clinical score improved significantly from 133±24 to 177±27. Within the first year after surgery, 81.3% of the patients returned to active sports playing. However, 4 of 8 patients (50%) in which osteochondral peg fixation was performed for lesions of the lateral widespread type required reoperation.
Our results indicate that osteochondral peg fixation and osteochondral autograft transplantation may improve elbow rating score, and may facilitate a return to active sports participation. However, osteochondral peg fixation may be insufficient for lesions of the widespread type because of their poor stability. The large lateral condyle lesions had a worse outcome, and future studies will need to develop improved treatment for these defects.
Level IV (case series).
肱骨小头剥脱性骨软骨炎（OCD）是一种关节内病变，是导致永久性肘关节功能障碍的主要原因之一。由于关节软骨自我修复的潜力有限，晚期肱骨小头OCD的治疗仍然具有挑战性。本研究的目的是调查肱骨小头OCD手术治疗的结果。
2000年至2010年，对32例患有晚期肱骨小头OCD病变的男性患者进行了手术治疗。患者手术时的平均年龄为14.4岁。29例患者从事棒球运动，3例从事其他运动。9例患者的病变为中央型，4例为外侧型，19例为广泛型。手术方式上，13例患者选择了骨软骨栓固定，19例患者选择了骨软骨自体移植。采用包括活动范围在内的肘关节评分系统评估临床结果，并确定术后1年内恢复积极体育活动的患者数量。
肘关节活动的平均总弧度从术前的123±17度增加到术后的132±14度。平均临床评分从133±24显著提高到177±27。术后第一年内，81.3%的患者恢复了积极的体育活动。然而，在8例因外侧广泛型病变接受骨软骨栓固定的患者中（50%），有4例需要再次手术。
我们的结果表明骨软骨栓固定和骨软骨自体移植可能会提高肘关节评分，并有助于恢复积极的体育活动。然而，由于稳定性差，骨软骨栓固定对于广泛型病变可能不足。外侧髁大的病变预后较差，未来的研究需要开发针对这些缺损更好的治疗方法。
IV级（病例系列）。
