The Cleveland Clinic Foundation, Cleveland, Ohio, USA.
The Cleveland Clinic Foundation, Cleveland, Ohio, USA. ; Cleveland Clinic Sports Health Center, Garfield Heights, Ohio, USA.
Orthop J Sports Med. 2014 Apr 22;2(4):2325967114530840. doi: 10.1177/2325967114530840. eCollection 2014 Apr.
There is a paucity of information regarding the effect of lesion location on surgical outcomes in the treatment of osteochondritis dissecans (OCD) of the humeral capitellum.
To survey the literature for conclusions that can be drawn regarding the effect of lesion location on treatment of capitellar OCD lesion. The hypothesis was that lesion severity and the need for more aggressive surgical interventions are increased for lesions that are located laterally on the capitellum.
Systematic review; Level of evidence, 4.
All studies from the past 20 years were determined using a literature search of PubMed, Scopus, and Cochrane databases. Included studies were clinical studies that specifically commented on the location of the OCD defect on the capitellum. Excluded studies were case reports, review articles, and those that did not include information regarding the location of the OCD lesion on the capitellum.
Six studies met the inclusion criteria. Autograft reconstruction was found to yield reliable outcomes regardless of lesion location, as 87% (26/30) of lateral lesions had excellent or good outcomes using the Timmerman and Andrews score, while 91% (21/23) of central lesions had excellent or good outcomes. There was a trend toward improved outcomes with more aggressive surgical management of lateral lesions, specifically those involving the lateral cartilage margin. The failure rate for nonreconstructive operative management for lateral lesions was noted to be significant, as failure rates for peg fixation of lateral lesions was seen to be as high as 44% (4/9) in one of the studies.
Studies regarding capitellar OCD lesion location, as it relates to symptom severity and surgical outcome, are limited. The literature suggests that lesions located on the lateral capitellum-particularly those involving the lateral cartilage margin-require more aggressive surgical management than those located medially. A refinement of the Takahara classification is proposed, which includes lesion location as a factor influencing surgical decision making.
关于肱骨小头剥脱性骨软骨炎（OCD）病变位置对手术结果的影响，相关信息十分有限。
通过文献调查，总结病变位置对治疗肱骨小头 OCD 病变的影响。假设是，病变的严重程度和需要更积极的手术干预的程度会随着病变位于肱骨小头外侧而增加。
系统评价；证据水平，4 级。
通过对 PubMed、Scopus 和 Cochrane 数据库的文献检索，确定了过去 20 年的所有研究。纳入的研究是专门对肱骨小头 OCD 缺损位置进行评论的临床研究。排除了病例报告、综述文章以及未包含肱骨小头 OCD 病变位置信息的研究。
符合纳入标准的研究有 6 项。自体骨重建的结果是可靠的，与病变位置无关，使用 Timmerman 和 Andrews 评分，30 例外侧病变中有 87%（26/30）结果为优或良，23 例中央病变中有 91%（21/23）结果为优或良。对于外侧病变，采用更积极的手术治疗方法（特别是涉及外侧软骨缘的病变），其结果有改善的趋势。非重建性手术治疗外侧病变的失败率是显著的，在一项研究中，外侧病变的钉固定失败率高达 44%（4/9）。
关于肱骨小头 OCD 病变位置与症状严重程度和手术结果的关系的研究有限。文献表明，位于肱骨小头外侧的病变——特别是涉及外侧软骨缘的病变——需要比位于内侧的病变更积极的手术治疗。提出了一种 Takahara 分类的改进方法，其中包括病变位置作为影响手术决策的因素。
