Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Orthopedic Surgery, Keiyu Orthopaedic Hospital, Tatebayashi, Japan.
J Shoulder Elbow Surg. 2018 May;27(5):923-930. doi: 10.1016/j.jse.2017.12.023. Epub 2018 Feb 21.
Predictive factors for the development of osteoarthritis in adolescent osteochondritis dissecans (OCD) of the humeral capitellum remain unclear. The objectives of this study were to assess subchondral bone density in the radial head fovea of patients with OCD and to evaluate stress distribution in the radiocapitellar joint. The relationship between radiologic classification and stress distribution, according to multivariate ordinal regression analysis, was also investigated.
Computed tomography (CT) imaging data from 54 male patients with OCD (mean age, 13.1 years) were collected. Stress in the radial head fovea was measured using CT osteoabsorptiometry. A stress map was constructed and divided into 4 sections, and percentages of high-density regions in each section were quantitatively analyzed. Multivariate ordinal regression analyses were performed of bone density, incorporating the stage, location, and size of the OCD lesion and the presence of medial elbow disturbance in the radiographic images.
The percentage of high-density area in the anteromedial, posteromedial, and the anterolateral sections of the radial head fovea were significantly increased compared with the posterolateral section. Multivariate ordinal regression analysis revealed that the location and size of the lesion and a history of excessive valgus stress were associated with imbalances in the radial head fovea.
When the OCD lesion is large and located laterally and a medial epicondyle disturbance is apparent on radiographs, the risk for developing advanced radiocapitellar osteoarthritis should be considered. These findings can be useful in the decision-making process for treating OCD.
青少年肱骨滑车骺骨软骨病（OCD）发展为骨关节炎的预测因素尚不清楚。本研究的目的是评估 OCD 患者桡骨头窝的软骨下骨密度，并评估桡尺骨关节的应力分布。还通过多变量有序回归分析研究了影像学分类与应力分布之间的关系。
收集了 54 名男性 OCD 患者的计算机断层扫描（CT）成像数据（平均年龄 13.1 岁）。使用 CT 骨吸收测量法测量桡骨头窝的应力。构建了一个应力图，并将其分为 4 个部分，对每个部分的高密度区域的百分比进行定量分析。对骨密度进行多变量有序回归分析，纳入影像学图像中的 OCD 病变的阶段、位置和大小以及内侧肘部干扰的存在。
与后外侧部分相比，桡骨头窝的前内侧、后内侧和前外侧部分的高密度区域百分比显著增加。多变量有序回归分析显示，病变的位置和大小以及过度外翻应力的病史与桡骨头窝的不平衡有关。
当 OCD 病变较大且位于外侧并且影像学上出现内侧髁突干扰时，应考虑发生进展性桡尺骨关节骨关节炎的风险。这些发现可用于治疗 OCD 的决策过程。
