Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan.
J Bone Joint Surg Am. 2018 Jun 6;100(11):903-913. doi: 10.2106/JBJS.17.01035.
Costal osteochondral grafting is a technique to achieve anatomical and biological repair of articular defects. Some small series of clinical applications of this procedure for advanced osteochondritis dissecans of the humeral capitellum, with short-term follow-up, have been reported; however, longer-term outcomes remain unclear. The purpose of this study was to clarify longer-term clinical outcomes of costal osteochondral autografts in the treatment of advanced osteochondritis dissecans of the humeral capitellum.
Seventy-two patients with an osteochondral defect of the humeral capitellum were treated with costal osteochondral autograft and followed for a minimum of 3 years (mean follow-up, 57 months; range, 36 to 147 months). The mean patient age was 14.3 years. Clinical outcomes, including elbow range of motion, Timmerman and Andrews clinical rating score, donor-site morbidity, responses to a questionnaire regarding a return to sporting activities, and radiographic findings, were evaluated.
The mean elbow range of extension/flexion increased significantly, from -21°/122° preoperatively to -4°/136° postoperatively (p < 0.001). The mean clinical rating score improved significantly, from 101 to 190 by the latest follow-up (p < 0.001). The overall clinical score-based assessment was excellent for 60 patients, good for 9, and fair for 3. Seventy of the 72 patients returned to their original sport. The remaining 2 patients had changed sporting activities before surgery and did not return to baseball, despite satisfactory clinical results.
Costal osteochondral autograft successfully achieved anatomical and biological reconstruction in the treatment of advanced osteochondritis dissecans of the humeral capitellum.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
肋软骨移植是一种实现关节缺损解剖学和生物学修复的技术。一些关于该技术应用于肱骨小头骨软骨炎的小系列临床研究报告了短期随访结果，然而长期结果尚不清楚。本研究旨在阐明肋软骨自体移植治疗肱骨小头骨软骨炎的长期临床结果。
72 例肱骨小头骨软骨缺损患者采用肋软骨自体移植治疗，随访至少 3 年（平均随访 57 个月；范围 36 至 147 个月）。患者平均年龄为 14.3 岁。评估了临床结果，包括肘屈伸范围、Timmerman 和 Andrews 临床评分、供区发病率、重返运动活动的问卷调查反应以及影像学发现。
肘屈伸范围从术前的-21°/122°显著增加到术后的-4°/136°（p < 0.001）。平均临床评分从术前的 101 分显著提高到末次随访时的 190 分（p < 0.001）。根据最新随访结果，整体临床评分评估为 60 例优秀、9 例良好、3 例一般。72 例患者中有 70 例返回原来的运动项目。其余 2 例患者在术前改变了运动项目，尽管临床结果满意，但仍未重返棒球运动。
肋软骨自体移植成功地实现了肱骨小头骨软骨炎的解剖学和生物学重建。
治疗性 IV 级。有关证据水平的完整描述，请参见作者说明。
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