Hospital for Special Surgery, New York, NY, USA.
Columbia University Medical Center, New York, NY, USA.
J Shoulder Elbow Surg. 2018 Oct;27(10):1762-1769. doi: 10.1016/j.jse.2018.03.029. Epub 2018 Jun 22.
The location of capitellar osteochondritis dissecans (OCD) lesions in the sagittal plane guides the surgical approach used for autologous osteochondral transplantation. We sought to compare the capitellar region accessible for orthogonal graft placement through 3 approaches: (1) posterior anconeus-split approach; (2) lateral approach with lateral collateral ligament (LCL) preservation (LCL-preserving lateral approach); and (3) lateral approach with LCL release (LCL-sacrificing lateral approach).
The 3 approaches were sequentially performed on 9 cadaveric elbows: posterior anconeus-split approach, LCL-preserving lateral approach, and LCL-releasing lateral approach. The extent of perpendicular access was delineated with Kirschner wires. Each specimen underwent computed tomography. The accessible region was quantified as degrees on the capitellum and converted into time on a clock, where 0° corresponds to the 12-o'clock position. Generalized estimating equation modeling was used to investigate for significant within-specimen, between-approach differences.
The LCL-preserving and LCL-sacrificing lateral approaches provided more anterior perpendicular access than the posterior anconeus-split approach (mean, 0° vs 83°; P < .001). The posterior anconeus-split approach provided more posterior perpendicular access (mean, 215.0°; P < .001) than the LCL-preserving (mean, 117°; P < .001) and LCL-sacrificing (mean, 145°; P < .001) lateral approaches. The LCL-sacrificing lateral approach provided more posterior exposure than the LCL-preserving lateral approach (mean, 145° vs 117°; P < .001). The mean arc of visualization was greater for the LCL-sacrificing lateral approach than for the LCL-preserving lateral approach (145° vs 117°, P < .001).
A capitellar OCD lesion can be perpendicularly accessed from a posterior anconeus-split approach if it is posterior to 83° (2:46 clock-face position). A laterally based approach may be required for lesions anterior to this threshold. These data inform clinical decisions regarding the appropriate surgical approach for any OCD lesion.
在矢状面中，滑车骨骨软骨炎（OCD）病变的位置指导着自体骨软骨移植所采用的手术入路。我们试图比较 3 种方法在桡骨头滑车区域进行正交移植物放置的可及性：（1）后尺骨鹰嘴劈开入路；（2）保留外侧副韧带（LCL）的外侧入路（保留 LCL 的外侧入路）；和（3）释放 LCL 的外侧入路（牺牲 LCL 的外侧入路）。
9 具尸体肘部依次进行 3 种方法：后尺骨鹰嘴劈开入路、保留 LCL 的外侧入路和释放 LCL 的外侧入路。使用克氏针划定垂直入路的范围。每个标本均进行 CT 检查。将可及区域量化为桡骨头上的度数，并转换为时钟上的时间，其中 0°对应 12 点位置。使用广义估计方程模型来研究标本内、入路间的显著差异。
保留 LCL 的外侧入路和牺牲 LCL 的外侧入路比后尺骨鹰嘴劈开入路提供了更靠前的垂直入路（平均 0° vs 83°；P < .001）。后尺骨鹰嘴劈开入路提供了更靠后的垂直入路（平均 215.0°；P < .001），而保留 LCL 的外侧入路（平均 117°；P < .001）和牺牲 LCL 的外侧入路（平均 145°；P < .001）。牺牲 LCL 的外侧入路提供了比保留 LCL 的外侧入路更靠后的暴露（平均 145° vs 117°；P < .001）。牺牲 LCL 的外侧入路的可视弧长大于保留 LCL 的外侧入路（145° vs 117°；P < .001）。
如果滑车骨 OCD 病变位于后尺骨鹰嘴劈开入路的 83°（2:46 点钟位置）之后，可以从后尺骨鹰嘴劈开入路垂直进入。对于位于此阈值之前的病变，可能需要进行基于外侧的入路。这些数据为任何 OCD 病变的适当手术入路提供了临床决策信息。
