Orthopedic Hospital Speising, Department of Pediatric Orthopaedics and Adult Foot and Ankle Surgery, Medical University Vienna, Speisingerstrasse 109, 1130, Vienna, Austria.
Medical University Vienna, Vienna, Austria.
Arch Orthop Trauma Surg. 2021 Sep;141(9):1541-1549. doi: 10.1007/s00402-021-03773-8. Epub 2021 Feb 4.
Osteochondrosis dissecans (OCD) is considered to be one of the main causes for pain, discomfort and morbidity in the pediatric elbow joint. Few treatment options, such as microfracture or autologous transplantation, of osteochondral bone grafts have been described to address advanced OCD. The aim of this retrospective case series is to present preliminary clinical and radiologic findings following advanced stage OCD repair using a novel combination of a hyaluronic acid-based scaffold with autologous iliac crest bone grafting.
Five adolescents, who underwent treatment of OCD (grade 3 or 4 according to Nelson) using a combination technique of defect debridement, transplantation of cancellous iliac crest bone and application of a HYALOFAST® membrane (Anika Therapeutics S.r.L., Italy), were re-assessed using clinical and radiologic examinations (defect diameter, depth, sclerosis, congruency, fragmentation, dissection, radiolucency, growth plate status; MRI) after a minimum of 2 years (mean, 34 months; range, 24-45) postoperatively. Dedicated outcome scores (Numeric Rating Scale [NRS], Pediatric Outcome Data Collection Instrument [PODCI], Mayo Elbow Performance Score [MEPS], and Timmerman-Andrews Score [TIMM] were collected.
All patients reported a NRS score of 0. The mean total TIMM, MEPS and PODCI (Global Functioning Scale) scores were 189 (range 165-200), 94 (range, 70-100), and 92 (range 83-98; normative score 47; range 35-55), respectively, indicating good to excellent clinical outcomes. The radiographic analysis showed overall improvements with regard to OCD width and depth reduction (35%, - 27-100%; 52%, 4-100%), but full resolution in only 2 of 5 cases. Elbow motion improved slightly after surgery. No complications were noted.
This study showed promising clinical short- to mid-term results in adolescent patients with advanced OCD using a novel surgical treatment combination. Radiographic results showed partial healing; hence, residual changes should be monitored over a longer period.
剥脱性骨软骨炎（OCD）被认为是小儿肘部疼痛、不适和发病的主要原因之一。已经描述了几种治疗选择，例如微骨折或自体移植骨软骨移植物，以解决晚期 OCD。本回顾性病例系列的目的是介绍使用新型透明质酸支架联合自体髂嵴骨移植治疗晚期 OCD 的初步临床和放射学发现。
5 名青少年接受了 OCD 治疗（根据 Nelson 分级为 3 或 4 级），采用联合技术进行缺损清创、松质髂嵴骨移植和 HYALOFAST®膜（Anika Therapeutics S.r.L.，意大利）应用，在术后至少 2 年（平均 34 个月；范围，24-45）进行了临床和放射学检查（缺损直径、深度、硬化、一致性、碎裂、分离、透光性、生长板状态；MRI）。收集了专门的结果评分（数字评分量表[NRS]、儿科结果数据收集工具[PODCI]、梅奥肘部表现评分[MEPS]和蒂曼-安德鲁斯评分[TIMM]）。
所有患者报告 NRS 评分为 0。平均总 TIMM、MEPS 和 PODCI（整体功能量表）评分分别为 189（范围 165-200）、94（范围 70-100）和 92（范围 83-98；正常评分 47；范围 35-55），表明临床结果良好至优秀。放射学分析显示 OCD 宽度和深度减小（35%，-27-100%；52%，4-100%）总体改善，但仅在 5 例中的 2 例中完全缓解。手术后肘部运动略有改善。无并发症。
本研究显示，在青少年晚期 OCD 患者中使用新型手术治疗联合治疗具有有前景的短期至中期临床结果。放射学结果显示部分愈合；因此，应在较长时间内监测残留变化。
