Imada Hideaki, Mori Ryo, Shibuya Hayatoshi, Ujigo Satoshi, Kaneta Hiroki, Kado Yuji, Kishi Kazuhiko, Adachi Nobuo
Department of Orthopedic Surgery, National Hospital Organization, Higashi-Hiroshima Medical Center, Hiroshima, Japan.
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
JSES Int. 2020 Oct 29;5(1):35-41. doi: 10.1016/j.jseint.2020.09.002. eCollection 2021 Jan.
It is generally considered that fragment fixation with bone pegs (FFBP) for osteochondritis dissecans (OCD) of the humeral capitellum can be indicated for stages I and II according to the International Cartilage Repair Society (ICRS) classification of OCD and it is difficult to obtain complete bone union for advanced lesions. However, the clinical and radiologic results of FFBP with cancellous bone graft for ICRS-OCD stage III with lateral wall involvement have not been described in detail. Good bone union can be achieved with the lateral wall fragment of the capitellum by FFBP in combination with refreshing the sclerotic surface at the base of the lesion and cancellous bone grafting even in ICRS-OCD stage III lesions.
In total, 10 adolescent baseball players with a diagnosis of OCD, a median age of 13.5 years at the time of surgery, and 26.7 months of postoperative follow-up were included. Preoperative imaging showed that all patients had lesions in the late detached stage and of the lateral-widespread type based on the site of the focal lesion. The intraoperative ICRS-OCD classification was stage III. We aimed to preserve and fix the lateral wall fragment with cancellous bone grafting if the condition of the articular cartilage was good and the size and thickness of the segment could withstand fixation.
Bone union of the lateral wall fragment was achieved in all cases. The elbow extension range of motion was -3.9° ± 9.7° before surgery and was eventually -0.4° ± 6.7° at the final assessment. Flexion range of motion ranged from 138.1° ± 10.5° to 142.4° ± 6.2°. The Timmerman and Andrews score significantly improved from 165.5 ± 10.9 points before surgery to 197.0 ± 6.3 points after surgery, demonstrating excellent results in all patients. All patients were able to return to competitive baseball.
The radiographic and clinical outcomes of FFBP for lateral wall fragments with cancellous bone graft were satisfactory, showing that the indications for this procedure could be extended to ICRS-OCD stage III.
一般认为，根据国际软骨修复协会（ICRS）对剥脱性骨软骨炎（OCD）的分类，肱骨小头剥脱性骨软骨炎采用骨栓碎片固定术（FFBP）适用于I期和II期，而对于晚期病变则难以实现完全骨愈合。然而，对于伴有侧壁受累的ICRS - OCD III期患者，采用松质骨移植的FFBP的临床和影像学结果尚未详细描述。即使在ICRS - OCD III期病变中，通过FFBP结合清理病变底部的硬化表面和松质骨移植，肱骨小头的侧壁碎片也能实现良好的骨愈合。
共纳入10名诊断为OCD的青少年棒球运动员，手术时的中位年龄为13.5岁，术后随访26.7个月。术前影像学检查显示，根据病灶部位，所有患者均处于晚期分离阶段且为外侧广泛型病变。术中ICRS - OCD分类为III期。如果关节软骨状况良好且碎片的大小和厚度能够承受固定，我们的目标是通过松质骨移植来保留和固定侧壁碎片。
所有病例均实现了侧壁碎片的骨愈合。术前肘关节伸展活动范围为-3.9°±9.7°，最终在最终评估时为-0.4°±6.7°。屈曲活动范围从138.1°±10.5°到142.4°±6.2°。Timmerman和Andrews评分从术前的165.5±10.9分显著提高到术后的197.0±6.3分，表明所有患者均取得了优异的结果。所有患者均能够重返有竞争力的棒球运动。
采用松质骨移植的FFBP治疗侧壁碎片的影像学和临床结果令人满意，表明该手术的适应证可扩展至ICRS - OCD III期。
