青少年运动员在接受关节镜下骨髓刺激治疗肘部剥脱性骨软骨炎后，运动能力和日常功能达到较高水平。
Adolescent Athletes Achieve High Levels of Athletic and Daily Function After Arthroscopic Marrow Stimulation for Elbow Capitellar Osteochondritis Dissecans.
作者信息
Michelin Richard M, Gornick Bryn R, Schlechter John A
机构信息
Department of Pediatric Orthopaedic Surgery, Children's Hospital of Orange County, Orange, California, U.S.A.
出版信息
Arthrosc Sports Med Rehabil. 2022 Sep 30;4(6):e1985-e1992. doi: 10.1016/j.asmr.2022.08.007. eCollection 2022 Dec.
PURPOSE
To determine the functional outcomes of adolescent athletes treated with arthroscopic marrow stimulation/microfracture for elbow capitellar osteochondritis dissecans (OCD).
METHODS
The medical records for all patients younger than 18 years of age with capitellar OCD who underwent arthroscopic treatment at a single institution were retrospectively reviewed. The variables examined included patient characteristics, bone age, pre- and postoperative lesion grade/size and range of motion (ROM), intraoperative lesion grade/size, time to postoperative return to sport, and validated outcome scores.
RESULTS
Twenty patients with 21 treated elbows met the study's inclusion criteria. Three patients were not available for follow-up, leaving 18 of 21 (85.7%) elbows in the final cohort. Mean age and follow-up was 14.1 and 4.4 years, respectively. All 18 elbows were treated with diagnostic arthroscopy, arthroscopic debridement with loose body removal as indicated, and marrow stimulation. Sixteen of 18 (88.9%) elbows returned to sports postoperatively, with 12 of 18 (66.7%) elbows returning to their primary sport at the same level or higher. Overall, there were significant improvements in elbow ROM (132.8°, range 120°-140° postoperatively, compared with 122.1°, range 80°-140° preoperatively) ( = .002) and excellent Quick Disabilities of the Arm, Shoulder and Hand scores (mean 2.3 ± 5.1), as well as Kerlan-Jobe Orthopaedic Clinic Overhead Athlete Shoulder and Elbow scores (mean 94.1 ± 8.7) in those who returned to sports. There was no correlation with outcome or return to sport for preoperative lesion grade/size, bone age, physeal status or open versus arthroscopic treatment.
CONCLUSIONS
Arthroscopic debridement and marrow stimulation for capitellar OCD in adolescent athletes leads to improvements in ROM, as well as a high rate of return to sport, and high levels of athletic and daily functional activity during follow-up, regardless of bone age and lesion grade/size at time of surgery.
LEVEL OF EVIDENCE
Level IV, therapeutic case series.
目的
确定接受关节镜下骨髓刺激/微骨折治疗的青少年运动员肘部肱骨小头剥脱性骨软骨炎（OCD）的功能预后。
方法
回顾性分析在单一机构接受关节镜治疗的所有18岁以下肱骨小头OCD患者的病历。检查的变量包括患者特征、骨龄、术前和术后病变分级/大小及活动范围（ROM）、术中病变分级/大小、术后恢复运动的时间以及经过验证的预后评分。
结果
20例患者的21个接受治疗的肘部符合研究纳入标准。3例患者无法进行随访，最终队列中21个肘部中的18个（85.7%）纳入分析。平均年龄和随访时间分别为14.1岁和4.4年。所有18个肘部均接受了诊断性关节镜检查、根据需要进行的关节镜下清创及取出游离体以及骨髓刺激治疗。18个肘部中的16个（88.9%）术后恢复运动，18个肘部中的12个（66.7%）恢复到同等水平或更高水平的原运动项目。总体而言，术后肘部ROM有显著改善（术后为132.8°，范围120°-140°，术前为122.1°，范围80°-140°）（P = .002），恢复运动的患者的手臂、肩部和手部快速残疾评分（平均2.3±5.1）以及克尔兰-乔布骨科诊所上肢运动员肩肘评分（平均94.1±8.7）均为优秀。术前病变分级/大小、骨龄、骨骺状态或开放手术与关节镜手术治疗与预后或恢复运动均无相关性。
结论
青少年运动员肘部肱骨小头OCD的关节镜下清创和骨髓刺激治疗可改善ROM，术后恢复运动的比例较高，随访期间运动和日常功能活动水平较高，无论手术时的骨龄和病变分级/大小如何。
证据水平
IV级，治疗性病例系列。
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