Department of Orthopedics, Yancheng First Hospital Affiliated to Nanjing University Medicine School, Yancheng, 224000, Jiangsu, China.
Department of Orthopedics, Yancheng First Hospital, Yancheng, 224000, Jiangsu, China.
BMC Musculoskelet Disord. 2024 Oct 25;25(1):851. doi: 10.1186/s12891-024-07851-x.
There are defects in the existing classification of capitellar cartilage injury (CCI) concomitant with radial head fracture (RHF). This study aimed to introduce a comprehensive classification of CCI and to analyze its surgical guidance value.
According to the affected site and severity, CCI was classified into four types: Type I - partial-thickness loss of articular cartilage, Type II - full-thickness loss of articular cartilage, Type III - full-thickness loss of articular cartilage with subchondral bone loss, Type IV - full-thickness loss of articular cartilage with thin cortex loss on the border of the capitellum; Different types suggest different surgical methods. Between January 2017 and January 2023, this comprehensive CCI classification was applied in 31 operated patients with CCI concomitant with RHF. The ranges of motion (ROM), Mayo Elbow Performance Index (MEPI) score, Hospital for Special Surgery (HSS) score and visual analog scale (VAS) for pain, were used to evaluate the functional recovery of the affected limb.
Mason Type I-IV RHF accounted for 6.45%, 38.71%, 48.39%, and 6.45%, respectively. Type I-IV CCI accounted for 12.90%, 35.48%, 45.16% and 6.45%, respectively. There was no relationship between the CCI and RHF types (p > 0.05). At the end of the follow-up period of 11-26 months with an average of 16 months, the elbow flexion and extension ROM recovered to (147.39 ± 9.84)°, forearm rotation ROM recovered to (168.74 ± 11.70)°, MEPI score recovered to (89.19 ± 4.17), HSS score recovered to (88.74 ± 4.62), VAS score recovered to (0.50 ± 0.57), indicating significant differences compared to preoperative measurements (p < 0.05). According to the MEPI and HSS scores, the excellent and good rate of functional recovery was 100%.
Different types of CCI differ not only in pathology but also in treatment methods. Surgical strategy according to the comprehensive CCI classification introduced in this paper may lead to a satisfactory outcome.
现有的肱骨小头软骨损伤（CCI）伴桡骨头骨折（RHF）分类存在缺陷。本研究旨在介绍一种全面的 CCI 分类，并分析其在手术中的指导价值。
根据受累部位和严重程度，CCI 分为四型：Ⅰ型 - 关节软骨部分厚度损失；Ⅱ型 - 关节软骨全厚度损失；Ⅲ型 - 关节软骨全厚度损失伴软骨下骨丢失；Ⅳ型 - 肱骨小头边缘关节软骨全厚度损失伴薄皮质丢失；不同类型提示不同的手术方法。2017 年 1 月至 2023 年 1 月，31 例 CCI 伴 RHF 患者应用该全面 CCI 分类进行手术。采用活动范围（ROM）、梅奥肘关节功能评分（MEPI）、特殊外科医院（HSS）评分和视觉模拟评分（VAS）评估患侧肢体的功能恢复情况。
Mason Ⅰ-Ⅳ型 RHF 分别占 6.45%、38.71%、48.39%和 6.45%，CCI Ⅰ-Ⅳ型分别占 12.90%、35.48%、45.16%和 6.45%。CCI 与 RHF 类型之间无相关性（p>0.05）。在 11-26 个月（平均 16 个月）的随访期末，肘关节屈伸 ROM 恢复至（147.39±9.84）°，前臂旋转 ROM 恢复至（168.74±11.70）°，MEPI 评分恢复至（89.19±4.17），HSS 评分恢复至（88.74±4.62），VAS 评分恢复至（0.50±0.57），与术前测量值相比均有显著差异（p<0.05）。根据 MEPI 和 HSS 评分，功能恢复的优良率为 100%。
不同类型的 CCI 不仅在病理学上不同，而且在治疗方法上也不同。根据本文介绍的全面 CCI 分类制定的手术策略可能会获得满意的结果。
