Ruch D S, Cory J W, Poehling G G
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1070, USA.
Arthroscopy. 1998 Nov-Dec;14(8):797-803. doi: 10.1016/s0749-8063(98)70013-1.
The management of avascular necrosis of the capitellum of the adolescent elbow continues to be a dilemma. This article is a critical retrospective analysis of 12 pediatric patients (mean age at surgery 14.5 years) who underwent arthroscopic debridement alone followed by early range of motion. Follow-up at a mean of 3.2 years (range, 2.0 to 5.7 years) indicated that the average flexion contracture improved from 23 degrees preoperatively to 10 degrees postoperatively. All patients had remodeling of the capitellum by plain radiographs; however, five patients had associated enlargement of the radial head. Eleven patients had minimal mechanical symptoms after the procedure and were highly satisfied. One patient had substantial enlargement of the radial head with continued loss of supination and mechanical symptoms requiring radial head resection 2 years after the index procedure. Five patients had a triangular avulsion fragment present off the lateral capsule. A statistically significant worse subjective outcome was associated with the presence of this fragment (P < .005). There were no complications.
青少年肘关节小头缺血性坏死的治疗仍然是一个难题。本文对12例儿科患者（手术时平均年龄14.5岁）进行了批判性回顾分析，这些患者仅接受了关节镜清创术，随后进行了早期活动度训练。平均随访3.2年（范围为2.0至5.7年）表明，平均屈曲挛缩从术前的23度改善至术后的10度。所有患者经X线平片检查均显示小头有重塑；然而，5例患者伴有桡骨头增大。11例患者术后机械性症状轻微，满意度很高。1例患者在初次手术后2年出现桡骨头明显增大，旋后功能持续丧失且有机械性症状，需要行桡骨头切除术。5例患者外侧关节囊有三角形撕脱碎片。该碎片的存在与主观结果在统计学上显著较差相关（P < .005）。无并发症发生。
