肱骨小头骨软骨炎的分类、治疗及疗效研究
Classification, Treatment, and Outcome of Osteochondritis Dissecans of the Humeral Capitellum
分离性肱骨小头骨软骨炎的分类、治疗及疗效
Background: Indications for the treatment of osteochondritis dissecans of the humeral capitellum have remained unclear. The aims of this study were to analyze the outcomes and to determine the most useful classification for the choice of treatment.
背景：分离性肱骨小头骨软骨炎的治疗适应症尚未明确。本研究的目的在于，通过分析疗效明确指导治疗的最有效分类。
Methods: The cases of 106 patients with osteochondritis dissecans of the capitellum were studied retrospectively. At the time of the initial presentation, the mean age of the patients was 15.3 years. The capitellar growth plate was open in eighteen patients and closed in eighty-eight. Thirty-six patients were treated nonoperatively. Fifty-five patients underwent fragment removal alone, twelve underwent fragment fixation with a bone graft, and three underwent reconstruction of the articular surface with use of osteochondral plug grafts from the lateral femoral condyle. The mean follow-up period was 7.2 years. The outcomes in terms of pain in the elbow, return to sports, and radiographic findings were analyzed and compared.
方法：对106例分离性肱骨小头骨软骨炎患者进行回顾性研究。最初发病平均年龄为15.3岁，18例患者肱骨小头生长板未闭，而其余88例则已经闭合。36例采取非手术治疗，55例仅切除游离骨片，12例采用植骨固定骨片，3例从股骨外侧髁移植软骨修复关节面。平均随访7.2年。观察项目包括肘关节疼痛、恢复体育锻炼及放射学表现，并进行比较。
Results: An osteochondritis dissecans lesion with an open capitellar physis and a good range of elbow motion resulted in a good outcome. Continued elbow stress resulted in the worst outcome in terms of pain and radiographic findings. In patients with a closed capitellar physis, surgery provided significantly better results than elbow rest (p < 0.01). Fragment fixation or reconstruction provided significantly better results than fragment removal alone (p < 0.05). The results of removal alone were dependent on the size of the defect in the capitellum. The outcome in terms of pain was closely associated with sports activity and radiographic findings.
结果：带有未闭合肱骨小头生长部和良好肘关节活动度的分离性骨软骨炎，临床疗效良好。持续的肘关节紧张在疼痛及放射学表现上结果较差。对于肱骨小头生长部闭合的患者，手术效果显著优于肘关节制动者(p < 0.01)。骨片固定或关节面重建的效果优于骨片切除者(p < 0.05)。而骨片切除的效果取决于肱骨小头缺损的大小。关节疼痛与体育活动及放射学表现关系密切。
Conclusions: We believe that osteochondritis dissecans of the capitellum can be classified as stable or unstable. Stable lesions that healed completely with elbow rest had all of the following findings at the time of the initial presentation: an open capitellar growth plate, localized flattening or radiolucency of the subchondral bone, and good elbow motion. Unstable lesions, for which surgery provided significantly better results, had one of the following findings: a capitellum with a closed growth plate, fragmentation, or restriction of elbow motion of ≥20°. For large unstable lesions, fragment fixation or reconstruction of the articular surface leads to better results than simple excision.
结论：分离性肱骨小头骨软骨炎可以分为稳定及不稳定型。稳定型可以通过肘关节制动达到完全愈合，其最初表现为：未闭合的肱骨小头生长板、扁平或X线可透的软骨下骨、良好的肘关节活动度。不稳定型通过手术可以取得更好的疗效，其表现为：闭合的肱骨小头生长板、骨折片、肘关节活动受限≥20°。对于较大的不稳定折块，骨片固定或关节面重建比简单切除效果更好。
[ 本帖最后由 daike_ren 于 2008-7-1 12:56 编辑 ]
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