Decreased Defect Size and Partial Restoration of Subchondral Bone on Computed Tomography After Arthroscopic Debridement and Microfracture for Osteochondritis Dissecans of the Capitellum.
关节镜下清理和小头剥脱性骨软骨炎微骨折后,缺损大小减小,软骨下骨部分恢复。
capitellum computed tomography debridement microfracture osteochondritis dissecans outcome
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摘要

BACKGROUND:Arthroscopic debridement and microfracture are considered the primary surgical treatment for capitellar osteochondritis dissecans (OCD). Healing of the subchondral bone plays an essential role in cartilage repair, while lack of healing is related to the development of osteoarthritis. To date, it is unknown to what extent healing of the subchondral bone occurs after this technique in the elbow.
PURPOSE:To analyze defect size changes and subchondral bone healing with computed tomography (CT) after arthroscopic debridement and microfracture for advanced capitellar OCD.
STUDY DESIGN:Case series; Level of evidence, 4.
METHODS:Between 2009 and 2016, 67 patients underwent arthroscopic debridement and microfracture for advanced capitellar OCD. Fifty-four patients (81% follow-up rate) with CT scans were included (mean ± SD: preoperative, 4.0 ± 1.7 months; postoperative, 29 ± 9.0 months). OCD defect size was assessed by measuring the largest diameter in 3 directions: medial-lateral direction (coronal plane) and anterior-posterior direction and depth (both in sagittal plane). Healing of the OCD was divided into 3 categories: good-complete osseous union or ossification; fair-incomplete osseous union or ossification but improved; poor-no changes between pre- and postoperative scans. Postoperative clinical outcome was assessed with the Oxford Elbow Score (OES) at the same time as the postoperative CT scan.
RESULTS:There were 30 female and 24 male patients (age, 15.7 ± 3.2 years). Defect size decreased ( P < .001) in all 3 directions (medial-lateral × anterior-posterior × depth) at 29 ± 9.0 months: preoperatively, 7.9 ± 2.8 × 8.0 ± 3.2 × 4.1 ± 1.5 mm; postoperatively, 3.5 ± 3.3 × 4.0 ± 3.5 × 1.6 ± 1.4 mm. Healing of the subchondral bone was graded as good in 19 defects (35%), fair in 27 (50%), and poor in 8 (15%). The mean postoperative OES score was 40 ± 8.4. Neither postoperative defect size nor healing grade correlated with the OES ( P > .05).
CONCLUSION:Arthroscopic debridement and microfracture for advanced capitellar OCD result in improved (ie, decreased) defect size at a mean follow-up of 29 months, both in width and in depth. Healing of the subchondral bone was either good or fair in 85%. Interestingly, CT findings did not correlate with clinical outcomes.

译文

背景: 关节镜下清理术和微骨折被认为是治疗头板软骨炎 (OCD) 的主要手术方法。软骨下骨的愈合在软骨修复中起着至关重要的作用,而缺乏愈合与骨关节炎的发展有关。到目前为止,还不知道肘部这项技术后软骨下骨的愈合程度。
目的: 利用计算机断层扫描 (CT) 分析关节镜下清理和微骨折治疗晚期小头强迫症后的缺损大小变化和软骨下骨愈合。
研究设计: 案例系列; 证据水平,4。
方法: 在 2009 至 2016 间,67 名患者接受了关节镜下清理和微骨折治疗晚期小头强迫症。包括 54 名接受 ct扫描的患者 (81% 的随访率) (平均值 ± 标准差: 术前,4.0 ± 1.7 个月; 术后,29 ± 9.0 个月)。通过测量三个方向的最大直径来评估 OCD 缺损大小: 内侧-外侧方向 (冠状面) 和前后方向和深度 (都在矢状面)。强迫症的愈合分为 3 类: 良好-完全骨结合或骨化; 相当-不完全骨结合或骨化但有所改善; 较差-术后扫描前后无变化。在术后 ct扫描的同时,用牛津肘部评分 (OES) 评估术后临床结果。
结果: 女性患者 30 例,男性患者 24 例 (年龄 15.7 ± 3.2 岁)。缺损尺寸减小 (P <。 001) 在所有 3 个方向 (内侧-外侧 × 前-后 × 深度) 在 29 ± 9.0 个月: 术前,7.9 ± 2.8 × 8.0 ± 3.2 × 4.1 ± 1.5毫米; 术后,3.5 ± 3.3 × 4.0 ± 3.5 × 1.6 ± 1.4毫米。软骨下骨的愈合在 19 个缺损处 (35%) 为良好等级,在 27 个缺损处 (50%) 为正常等级,在 8 个缺损处 (15%) 为不良等级。术后平均 OES 评分为 40 ± 8.4。术后缺损大小和愈合程度均与 OES 无关 (P>.05)。
结论: 关节镜下清理和微骨折治疗晚期小头强迫症,平均随访 29 个月,无论是宽度还是深度,都会导致缺损大小的改善 (即减小)。在 85%,软骨下骨愈合良好或公平。有趣的是,CT 结果与临床结果无关。

Debridement

骨科 伤口处理 手术操作
概述  :  

目前的清创术遵循20世纪末提出的有限清创理论,即剪除坏死组织的同时尽量减少对组织的损伤。不彻底清创会引起术后感染;有限清创也不等于彻底清创,因为彻底清创会牺牲邻近的正常组织,导致较大的组织缺损、愈合延迟甚至器官功能障碍。清创能减轻伤口疼痛和减少血管的破坏,这为慢性伤口转变成急性伤口愈合反应状态提供了适宜的血供和营养,从而使伤口沿着炎症期、增殖期和塑形期的顺序愈合。 外科清创术   在无菌环境下,医生对符合外科清创指征的慢性伤口行手术清创,多采用刀片、刮钥等器械,

Debridement /di'bri:dmənt/      

释义   n. [外科] 清创术;扩创术;创伤切开法

例句   A continued source of controversy in orthopaedic trauma is whether increased time to surgical debridement increases the infection rate in patients with open fractures. 增加外科清创术时间是否会增加开放性骨折患者的感染率一直是创伤骨科的争论焦点。


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