PDF(Pubmed)
Abstract：
UNASSIGNED: The etiology and pathogenesis of osteochondritis dissecans (OCDs) lesions remain controversial.
UNASSIGNED: This review presents the recent evolution about the healing, imaging, pathogenesis, and how to treat OCD of the capitellum in overhead athletes.
UNASSIGNED: Compressive and shear forces to the growing capitellum can cause subchondral separation, leading to OCD, composed of 3 layers: articular fragment, gap, and underlying bone. Subchondral separation can cause ossification arrest (stage IA), followed by cartilage degeneration (stage IB) or delayed ossification (stage IIA), occasionally leading to osteonecrosis (stage IIB) in the articular fragment. Articular cartilage fracture and gap reseparation make the articular fragment unstable. The mean tilting angle of capitellar OCD is 57.6 degrees in throwers. Anteroposterior radiography of the elbow at 45 degrees of flexion (APR45) can increase the diagnostic reliability, showing OCD healing stages, as follows: I) radiolucency, II) delayed ossification, and III) union. Coronal computed tomography and magnetic resonance imaging with an appropriate tilting angle can also increase the reliability. MRI is most useful to show the instability, although it occasionally underestimates. Sonography contributes to detection of early OCD in adolescent throwers on the field. OCD lesions in the central aspect of the capitellum can be more unstable and may not heal. Cast immobilization has a positive effect on healing for stable lesions. Arthroscopic removal provides early return to sports, although a large osteochondral defect is associated with a poor prognosis. Fragment fixation, osteochondral autograft transplantation, and their hybrid technique have provided better results.
UNASSIGNED: Further studies are needed to prevent problematic complications of capitellar OCD, such as osteoarthritis and chondrolysis.
UNASSIGNED: This review presents the recent evolution about the healing, imaging, pathogenesis, and how to treat OCD of the capitellum in overhead athletes.
UNASSIGNED: Compressive and shear forces to the growing capitellum can cause subchondral separation, leading to OCD, composed of 3 layers: articular fragment, gap, and underlying bone. Subchondral separation can cause ossification arrest (stage IA), followed by cartilage degeneration (stage IB) or delayed ossification (stage IIA), occasionally leading to osteonecrosis (stage IIB) in the articular fragment. Articular cartilage fracture and gap reseparation make the articular fragment unstable. The mean tilting angle of capitellar OCD is 57.6 degrees in throwers. Anteroposterior radiography of the elbow at 45 degrees of flexion (APR45) can increase the diagnostic reliability, showing OCD healing stages, as follows: I) radiolucency, II) delayed ossification, and III) union. Coronal computed tomography and magnetic resonance imaging with an appropriate tilting angle can also increase the reliability. MRI is most useful to show the instability, although it occasionally underestimates. Sonography contributes to detection of early OCD in adolescent throwers on the field. OCD lesions in the central aspect of the capitellum can be more unstable and may not heal. Cast immobilization has a positive effect on healing for stable lesions. Arthroscopic removal provides early return to sports, although a large osteochondral defect is associated with a poor prognosis. Fragment fixation, osteochondral autograft transplantation, and their hybrid technique have provided better results.
UNASSIGNED: Further studies are needed to prevent problematic complications of capitellar OCD, such as osteoarthritis and chondrolysis.
摘要：
■剥脱性骨软骨炎（OCD）病变的病因和发病机制仍存在争议。
■这篇综述介绍了关于愈合的最新演变，成像,发病机制，以及如何治疗高架运动员的强迫症。
■对正在生长的头状骨施加的压缩力和剪切力会导致软骨下分离，导致强迫症，由3层组成：关节碎片，间隙,和下面的骨头。软骨下分离可导致骨化停滞（IA期），其次是软骨退变（IB期）或延迟骨化（IIA期），偶尔导致关节碎片骨坏死（IIB期）。关节软骨骨折和间隙分离使关节碎片不稳定。投掷者的头状强迫症的平均倾斜角为57.6度。肘部弯曲45度前后行X线摄影（APR45）可提高诊断的可靠性，显示强迫症愈合阶段，如下：I)射线可透性，II)延迟骨化，和III）工会。具有适当倾斜角度的冠状计算机断层扫描和磁共振成像也可以增加可靠性。MRI对显示不稳定性最有用，虽然偶尔会低估。超声检查有助于检测野外青少年投掷者的早期强迫症。小脑中央的OCD病变可能更不稳定，可能无法愈合。铸造固定对稳定病变的愈合具有积极作用。关节镜下切除可以早日恢复运动，尽管巨大的骨软骨缺损与不良预后相关。片段固定,自体骨软骨移植,他们的混合技术提供了更好的结果。
■需要进一步的研究来防止头颅强迫症的并发症，如骨关节炎和软骨溶解。
■这篇综述介绍了关于愈合的最新演变，成像,发病机制，以及如何治疗高架运动员的强迫症。
■对正在生长的头状骨施加的压缩力和剪切力会导致软骨下分离，导致强迫症，由3层组成：关节碎片，间隙,和下面的骨头。软骨下分离可导致骨化停滞（IA期），其次是软骨退变（IB期）或延迟骨化（IIA期），偶尔导致关节碎片骨坏死（IIB期）。关节软骨骨折和间隙分离使关节碎片不稳定。投掷者的头状强迫症的平均倾斜角为57.6度。肘部弯曲45度前后行X线摄影（APR45）可提高诊断的可靠性，显示强迫症愈合阶段，如下：I)射线可透性，II)延迟骨化，和III）工会。具有适当倾斜角度的冠状计算机断层扫描和磁共振成像也可以增加可靠性。MRI对显示不稳定性最有用，虽然偶尔会低估。超声检查有助于检测野外青少年投掷者的早期强迫症。小脑中央的OCD病变可能更不稳定，可能无法愈合。铸造固定对稳定病变的愈合具有积极作用。关节镜下切除可以早日恢复运动，尽管巨大的骨软骨缺损与不良预后相关。片段固定,自体骨软骨移植,他们的混合技术提供了更好的结果。
■需要进一步的研究来防止头颅强迫症的并发症，如骨关节炎和软骨溶解。
