背景:自体骨软骨移植手术(OATS)被引入作为手部剥脱性骨软骨炎(OCD)的治疗方法,并报告了成功的结果。然而,与其他关节相比,供体栓的软骨高度尚未确定。我们介绍了一个使用OATS治疗士兵发生的第3掌骨(MCP)头OCD的案例,以及手术后12周拍摄的磁共振成像(MRI)图像的发现。
方法:一名21岁男性,右手第三个MCP关节肿胀。他是一名士兵,惯用右手;此外,他不记得任何创伤事件,他以前也没有服用任何皮质类固醇药物。患者被排除在军事训练之外,并在军事医院接受了药物和支架的保守治疗3个月。
方法:患者经X线和MRI诊断为右手第3MCP头缺血性坏死所致强迫症。
方法:OATS计划作为手术治疗。手术发现了第3个MCP头的10×10mm2,孤立的软骨缺损,其边缘不规则,身体松弛。使用ArthrexOATS,一个10毫米的直径,在关节缺损部位做了10毫米深的孔,直径11毫米,从左股骨外侧髁收获12长栓。用压配合固定将供体塞插入准备好的缺损部位。
结果:在最后一次随访中,手术后12周,MRI显示关节软骨高度随着关节愈合而消退.然而,患者无症状,右手活动范围正常,他回到了军事训练。
结论:尽管手的关节很小且不承重,在我们的病例中,在随访的MRI中,供体栓的关节软骨水平下降.我们认为供体和受体之间软骨厚度的差异可能是关节软骨下沉的原因,因此,这可能有助于移植具有相似厚度的关节软骨的供体。
BACKGROUND: Osteochondral autograft transplantation surgery (OATS) was introduced as a treatment for hand osteochondritis dissecans (OCD), and successful results were reported. However, the cartilage height of the donor plug has not yet been established compared with that of other joints. We present a
case using OATS for OCD of the 3rd metacarpal (MCP) head that occurred in a soldier and the findings of magnetic resonance imaging (MRI) images taken at 12 weeks after surgery.
METHODS: A 21-year-old male presented with a painful, swollen 3rd MCP joint in the right hand. He was a soldier and right-handed; in addition, he did not recall any traumatic events, nor had he taken any corticosteroid medications before. The patient was excluded from military training and underwent conservative treatment with medication and a brace in a military hospital for 3 months.
METHODS: The patient was diagnosed with OCD due to avascular necrosis of the 3rd MCP head of the right hand through X-ray and MRI.
METHODS: OATS was planned as a surgical treatment. Surgery uncovered a 10 × 10 mm2, isolated cartilage defect of the 3rd MCP head that had an irregular margin and a loose body. Using Arthrex OATS, a 10-mm diameter, 10-mm depth hole was made at the articular defect site, and an 11-mm diameter, 12-length plug was harvested from the left lateral femoral condyle. The donor plug was inserted into the prepared defect site with press-fit fixation.
RESULTS: At the last follow-up, the height of the articular cartilage had subsided with union on MRI 12 weeks after the surgery. However, the patient was asymptomatic with a normal range of motion of the right hand, and he returned to military training.
CONCLUSIONS: Although the joints of the hand are small and non-weight bearing, the level of articular cartilage of the donor plug was subsided in a follow-up MRI in our
case. We suggest that the difference in cartilage thickness between the donor and the recipient might have been the cause of subsidence of the articular cartilage, and therefore, it may be helpful to transplant donors with similar thicknesses of articular cartilage.