進行期肘離断性骨軟骨炎に対する生体吸収性ピンを用いた骨軟骨片固定術

Fragment Fixation with Bioabsorbable Pins for Advanced Osteochondritis Dissecans Lesions of the Elbow

　抄録：病巣が分離あるいは遊離した肘離断性骨軟骨炎例に対し，当科ではできるだけ骨軟骨片を温存するという方針のもと，母床側の十分な掻爬と欠損部への海綿骨移植を行い，骨軟骨片を吸収性のピンで固定する骨軟骨片固定術を行っている．今回その短期成績および問題点について検討した．症例は7例で全例男性，手術時平均年齢は15歳，術後経過観察期間は12カ月，スポーツは全例野球であった．7例全例で骨癒合が得られ1例を除き野球に復帰した．可動域では1例を除き改善を認め，疼痛では1例で軽い投球後痛を認めたが他の例では全く認めなかった．今回われわれは骨軟骨片の固定力を向上させるため径1.5mm，長さ15mmの細く短いPLLAピンを特別に作成し複数本で固定した．骨軟骨片と母床との癒合は全例で得られた．本術式は，摘出術や自家骨軟骨移植術の前に行うべき治療法と考える．

　To preserve osteochondral fragment in advanced osteochondritis dissecans of the elbow joint seven patients were treated by means of curettage, cancellous bone grafts, and internal fixation of the fragment with bioabsorbable pins. All patients were male baseball players, and their average age was 15 years. Average follow-up time was 12months. Multiplanar reconstruction CT showed that unions between the fragment and subchondral bone had been achieved in all seven patients. Six patients were pain-free and had returned to their previous sporting activities. Range of motion increased by an average of 10°after surgery, but there was no increase in ROM in one of the patients. Fine, short bioabsorbable pin (poly-L-lactate acid, 1.5-mm diameter, 15-mm length) were used in this series, and more than one pin was used to fix each fragment. Internal fixation with the small bioabsorbable pins yielded good results.