上腕骨骨頭の骨軟骨損傷に対して試みた骨軟骨移植術
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We report the treatment of osteochondral defect of the humeral head in an 18-year-old patient who had no history of trauma. On physical examination, the patient demonstrated left shoulder pain and his range of motion was limited because of pain. Plain radiographs and computed tomography showed a radiolucent bony defect in the posterosuperior aspect of the humeral head. Laboratory investigations were normal.<BR>Arthroscopy showed several free bodies and osteoarthritis of glenohumeral joint. The osteochondral defect was filled with granulation tissues. Surgical treatment included removal of free bodies, debridement and resurfacing of the defect with an osteochondral autograft.<BR>At a follow-up of 6 months, his range of motion was not fully recovered but the pain had disappeared. MRI showed resolution of the defect of the humeral head.<BR>In this case, the osteochondral defect may have been caused by osteochondritis dissecans (OCD) because there was no clear relationship between the symptoms and a history of trauma. Other possible differential diagnoses including avascular necrosis, infection and osteochondral fracture were ruled out by physical findings and examinations. It was considered that the free body caused by OCD produced another chondral lesion followed by osteoarthritis.<BR>Treatment options include rest, debridement, drilling, removal of loose bodies and osteochondral autograft transfer. We selected osteochondral autograft transfer for restoration of the articular humeral surface. At follow-up, the clinical result was good and recipient site was healed.
- 日本肩関節学会の論文
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