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Osteonekrose und Ostechondrosis dissecans am Ellbogengelenk

  • Osteonekrose
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Die Osteonekrose und Osteochondrosis dissecans des Ellbogengelenks sind ähnliche Erkrankungsbilder idiopathischer Genese. Während beim Morbus Panner (Osteonekrose) vorwiegend Knaben im Alter von 6–10 Jahren erkranken, stellt die Osteochondrosis dissecans eine Erkrankung des adoleszenten Jugendlichen dar. Besonders prädisponiert scheinen Sportler mit Ausübung von Wurfsportarten aber auch Gynmnastiksport zu sein. Klinisch imponiert die Erkrankung in uncharakteristischen, meist lateral betonten Ellbogenschmerzen und einer sich entwickelnden Bewegungseinschränkung. Die frühe Diagnosestellung hat sich für den therapeutischen Erfolg als entscheidend erwiesen. Röntgenbilder in a.p.-Projektion bei 45° gebeugtem Ellbogengelenk stellen in der Frühphase eine Abflachung des lateralen Anteils des Capitulum humeri dar. Fortgeschrittenere Stadien sind an dem typischen Aufhellungssaum unter dem Knochenkern zu diagnostizieren. Das MRT hat in der Frühphase der Erkrankung mit einem hypointensen Signal in der T1-Wichtung einen wegweisenden Stellenwert. In weiter fortgeschrittenen Fällen zeigt sich auf T2-gewichteten Bildern eine hohe Signalintensität. In den Frühstadien der Erkrankung sollte eine konservative Therapie von 6 Monaten ausreichen. Operative Therapieverfahren bestehen in der Entfernung freier Gelenkkörper, Anbohrung oder Kürettage des Mausbetts, Spongiosatransplantation, Refixierung der OD sowie in der autologen osteochondralen Zylindertransplantation. Auch Osteotomien im lateralen Epikondylusbereich haben zur Kompressionsreduktion ihren Stellenwert.

Abstract

Osteonecrosis and osteochondritis dissecans are similar diseases of the elbow joint of unknown origin. The osteonecrosis of the elbow joint is also called Morbus Panner and mostly young men with the age of 6–10 years suffer from it. The osteochondritis dissecans is a disease of the adolescent. Overhead throwing activities and gymnastics are the most often related sports of the patients. Clinically patients suffer from a not very characteristic lateral elbow pain and a loss of range of motion. The early diagnosis is very important for the therapeutic success. X-rays of the elbow joint in 45° of flexion show especially in the early phase a marked flattening of the lateral part of the capitulum humeri. Later one can see a radiolucent line around the osseus nucleus of the osteochondritis dissecans. The MRI shows at the beginning a hypointense signal in T1-weighting, later a hyperintensity in T2-weighting. Conservative treatment is the way of choice in the first 6 months. The operative treatment is on the one hand the removal of loose bodies, drilling and currettage of the defect, microfracturing or bone transplantation, on the other hand refixation of the OD and the autologous osteochondral cylinder transplantation. Even osteotomies are relevant.

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  1. Abteilung für Sportorthopädie, TU München

    A. Burkart

  2. Abteilung für Sportorthopädie, TU München, Connollystr. 32, 80809 , München

    A. Burkart

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Burkart, A. Osteonekrose und Ostechondrosis dissecans am Ellbogengelenk. Arthroskopie 16, 104–109 (2003). https://doi.org/10.1007/s00142-003-0216-0

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