膝关节前交叉韧带断裂后股骨外髁髁间侧壁关节软骨的关节镜下表现

235 Cases Clinical Study of the Articular Cartilage of Femoral Intercondylar Notch Followed ACL Rupture

目的 :探讨股骨外髁髁间侧壁软骨作为骨软骨移植术和软骨细胞移植术的取材部位的可行性。方法 :回顾研究了 2 35例膝前交叉韧带断裂行关节镜下韧带重建时的软骨损伤情况 ,分析了前交叉韧带断裂患者股骨外髁髁间侧壁软骨有无退变及其与髁软骨损伤、年龄、病程的关系。结果 :本组 2 35例患膝中 ,伴Ⅲ度以上软骨损伤占 2 0 %(其中伴髁间增生 1 0例 )。Ⅲ度以上局限性软骨损伤而髁间侧壁非负重区软骨外观正常占 1 5 74 %。髁间侧壁非负重区软骨外观正常的Ⅲ度以上软骨损伤患者平均年龄为 2 5 8岁 ,平均病程为 1 6 75月 ;髁间侧壁非负重区软骨外观异常的Ⅲ度以上软骨损伤患者平均年龄为 4 2 6岁 ,平均病程 1 2 2 5月 ,后者明显大于前者 ,有显著性差异 (t检验 ,P <0 0 2 )。结果提示 ,前交叉韧带断裂合并软骨损伤需要进行骨软骨移植时 ,可同时考虑在外髁髁间侧壁取材进行修复 ;ACL损伤后急性期和亚慢性期 ,关节镜下未见股骨外髁髁间侧壁软骨明显异常。自体骨软骨移植或自体软骨细胞移植治疗软骨损伤时 ,病程越短 ,供区所提供的骨软骨质量就越好 ,病程较长、年龄较大患者多发生膝骨关节炎 ,往往累及髁间侧壁 ,骨赘形成、髁间窝变窄 ,此时软骨的质量差 ,不能作为供区。

Objective To observe and analyze the changes of the intercondylar cartilage followed anterior cruciate ligament(ACL)rupture and to study the possibility of repairing cartilage defect with intercondyle cartilage of ACL rupture. Methods The articular cartilage lesions in 235 patients who performed ACL reconstruction under arthroscopy were retrospectively studied. Results There were 47 cases (20%) suffering from severe(Ⅲ) injury of cartilage in condylus (inluding 10 cases accompanied with intercondylar notch cartilage hyperplasia). The average age was older (42.6 vs 25.8 years) and history was longer (122.5 vs 16.75 months) in the patients suffering from injury of the lateral wall of intercondylar notch. Conclusion Our study shows that in ACL ruptured patients the cartilage in intercondylar notch were not degenerated or injured so quickly as articular cartilage in the condyle. We concluded that the articular cartilage of the lateral wall in intercondylar notch might be used as an autograft source for the treatment of articular cartilage defect with ACL rupture.