关节镜下微骨折术治疗膝关节软骨损伤

Arthroscopic microfrature for articular cartilage damage of the knee

[目的]分析关节镜下膝关节软骨损伤的特点并探讨采用微骨折术治疗的手术方法和疗效。[方法]对2003年2月-2005年8月79例膝关节软骨损伤患者采取关节镜下微骨折术治疗，男38例，女41例；左膝35例，右膝34例；平均年龄38．3岁（15—57岁）。术前膝关节症状持续时间平均11个月（3—23个月），其中有明确外伤史鸫例，占60．7％。软骨成形术基础上采用微骨折尖椎在软骨缺损区钻孔，孔径3mm，孔间距3mm，孔深3mm。[结果]79例患者共发现软骨损伤131处，平均每例存在软骨损伤1．6处，其中股骨内髁和髌骨关节面最常见，分别占33．6％和22．1％；软骨损伤程度按Outerbridge分级最常见为Ⅳ级损伤，占60．3％；软骨损伤面积多数在1—2cm^2，占43．5％。术后随访73例，失访6例，随访率92．4％，平均随访17个月（10—33个月），采用Tegner运动评级和Lysholm膝关节评分进行评价，45例优，18例良，16例差，优良率79．7％；Lysholm膝关节评分由术前平均43分提高到术后88分。[结论]关节镜下微骨折术方法简单，操作方便，是治疗膝关节全层软骨损伤的一种安全有效方法，不管是急性或慢性软骨损伤．均可明显改善患者的关节功能和减轻疼痛症状，提高生活质量。

[ Objective ] To analyze the characteristics of articular cartilage lesions in knees and evaluate the therapeutic efficacy of microfracture technique under arthroecopy for articular carrtilage lesions. [ Method ] A total of seventy-nine patients with articular cartilage lesions were treated with the microfracture technique. Thirty-eight patients were males and forty-one were female, with the mean age of 38. 3 years （ 15 - 57years ）. The averaged preoperative duration of symptoms was 11 months （3 - 23 months）. After preparation of the lesion, used an arthroscopic awl to make multiple holes, results in microfracture holes approxinmtely 3mm apart and the depth approximately 3 mm. [ Result]A total of 131 articular cartilage lesions were found in Seventynine patients,for an average of 1.6 lesions per case. The main lesion was found on the medial femoral condyle in 33. 6% and the patella in 22. 1% ;60. 3% of lesions were grade Ⅳ according to Modified Outerbfidge Seale;In 43.5% of the lesions the total area was from 1 - 2 cm^2. Seventy-three patients were followed up for 17 months in average （ 10 - 33 months）. At the time of the latest follow-up,79. 7% of patients were sattsfied with the results. According to Lysholm knee evaluation system,the mean scores was improved from 43 points preoperative to 88 points postoperative. [ Conclusion] Arthroscopic microfrature is simple and effective to repair of articular cartilage lesions of knee joint. This method can release pain and improve joint function.