关节镜辅助下同种异体骨软骨移植修复膝关节剥脱性骨软骨炎

ALLOGRAFT OSTEOCHONDRAL TRANSPLANTATION WITH ARTHROSCOPIC ASSISTANCE FOR REPAIR OF OSTEOCHONDRITIS DISSECANS

目的评价关节镜辅助下采用同种异体骨软骨移植修复膝关节剥脱性骨软骨炎(osteochondritis dis-secans,OCD)伴大面积骨软骨缺损的可行性和有效性。方法2004年1月-2007年5月,收治13例膝关节股骨髁OCD伴大面积骨软骨缺损患者。男7例,女6例;年龄18～59岁。左膝8例,右膝5例;病程7d～20年,中位病程为42个月。4例有明确膝关节扭伤史。受累部位:股骨内侧髁外侧份5例,股骨内侧髁滑车面2例,股骨外侧髁6例。主动关节活动度为(95.0±13.5)°。Lysholm膝关节功能评分为(62.23±7.79)分。软骨损伤根据国际软骨修复协会分型和关节镜下的Guhl分型,均为Ⅳ型。关节镜下见骨软骨缺损面积为3～7cm2,平均4.32cm2;缺损深度0.8～2.0cm,平均1.55cm。采用同种异体骨软骨块修复缺损,并联合可吸收钉固定骨软骨块。术后指导功能锻炼。结果术后伤口均Ⅰ期愈合。13例均获随访,随访时间1年2个月～4年,平均2.2年。术后3个月2例持续活动1h以上后膝关节疼痛,指导其功能锻炼后缓解。术后6个月2例关节摩擦感明显,关节稳定性尚好,予药物保守治疗。末次随访时主动关节活动度为(137.0±9.8)°,与术前比较差异有统计学意义(P<0.05)。X线片检查示术后4～6个月移植骨软骨与受区松质骨融合,关节面平整,关节间隙正常。末次随访EMRI检查示骨软骨愈合,关节面完整;骨软骨移植物无缺损、退行性变。术后1年Lysholm膝关节功能评分为(92.08±7.64)分,与术前比较差异有统计学意义(P<0.05)。结论对于膝关节股骨髁OCD伴大面积骨软骨缺损,在关节镜辅助下采用同种异体骨软骨移植修复缺损能重建关节面的完整性和恢复关节稳定性,可取得良好的治疗效果。

Objective To evaluate the feasibility and effectiveness of allograft osteochondral transplantation with arthroscopic assistance for osteochondritis dissecans （OCD） associated with large osteochondral defects. Methods From January 2004 to May 2007,13 patients with OCD with large osteochondral defects were treated. There were 7 males and 6 females,aged 18-59 years with an average of 35.8 years. The locations were left side in 8 cases and right side in 5 cases. The disease course was 7 days to 20 years with the median duration of 42 months. Four cases had obvious sprained history. The involved locations were lateral portion of the medial femur condyle （MFC） in 5 cases,thochlea area of MFC in 2 cases and lateral femur condyle in 6 cases. The range of motion was （95.0 ± 13.5）° and the Lysholm score was 62.23 ± 7.79. According to International Cartilage Repair Society classi cation system and the Guhl classi cation of OCD under arthroscopy,all the patients were type IV. Defect areas were 3-7 cm^2 with an average of 4.32 cm^2. The depths of defects were 0.8-2.0 cm with an average of 1.55 cm. Allograft osteochondral transplantation combining with adsorbable screw was applied for the lesions. The patients were closely instructed to do exercise through following up. Results The wounds all healed by rst intention. Thirteen cases were followed up for 2.2 years （14 months to 4 years） after operation. Three months after operation,2 cases had pain after continuous exercise for 1 hour,they were directed in the methods of functional exercise and to strengthen their quadriceps femoris. Medicine was given in 2 patients who had sign of friction feeling of joint 6 months after operation. The range of motion at the last follow-up was （137.0 ± 9.8）°,showing statistically signi cant di erence when compared with that before operation （P 〈 0.05）. The X-rays and EMRI examinations at following-up indicated that bone healed well and articular facet was integrity. The Lysholm score was 92.08 ± 7.64 one year after operation,showing statistically signi cant di erence when compared with that before operation （P 〈 0.05）. Conclusion Allograft osteochondral transplantation with arthroscopic assistance is a useful method in treatment of OCD with large osteochondral defects of the knees.