骨-骨膜原位翻转修复髌软骨软化症的中长期疗效

Mid-long term efficacy of osteo-periosteal turned over orthotopically for chondromalacia patellae

目的探讨骨-骨膜原位翻转修复治疗髌骨软化症的软骨缺损方法，观察其中长期疗效。方法1996年4月至2000年6月，拟在我院手术治疗的21例髌软骨软化症患者经术前和术中评估，接受骨-骨膜原位翻转术治疗13例。男3例，女10例；年龄47-65岁，平均59岁。采用HSS和Lrrsholm膝关节功能评分标准进行评分。结果术后随访114-162个月（平均133．2个月），13例患者中1例患者死亡，余12例获随访。按照HSS膝关节功能评分标准：术前20-58（34．2±3．8）分，术后1年为55-70（60．0±7．0）分，术后3年55±82（64．1±5．9）分，术后5年60-90（70．1±3．2）分，术后7年50-85（63．1±4．1）分，术后9年50-75（57．3±2．9）分。Lysholm膝关节功能评分：术前34-48（37．2±1．5）分，术后1年为45-65（54．0±5．5）分，术后3年55-70（60．1±3．7）分，术后5年55-80（67．1±2．4）分，术后7年55-70（62．5±1．8）分，术后9年50-70（58．5±3．1）分。两种评分术前与术后各随访时间点差异均有统计学意义（HSS评分：F=32．816，P=-0．000；Lysholm评分：F=41．793，P=-0．000）。骨-骨膜移植组织与缺损周围组织完全愈合，功能恢复良好。1例患者因膝内翻畸形于术后13年行人工膝关节置换术，术中见髌骨软骨表面光滑，白色且质韧，修复区域与周围软骨无界限。结论原位翻转的骨-骨膜具有成软骨能力，修复手术后髌骨关节面恢复良好，疗效满意。此原位翻转术仅可以修复髌骨关节软骨，对膝关节畸形不具有矫形作用。

Objective To investigate the method of osteo-periosteal turned over orthotopically for treating chondromalacia patellae disease and observe the mid-long term efficacy postoperatively. Methods From April 1996 to June 2000, 21 patients with chondromalacia patellae were treated in our hospital. Amone them, 13 cases were performed osteo-periosteal turned over orthotopically, including 3 males, 10 females; with the mean age of 59 years （range, 47-65 years）. HSS and Lysholm knee rating scale were employed to analysis the results. Results The patients were followed up from 114 to 162 months （mean, 133.2 months）. One of the patients lost follow-up due to death. Before operation the HSS knee score was 20-58 （34.2±3.8）, and 1 year, 3 year, 5 year, 7 year, and 9 year after operation the HSS knee score were 55-70 （60.0±7.0）, 55-82 （64.1±5.9）, 60-90 （70.1±3.2）, 50-85 （63.1±4.1）, and 50-75 （57.3 ±2.9） respectively. And Lysholm knee rating scale also showed similar results. The chondromalacia patellae patients before and after operation were significant different. Bone periosteum transplant tissue and surrounding defective tissue healed perfectly, functions recovered perfectly. Conclusion The method of osteo-periosteal turned over orthotopically has the capabilities to form cartilage. The therapeutic effect and facies articularis patellar is satisfactory. But it only can restore articular cartilage of patellar and does not help for genual malformation.