关节镜下自体镶嵌式骨软骨移植修复膝关节股骨髁软骨缺损

Osteochondral autograft transfer system for chondral defect on femoral condyles under arthroscopy

目的:评价自体镶嵌式骨软骨移植(osteochondral autograft transfer system,OATS)修复膝关节股骨髁软骨缺损的效果。方法:对12例股骨髁软骨缺损患者采用关节镜下OATS修复,缺损面积约2.0～4.0cm^2,平均2.72 cm^2。术后随访,对比手术前后的膝关节Lysholm评分、MRI表现以及术后并发症。结果:术后随访5～37个月,平均16.5个月。最终随访Lysholm评分优4例、良5例、中2例、差1例,优良率为75%。术前Lysholm评分(36.5±3.8)分,随访终末时(86.2±5.2)分,差异具有统计学意义(P<0.05)。术后3个月MRI T2加权像和脂肪抑制序列示移植骨软骨柱和周围软骨、软骨下骨间呈高信号,移植软骨和周围软骨基本平整。术后6个月高信号减少,软骨面平整。术后12个月移植软骨厚度与正常软骨相当。5例并发膝关节腔积血;2例患膝关节内有可以忍受的疼痛,其中1例偶有交锁。结论:OATS对膝关节股骨髁软骨损伤的修复效果满意,是一种实用的软骨修复技术。

Objective To evaluate the efficacy of osteochondral autografl transfer system （OATS） for chondral defect on femoral condyles. Methods Twelve patients with ehondral defect on the femoral weight-bearing surface were treated by OATS arthroscopy, with the defect area of 2.0-4.0 cm^2 （average 2.72 cm^2）. During the followed-up period, the knee Lysholm scores, MRI image, and complications were observed. Results All the patients were followed-up for 5-37 months （means 16.5 months）. Four cases were rated as excellent, 5 as good, 2 as lair, and 1 poor, and the excellent-good rate was 75% of the uhimate knee Lysholm scores. The knee Lyshohn scores was 36.5 ± 3.8 preoperatively, and was 86.2 ± 5.2 ultimately （P 〈 0.05）. There were high signals at the transplanted plugs, surrounding articular cartilage,and subchondral bone on MRI T2 weighted imaging and fat suppression sequence 3 months after the operation, and 6 months later, the high signals were decreased obviously, the repaired tissues were congruent to normal cartilage. After 12 months, the thickness of the repaired cartilage was similar to that of normal articular cartilage. Five patients had hematoma in knee joint capsule, 2 eases had slight joint pain, and one of them clicked occasionally. Conclusions OATS is effective for treating ehondral defect on femoral condyles, and is a practical method for cartilage repair.