关节镜下可吸收软骨钉治疗膝关节骨软骨损伤

Arthroscopic treatment of osteochondral injury of the knee using bioabsorbable cartilage screws

背景:关节软骨骨折的手术治疗是骨关节外科常见难题,骨软骨骨折块缺乏有效的固定物,各种治疗方法的疗效也缺乏长期临床观察。目的:探讨关节软骨损伤在关节镜下采用可吸收软骨钉固定治疗的临床疗效。方法:纳入19例膝关节骨软骨缺损患者,在关节镜下修整损伤区及骨软骨骨折块以自身增强聚丙烯可吸收软骨钉固定,内固定后24h拔出负压引流管,抗生素预防感染不超过48h,充分镇痛条件下持续被动活动关节,膝关节铰链支具固定6周后完全负重行走。结果与结论:19例患者均获得3个月-2年随访,平均13.2个月。修复后患者2周-3个月恢复社会活动。膝关节Lysholm评分为(83.25±5.63)分,tegner运动评级6.1±0.87,修复前后配对t检验,差异有显著性意义(P<0.05)。说明膝关节骨软骨损伤采用可吸收软骨钉固定可有效固定脱落的骨软骨块,促进软骨修复,改善膝关节功能。

BACKGROUND：Because osteochondral fracture fragments are lack of effective fixators and long-term clinical observation,the treatment of osteochondral fracture of the knee is a common difficult problem in bone and joint surgery.OBJECTIVE：To explore the clinical effectiveness of arthroscopic bioabsorbable cartilage screws in the treatment of osteochondral injury of the knee.METHODS：Totally 19 patients with osteochondral injury of the knee were included.Cartilage damage areas and bone fractures were fixed with self-reinforced polypropylene bioabsorbable cartilage screws under arthroscopy.Then,negative pressure drainage tube was removed within 24 hours after internal fixation.Besides,antibiotic prophylaxis for surgical site infection was no more than 48 hours and adequate analgesia conditions were provided for the continuous passive motion of the knee.After that,patients could walk with full weight bearing after knee hinge brace fixation for 6 weeks.RESULTS AND CONCLUSION：All 19 patients were followed up for 3 months to 2 years,and the average was 13.2 months.Patients resumed social activities in 2 weeks to 3 months after treatment.Postoperative Lysholm knee score was （83.25±5.63） points,and tegner movement rating was 6.1±0.87.There was a significant difference between the preoperative and postoperative paired test （P 0.05）.These results suggest that arthroscopic bioabsorbable cartilage screws for osteochondral injury of the knee can effectively fix the shedding cartilage bone,promote cartilage repair and improve knee function.