手术治疗膝关节早中期骨坏死的疗效分析

Clinical Effect of Surgery Treatment on the Early and Middle Phrase Osteonecrosis of Knee

目的探讨早中期膝关节骨坏死手术治疗的临床效果。方法本组共25例,男8例,女17例;年龄19～55岁,平均(36.6±12.1)岁。共包括41个膝关节。有症状的31例膝关节接受了手术治疗。其中坏死区髓心减压术治疗15膝,关节镜探查清理5膝,坏死骨刮除打压植骨7例,自体骨软骨移植术治疗4例。术前美国特种外科医院(thehospital special surgery,HSS)评分59～87分,平均(67.2±8.3)分。结果术后平均随访时间3.9年。其中2例经关节镜治疗的膝关节症状无缓解,X线检查显示关节破坏;1例经打压植骨术的膝关节发生软骨下骨塌陷;其余28例疼痛症状均有不同程度缓解。所有膝关节活动范围无减小,HSS评分71～100分,平均(87.8±12.1)分。结论对于早中期继发性膝关节骨坏死,选择合适的手术治疗,可以得到较满意的疗效。

Objective To explore the clinical effect of surgery treatment on the early and middle phrase os- teonecrosis of knee. Methods There are 25 cases ,including 8 male and 17 female. The age ranged from 19 to 55 years （mean 36.6d： 12.1 years）. 41 knee joints were included, 31 knees with symptoms underwent operation treatment. 15 knees treated with core decompression surgery. 5 knees cleaned under arthroscopy, 7 cases treated with the necrotic bone cleaning and impact bone grafting,and 4 cases were treated with autologous osteochondral transplantation. Re- sults The patients were followed up for 3.9 years. There were two cases without symptom improvement after de- bridement under arthroscopy. X-ray examination revealed the joint destructed. The subchondral bone collapse in 1 cas- es treated with impact bone grafting. The pain symptoms improved in the remaining 28 cases There were no knee range of motion reduction in all cases,HSS score improved from（67.2± 8.3）to（87.8 ±12. 1）. Conclusion The os- teonecrosis of the knee with early and middle phase can get satisfactory effect with appropriate surgery treatment.