早中期继发性膝关节骨坏死手术疗效的临床体会

Curative effect of surgery for secondary osteonecrosis of knee joint in early and medium stage

目的 探讨手术治疗早中期继发性膝关节骨坏死的临床疗效.方法 我院2009年6月至2013年6月收治23例早中期继发性膝关节骨坏死住院患者,共35个膝关节,其中27例膝关节有手术适应证.27例膝关节术前膝关节HSS评分59～84分,平均（63.4±3.8）分.根据膝关节不同情况选用不同的手术方法,12例坏死区髓心减压术,5例死骨刮除打压植骨术,7例关节镜下探查清理术及5例自体软骨移植术.结果 术后随访3年,HSS评分73～ 94分,平均（77.6±4.8）分.有2例坏死区髓心减压术临床症状无明显改善;1例死骨刮除打压植骨术软骨下骨塌陷,关节坏死面进一步扩大;1例关节镜探查清理关节破坏进一步加重;其余患者临床症状均有明显改善.结论 早中期继发性膝关节骨坏死患者手术治疗可推迟或组织膝关节的进一步坏死.

Objective To discuss the clinical curative effect of operation treatment for secondary necrosis of the knee joint in early stage. Methods There were 23 patients with early and middle secondary knee necrosis from 2009 June to 2013 June in our hospital,including 35 knee joints. 27 cases with knee joint having operation conditions were selected according to different conditions in different operation therapys. The score of 27 cases before knee operation was 59 - 84 by HSS, the average was （63.4 ± 3.8 ）. According to different conditions, 12 cases received core decompression,5 cases treated by the necrotic bone cleaning and impact bone grafting,7 cases received arthroscopy and 5 cases received autologous osteochondral transplantation. Results The postoperative patients were followed up for 3 years,the clinical symptom of 2 cases with core decompression had no obvious improvement, the subehondral bone of 1 case with the necrotic bone cleaning and impact bone grafting collapsed, and the necrosis of the joint was further expanded, joint damage of 1 case increased. The clinical symptoms of the rest patients were improved, and score was 73 - 94 by HSS, the average （77.6 ± 4.8 ）. Conclusion The clinical effect of operation for early and middle secondary knee necrosis is obvious.