丹红注射液联合关节镜下自体骨软骨移植治疗股骨滑车骨软骨损伤

Danhong Injection and Arthroscopic Osteochondral Autologous Graftsof Treatment of Osteochondral Lesions of Femoral Trochlea

目的:评价丹红注射液联合关节镜下自体骨软骨移植治疗膝关节骨软骨损伤的短期疗效。方法:回顾性分析了2010年8月—2014年5月采用丹红注射液联合关节镜下髌股关节面骨软骨移植治疗的48股骨滑车负重区骨软骨损伤病例。其中男26例,女22例;年龄12~46岁,平均33岁。左膝21例,右膝27例。31例患者有外伤史。明确诊断至手术时间5 d^6个月,平均16 d。结果:术后切口均I期愈合。48例均获随访,随访时间6~18个月,平均11个月。复查MRI示骨软骨柱与植骨床愈合良好,软骨面形态连续性良好,骨软骨愈合时间8~15 W,平均10 W。术前患侧膝关节疼痛视觉模拟评分(visual analogous scale,VAS)为6.79±1.01,膝关节Lysholm评分为59.77±12.80,膝关节运动Tegner评分2.15±0.17。末次随访时VAS平方评分为1.54±0.94,与术前比较差异有统计学意义(P=0.000,t=23.67);膝关节Lysholm评分为92.58±4.14,与术前比较差异有统计学意义(P=0.000,t=-16.78)。膝关节运动Tegner评分为5.02±1.02,与术前比较差异有统计学意义(P=0.000,t=-15.95)。随访期间无软骨剥脱、膝关节粘连、膝关节疼痛,无神经、血管损伤,无深静脉栓塞等并发症发生。结论:丹红注射液联合关节镜下自体骨软骨移植治疗膝关节骨软骨损伤的短期疗效良好、创伤小、恢复快,是安全可靠的治疗方法。

Objective： To investigate the efficacy of combined treatment of Danhong Injection and arthroscopic osteochondral autologous grafts for the treatment of osteochondral lesions of the femoral trochlea. Methods： A retrospective analysis of inclusive 48 cases of osteochondral lesions of the femoral trochlea patientswho accepted combined treatment of Danhong injection and arthroscopic osteochondral autologous grafts fromA ugust 2010 to May2014,including 26 males and22 females with averaged age 33（ range from 12 to 46 years old）. Twenty- one left knee and 27 right ones were affected.Thirty- one patients had a history of trauma. Definite diagnosis to operation time ranged from 6 days to 6 months,with an average of 16 days. Results： Operations were all successfully completed and the incision in all cases healed well. All cases got followed up from 6 to 18 months（ average 11 months）. Postoperative follow- up magnetic resonance imaging（ MRI） showed that the bone and cartilage grafts and bone beds healed well. The cartilage surface was in good shapeand the healing time of bone and cartilage was 8 ~ 15 weeks（ average 11 weeks）. At the last follow- up,the bad side knee pain visual analogue scale（ VAS） before operation was 6. 79 ± 1. 01,postoperative significantly reduced [（ 1. 54 ±0. 94）,P = 0. 000,t = 23. 67]. The Lysholm score for supported side knee joint before surgery was 59. 77 ± 12. 80,sig-nificantly increasedafter surgery[（ 92. 58 ± 4. 14）,P = 0. 000,t =- 16. 78]. The Tegner score was 2. 15 ± 0. 17,compared with pre- operation,increased much [（ 5. 02 ± 1. 02）,P = 0. 000,t =- 15. 95]. Neither cartilage peeling off,knee adhesion,knee joint pain,nerve and vascular injury,deep venous thrombosis nor any other complications were found in follow- up period. Conclusion： Combined treatment of Danhong Injection and arthroscopic osteochondral autologous grafts for osteochondral lesions of the femoral trochleais a safe and reliable treatment,which achieves a good short term effect,less traumaand quicker recovery.