自体骨软骨移植治疗股骨髁软骨缺损

Cartilage Defects of Femoral Condyle Treated with Autogenous Osteochondral Grafting

目的探讨自体骨软骨移植技术治疗股骨髁软骨缺损的临床疗效。方法选取同济医院2011年9月至2014年3月收治的股骨髁负重区软骨缺损患者的患膝,共19例,均经膝关节MRI及手术过程中获得确认,其软骨缺损面积在0.64~4.15cm2。于软骨缺损处制备合适的骨床后,在同侧股骨髁非负重区截取不同直径及深度的骨软骨柱（包含软骨及软骨下松质骨）植入到软骨缺损处,并保证移植的骨软骨柱高于正常软骨面1mm左右,同时将凝血块覆盖骨软骨柱。术后1周内即在床上行患肢股四头肌及膝关节不负重屈伸功能锻炼,术后2~8周拄拐患肢不负重行走,8周后部分负重行走,3个月后恢复正常行走。结果所有患者均获得随访,时间25~46个月,平均33个月,Lysholm评分由术前的（57.63±10.33）分提升至末次随访时的（86.31±11.61）分（P〈0.05）,术后优良率占78.95%。VAS评分由术前的（5.95±1.26）分下降至术后的（0.74±1.15）分,疼痛明显缓解。术后症状均有所改善,无感染、血栓、移植物脱出等并发症,所有患者对术后效果表示满意。结论对于年轻患者,骨软骨移植技术治疗股骨髁局部软骨缺损短期疗效显著,费用较低,可在临床推广应用。

Objective To evaluate the efficacy of autogenous osteochondral graft for treating cartilage defects of femoral condyle.Methods Nineteen knees with cartilage defects on the femoral weight-bearing surface were chosen from September2011 to March 2014 in our hospital,the defect areas were 0.64-4.15cm2,and all were confirmed by MRI and knee surgery.After finishing preparation of suitable bone bed in the cartilage defect,the osteochondral cylinders with different diameters and depths,including subchondral cancellous bone and cartilage,which were got from the non-weight-bearing area of ipsilateral femoral condyle,were implanted into the cartilage defect,ensuring that implants were higher than normal cartilage around 1mm and covered with blood clot.One week after the surgery,exercise of flexion and extension without weight-bearing was performed in quadriceps and knee of affected side;2to 8weeks after the surgery,the patients could walk without weight-bearing with the help of crutches;8weeks after the surgery,they could walk with weight-bearing;3 months later,they recovered the ability to walk normally.Results All patients were followed up for 25 to 46months（an average of 33months）.At the time of the latest follow-up,Lysholm knee score improved from（57.63±10.33）of pre-operation to（86.31±11.61）of post-operation,and the difference was statistically significant（P〈0.05）.Also the VAS score decreased from（5.95±1.26）before the operation to（0.74±1.15）of postoperation,the pain was relieved obviously.The excellence rate accounted for 78.95%.The knee X-ray and MRI showed no arthritis after the operation,also the MRI showed the implanted osteochondral cylinders got healed smoothly.No infection,deep venous thrombosis and graft loosening were found.All patients expressed satisfaction with postoperative results.Conclusion For younger patients,autogenous osteochondral graft is an effective way for treating local cartilage defects on femoral condyle,which has good short-term effect significantly and low cost,and can be widely applied.