膝关节局灶性软骨损伤临床修复技术进展

Advances in clinical repair techniques for localized knee cartilage lesions

目的总结临床实践中膝关节局灶性软骨损伤的经典和最新治疗技术,创建新的综合临床决策流程。方法广泛查阅国内外近年相关研究文献,总结膝关节局灶性软骨损伤各种治疗方法的优势和局限。结果目前临床治疗膝关节局灶性软骨损伤的手术方式较多,各有利弊。对于<2 cm^(2)和2~4 cm^(2)伴有骨质丢失的软骨损伤患者,推荐采用自体骨软骨移植(osteochondral autograft,OAT)和同种异体骨软骨移植(osteochondral allograft,OCA)手术;<2 cm^(2)和2~4 cm^(2)不伴有骨质丢失的软骨损伤患者,手术选择包括基于骨髓的技术(微骨折和自体基质诱导软骨生成)、自体软骨细胞植入术(autologous chondrocyte implantation,ACI)/基质材料复合ACI、颗粒状幼年同种异体软骨移植技术(particulated juvenile allograft cartilage,PJAC)、OAT和OCA;>4 cm^(2)伴有骨质丢失的软骨损伤患者首选OCA;而>4 cm^(2)不伴有骨质丢失的软骨损伤患者,手术选择包括ACI/基质材料复合ACI、OCA和PJAC。结论膝关节局灶性软骨损伤有很多治疗技术可供选择;治疗策略应基于病变大小、病变位置、软骨下骨累及程度以及文献中支持每种技术的证据水平进行选择。

Objective To summarize the classic and latest treatment techniques for localized knee cartilage lesions in clinical practice and create a new comprehensive clinical decision-making process.Methods The advantages and limitations of various treatment methods for localized knee cartilage lesions were summarized by extensive review of relevant literature at home and abroad in recent years.Results Currently,there are various surgical methods for treating localized knee cartilage injuries in clinical practice,each with its own pros and cons.For patients with cartilage injuries less than 2 cm^(2) and 2-4 cm^(2) with bone loss are recommended to undergo osteochondral autograft(OAT)and osteochondral allograft(OCA)surgeries.For patients with cartilage injuries less than 2 cm^(2) and 2-4 cm^(2) without bone loss had treatment options including bone marrow-based techniques(micro-fracture and ogous matrix induced chondrogenesis),autologous chondrocyte implantation(ACI)/matrix-induced ACI,particulated juvenile allograft cartilage(PJAC),OAT,and OCA.For patients with cartilage injuries larger than 4 cm^(2) with bone loss were recommended to undergo OCA.For patients with cartilage injuries larger than 4 cm^(2) without bone loss,treatment options included ACI/matrix-induced ACI,OAT,and PJAC.Conclusion There are many treatment techniques available for localized knee cartilage lesions.Treatment strategy selection should be based on the size and location of the lesion,the extent of involvement of the subchondral bone,and the level of evidence supporting each technique in the literature.