关节镜下自体骨软骨移植修复股骨关节面软骨缺损

The technique of autologous osteochondral mosaicplasty for repair of the cartilaginous defects under arthroscopy

目的探讨关节镜下自体骨软骨镶嵌式移植术治疗股骨负重面关节软骨缺损的可行性。方法2001年6月起,共17例股骨关节面软骨缺损患者,男12例,女5例;年龄18～45岁,平均29岁;左膝10例,右膝7例。按照Brittberg-Peterson功能评定标准,膝关节的功能为65～105分,平均(80.65±9.69)分。3例无明显外伤史,但有风湿病史;14例有外伤史,均有膝关节疼痛,大腿肌肉萎缩。3例伴绞锁,2例伴弹响。14例外伤患者为股骨外髁负重面局灶性软骨损伤,均为单个创面,损伤范围2.5～3.0cm2;3例无外伤患者为股骨内髁负重面局灶性软骨软化或软骨剥脱,损伤范围2.0～2.5cm2。采用镶嵌式骨软骨移植器,在关节镜下取膝关节非负重关节面骨软骨条,将之移植修复膝关节负重面的局灶性软骨缺损。结果术后随访10～20个月,平均15个月,患者临床症状消失,关节活动度正常。术后Brit-tberg-Peterson评分,14例为0分,3例因活动时轻微疼痛分别评为3分和2分。MRI显示软骨缺损区软骨表面平整,移植的骨软骨柱位置良好。结论自体骨软骨镶嵌式移植术对关节负重面局灶性软骨缺损有较好、确切的治疗效果。

Objective To evaluate the possibility for the treatment of chondral defects on the femoral bearing surface with autologous osteochondral transplantation under arthroscopy. Methods There were 17 patients with cartilaginous surface defects, including 12 males and 5 females. The average age of patients was 29 years ranging from 18 to 45 years. The defects were located at 10 left knees and 7 right knees. The functional status of patients were evaluated according to the Brittberg-Peterson scoring scale system, the results were average 80.65±9.69 points ranging from 65 to 105. 3 patients had no an obvious history of trauma, but suffered from the rheumatoid disease; however, the other 14 patients had been injured at the knee joint with pain and followed with muscle atrophy on the thigh. 3 patients experienced interlocking, and 2 had snapping in their knee joints. All the 14 patients with traumatic history had only solitary lesion, the area of local cartilaginous defects at the bearing surface of the lateral femoral condyle was of 2.5-3.0 cm2; the local defects of the other 3 patients were located at the medial femoral condyle with defect area of 2.0-2.5 cm2, which was diagnosed either as chondomalacia or corruption. The procedures of the mosaicoplasty consisted of harvesting osteochondral cylinders from non-weight bearing surface of the knee and then implanting the grafts into the cartilaginous defects under arthroscopy. Results All the patients were followed up for 10 to 20 months (mean, 15 months). The joint mobility recovered to nearly normal. According to the Brittberg-Peterson system, 14 patients had score of 0, and 3 had scores of 2-3 because of mild pain. The follow-up MRI showed adequate cartilaginous coverage in the original lesions and excellent position of the cylindrical osteochondral grafts. Conclusion The autologous osteochondral mosaicplasty is proved to have good and reliable clinical results for the cartilaginous defects in the knee bearing surface.